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Does Lexapro (Escitalopram) Cause Hair Loss or Thinning?

It’s no secret that many people derive therapeutic benefit from the serotonergic antidepressant Escitalopram, marketed under the brand name “Lexapro.”  However some Lexapro users have become increasingly frustrated with its side effect profile.  One side effect in particular that is often reported by users, yet infrequently reported by its manufacturer (Forest Laboratories) – is that of hair loss.

Imagine taking a drug that’s finally starting to treat your major depression and/or anxiety disorder, only to suddenly lose a substantial amount of hair.  This scenario creates a catch-22 for users: stay on the drug for the mood boost or discontinue the drug in attempt to grow back lost hair.  Other users may not notice “hair loss” per se, but may notice changes such as hair thinning or increased pattern baldness.

Does Lexapro Cause Hair Loss or Thinning? (The Case Studies)

Upon sifting through the scientific journals, there’s really no substantial evidence to conclude that Lexapro (Escitalopram) causes hair loss.  However, it could be that this side effect wasn’t well-documented, well-researched, or that it could’ve been downplayed by manufacturers.  There’s really only one “case study” of a 40-year old woman who reported significant hair loss when taking Escitalopram.

2011: “Hair Loss Associated With Escitalopram but Not With Venlafaxine”

Medical doctor William Pitchot (PhD) highlighted the case of a 40-year old woman who was suffering from a moderate case of major depressive disorder (MDD).  At the time of her doctor visit, she was considered in good health and was not taking any other medications.  Initially, she attained a prescription for Effexor (Venlafaxine) and took it for 12 weeks without any benefit.

As a result of no therapeutic response to venlafaxine, the doctor switched her to Lexapro (Escitalopram).  Upon taking Lexapro for a period of 4 weeks, the woman noticed substantial improvement in her depressive symptoms.  Despite significant symptomatic improvement, the woman began noticing hair loss whenever she brushed or washed her hair.

This hair loss was documented as occurring 3 weeks into treatment and verified by the woman’s hairdresser.  Nearly 3 months into treatment (after ~90 days) the woman opted to discontinue the drug, as she viewed the hair loss as being an unacceptable adverse effect.  An estimated 2 weeks into Lexapro withdrawal, her hair loss subsided – further supporting the idea that Lexapro caused hair loss.

Despite the fact that her hair loss subsided upon discontinuation of Lexapro, the woman experienced a relapse in depressive symptoms within 2 months.  As a result of this relapse, she visited her doctor who recommended trying Lexapro again (after all, it had worked in the past).  Hopeful that Lexapro wouldn’t cause hair loss during her second round of treatment, the woman agreed to take 10 mg per day.

After just 2 weeks of taking 10 mg Lexapro, the woman reported hair loss again.  This time she continued treatment for 3 months and the hair loss continued.  Although Lexapro clearly caused hair loss for this woman, the author of the case study suggested that it is an infrequent side effect, but usually intolerable for women.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219523/

2000: “Citalopram and Hair Loss”

Though there is just one case study documenting the relationship between Lexapro and hair loss, another case study reported hair loss from Lexapro’s predecessor compound “Celexa.”  Celexa or “Citalopram” is a (1:1) racemic mixture of enantiomers R-citalopram and S-citalopram.  Lexapro is comprised of solely the S-enantiomer of Citalopram; hence it is a very similar drug.

Due to the similarity of Celexa and Lexapro, highlighting a case study of hair loss associated with Celexa may be useful.  A study published in 2000 entitled “Citalopram and Hair Loss,” written by Sanjay Gupta, M.D. and Prakash S. Masand, M.D. – documented a case of a 50-year-old woman who experienced significant hair loss while taking Celexa.  The woman had fit DSM-IV diagnostic criteria for bipolar disorder and she had a history of depressive episodes.

The woman was initially put on a cocktail of psychiatric drugs including Lamictal, Paxil, and Klonopin.  She successfully discontinued the Klonopin after stabilizing on Lamictal and Paxil, but after 1 year of treatment, she began experienced problems related to Paxil such as nightmares and a relapse of depressive symptoms.  Medical professionals switched her from Paxil to Celexa, starting at 20 mg and titrating up to 40 mg.

She experienced symptomatic relief with Celexa, however within 2 months after starting treatment – she noticed that she was losing clumps of hair while shampooing.  As a result of the hair loss, her anxiety increased and she consulted a dermatologist in attempt to pinpoint the root cause of the hair loss.  The dermatologist was unable to detect any other potential causes of hair loss other than the Celexa.

It was speculated that a Celexa dosage increase from 20 mg to 40 mg significantly increased the hair loss to the extent that it became noticeable.  Although the woman contemplated decreasing her dosage, she wanted to ensure that her depressive symptoms were kept under control – so she stayed the course of treatment.  In attempt to combat the Celexa-induced hair loss, she added a multivitamin (Centrum Silver) supplement to her diet, one specifically formatted for adults (ages 50+).

The woman took one tablet of the Centrum Silver daily and decided that if it didn’t effectively combat her hair loss within 1 month, she would switch antidepressant medications.  To her pleasant surprise, the Centrum Silver attenuated her Celexa-induced hair loss.  The case study documented that 5+ months after introducing the Centrum Silver, no additional hair loss was reported.

Though researchers weren’t sure exactly how Celexa caused the hair loss, they noted that the dosage of Celexa directly correlated with the degree of hair loss.  Specifically, higher doses of Celexa resulted in more rapid hair loss.  They also note that the woman’s hair loss was likely reversed with daily administration of Centrum Silver multivitamins, but also consider the possibility of spontaneous resolution.

How Lexapro Could Cause Hair Loss or Thinning (Etiological Possibilites)

Despite the fact that Lexapro-induced hair loss can occur, most researchers haven’t bothered pinpointing its etiology.  Many professionals and patients simply accept that their hair is falling out because of a medication, but remain clueless in regards to the cause.  Though the root causes of antidepressant-induced hair loss aren’t fully elucidated, there are several hypotheses circulating throughout the internet.

Vitamin deficiencies: It is possible that via some complex (or even simple, but undocumented) neurophysiologic mechanism, Lexapro may affect our ability to absorb dietary nutrients and/or may deplete certain essential vitamins.  Lexapro-induced vitaminergic deficiencies and/or function may contribute to hair loss experienced while taking the drug.

Speculation of Lexapro as causing hair loss via depletion of certain vitamins is based on the finding that a woman was able to combat hair loss from taking Centrum Silver.  Although this woman was on Celexa, the formulation is very similar to Lexapro, and underpinnings of hair loss associated with each medication may be identical – possibly vitamin-based.  Consider the possibility that the absorption, function, and levels of specific vitamins may be altered as a result of taking Lexapro – which could cause hair loss.

Physiologic stress: In some cases, it may be necessary to consider that the Lexapro you’re taking could be taxing your physiology to mimic a state of extreme stress.  Additionally, the drug could be perceived as an exogenous toxin by your body and/or may be eliciting toxic effects.  As a result, this could trigger a reaction of physiologic stress and hair loss may ensue as a result of this high stress.

This stress-induced hair loss is referred to as “telogen effluvium.”  Assuming the Lexapro you’re taking is taxing your neurophysiology to a significant extent (even if its improving your mood), hair loss may ensue.  Those who experience “telogen effluvium” are capable of hair regrowth when they lower their stress.  Similarly, those who stop taking Lexapro typically notice regrowth upon discontinuation; this could be due to a reduction in physiologic stress.

Genetic interactions: Why do some people experience hair thinning, pattern baldness, and hair loss while taking Lexapro – yet others don’t?  It is thought that adverse reactions like hair loss could be a result of genetics.  One person may have a specific set of genes that makes them susceptible to hair loss upon ingestion of Escitalopram, yet another may have entirely different genes that won’t cause their hair to fall out.

As personalized medicine and scientific research continues to improve, we should be able to accurately predict which individuals will experience adverse effects like hair loss prior to taking a medication.  One day you may be able to get a test like Genesight and know whether you carry a certain polymorphism that increases your risk of hair loss while taking Lexapro.

Hormone changes: It is understood that fluctuations in hormone levels can cause conditions like alopecia.  For example, among men the hormone known as “DHT” shrinks hair follicles and leads to pattern baldness.  Many anecdotal reports suggest that antidepressants can lower testosterone and/or possibly elicit a cascade of effects across other hormones.

Though it shouldn’t be implied that Lexapro alters DHT or testosterone to trigger hair loss, it may induce hormonal alterations that contribute to hair loss.  Though this effect may be subtle or occur in a select number of users, it is a possibility that warrants speculation.  It could be that when an individual stops taking Lexapro, hormone levels revert back to a homeostatic baseline, thereby reversing the hair loss.

Note: It is also necessary to consider that the mechanisms of Lexapro-induced hair loss for one person may differ from that of another.  For example, one person may experience hair loss as a result of a genetic reaction to the drug, yet another could lose hair from drug-induced hormonal changes.  Furthermore, certain individuals may lose hair while taking Lexapro, yet the drug may not be the root cause (it could simply be a result of aging).

Variables that may influence degree of hair loss from Lexapro

Below is a list of possible variables that may impact the degree of hair loss a person experiences while taking Lexapro.  These variables may influence how quickly someone loses their hair after starting the medication, as well as the quantity of hair that is lost.  Realize that certain variables may play a more prominent role in Lexapro-induced hair loss for some people compared to others.

  1. Dosage (10 mg to 40 mg)

Researchers have noted that dosage is likely to influence the degree of hair loss experienced on Lexapro.  They’ve specifically noted that greater doses of the drug are likely to accelerate the onset of hair loss experienced.  Furthermore, one could speculate that not only will higher doses accelerate hair loss onset, but they could increase the amount of hair that is lost.

Assuming Lexapro is the root cause of your hair loss, the greater the amount you ingest on a daily basis, the more severe the hair loss is likely to be.  For this reason, it should be recommended to take the “minimal effective dose” or the least amount possible to derive therapeutic benefit while minimizing side effects.  Lower doses are unlikely to cause substantial hair loss compared to higher ones.

  1. Genetic variation

It remains unclear as to whether the drug facilitates hair loss as a result of an interaction with certain genes.  It is known that some people experience intolerable side effects from drugs as a result of their genetics.  Something as simple as genes related to the metabolism of Escitalopram such as CYP2C19 or CYP2D6 could be responsible for Lexapro-induced hair loss.

Someone who has a certain genetic variant that inhibits efficient metabolism of the drug due to poor enzymatic expression of cytochrome P450 isoenzymes may accumulate higher serum levels of Escitalopram.  As a result of this accumulation, even a lower dose could be more likely trigger an adverse physiological reaction, leading to hair loss.

That said, it is possible that genes that aren’t well-documented as being affected by Escitalopram could also facilitate hair loss.  In other words, genes that aren’t involved in Lexapro metabolism could directly cause hair loss when affected by the drug.

  1. Other drugs

Taking another drug with Lexapro could spur a synergistic interaction that causes hair loss.  This synergistic effect may be facilitated as a result of the drugs altering gene function, hormones, or your entire neurophysiology.  Even if it is considered safe to ingest multiple medications simultaneously, the physiological impact may differ substantially from taking either drug individually.

If you are on multiple medications, it is impossible to be 100% certain that Lexapro is causing your hair loss – especially if they were introduced at the same time.  If Lexapro was introduced later, it could be the cause of hair loss, but the complex interaction of Lexapro and your other drug(s) could also be the cause; rather than solely just the Lexapro.

  1. Term of Administration

There is often variation in how long someone has been taking Lexapro before they notice they’re losing hair.  Case studies suggest that it may be noticed as soon as 2 weeks after starting treatment, but others may become aware of it several months into treatment.  Usually it is noticed within the first several months of treatment (at the very latest), but could become more severe if the dosage is titrated upwards.

If you’ve been taking Lexapro for at least several weeks, you may be less likely to notice hair loss as a long-term user.  Long-term users will have accumulated more of the drug in their system and are more likely to be taking a higher dose.  Higher doses are thought to be more problematic in regards to hair loss, and as a result, short-term low-dose users may be less susceptible to hair loss.

How much hair will you lose while taking Lexapro?

Assuming you end up losing hair from Lexapro, it is unknown exactly how much you’ll lose.  The amount of hair you lose will likely be due to significant individual variation including the dosage you’re taking, your genes, whether you’re taking supplements (to potentially combat the hair loss), etc.  Most people notice gradual hair loss after they start taking Lexapro in the form of hair thinning and shedding.

Over time, people may notice that clumps or chunks of hair fall out in the shower while shampooing and/or washing.  This could be due to changes in follicle size that are directly or indirectly caused by Lexapro.  Since there isn’t much research and the amount of hair lost isn’t usually “measured,” it is unclear exactly how much hair you can expect to lose on Lexapro.

Does everybody lose hair from taking Lexapro?

No, not everyone loses hair from taking Lexapro.  In fact, hair loss as a result of Lexapro is considered an extremely uncommon, adverse reaction.  It’s a rare side effect that is seldom discussed by users because it is unlikely to occur.  However, just because hair loss doesn’t occur in all users, hair thinning or changes to hair growth may occur in more people than is suspected.

A majority of Lexapro users are unlikely to consider that the drug could be causing their hair loss.  Instead, they may chalk their hair loss up to other factors such as old age, genetics, or menopause – failing to realize that it is in-fact the drug.  Furthermore, those with already-short hair may fail to notice drug-induced hair changes because they have a minimal amount of hair.

On the other hand, some people may believe that Lexapro is causing their hair loss when in fact it is a result of other factors such as old age, genetics, etc.  Long-term, high-dose Lexapro users are more likely to lose hair than short-term, low dose users.  However, evidence suggests that most individuals taking Lexapro aren’t likely to lose hair.

What to do if Lexapro is causing hair loss…

If you know for a fact that Lexapro is causing your hair loss, or suspect that it is the most likely culprit – this should be discussed with a medical professional.  To accurately pinpoint whether the Lexapro is the root cause, a person could theoretically discontinue the drug for awhile and determine whether their hair grows back.  If the hair grows back after discontinuation, the medication is probably the root cause.

  1. Dosage reduction: If the Lexapro is effectively treating your psychiatric symptoms, you probably won’t want to fully discontinue. However, you could ask your doctor if a gradual dosage adjustment may be beneficial. In other words, if you’re currently taking 20 mg, reducing to 10 mg under medical supervision could prove beneficial in regards to hair regrowth.
  2. Multivitamin / Supplement: In one aforementioned case study, a woman was able to attenuate hair loss from Celexa, a compound related to Lexapro, with administration of Centrum Silver multivitamins. If the drug is somehow depleting vitamin levels responsible for hair strength/growth, a multivitamin (and/or more specific vitamins) may offset Lexapro-induced hair loss.
  3. Rule out other causes: Some people who lose hair on Lexapro maybe would’ve lost hair regardless of whether they took a medication or not. Since it just so happens that they’re losing hair on a medication, they put full blame on the drug. To be sure that Lexapro is the root cause of your hair loss, you may want to consult with an expert (e.g. dermatologist).
  4. Cost-benefit analysis: If you’re certain that Lexapro is the root cause of your hair loss, you should conduct a cost-benefit analysis. In other words, analyze the benefits you’re getting from the drug (e.g. mood elevation) and compare them with the cost of hair loss (as well as other side effects). If the costs clearly override the benefits, you may want to consider other medications.  However, if you need the mood boost and the hair loss doesn’t affect your self-image – staying the course of treatment may be ideal.
  5. Switch medications: If you find the hair loss stemming from Lexapro to be intolerable, you’ll probably want to switch medications. There are plenty of other antidepressants on the market including other SSRIs, SNRIs, tricyclics, and MAOIs. There is a good chance that another medication will provide therapeutic benefit without the hair loss.

Have you experienced hair loss on Lexapro?

Hair loss is a serious problem that can lead to low-self esteem and even exacerbate depressive symptoms.  If you’ve experienced hair loss while taking Lexapro, you may feel as if you’re “damned if you do, damned if you don’t” in regards to treatment.  Sure the drug may boost your mood, but this mood boost may be offset by the toll hair loss has taken on your self-esteem.

If you’ve experienced hair loss on Lexapro, share your story in the comments section below and discuss any theories regarding the etiology.  Mention when you first noticed the hair loss after starting treatment, how much hair you’ve lost, and whether anything has helped offset it.  To help others understand your situation, note the dosage of Lexapro you’re taking, your age, and why you’re certain that your hair loss was caused by Lexapro.

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{ 12 comments… add one }
  • Molly December 8, 2015, 10:01 pm

    I started taking lexapro in July of 2015 and noticed large amounts of hair loss in September 2015…It is now December and I have lost about 50% of my hair. I panicked after it did not stop falling out after a month and stopped taking the lexapro. I have been off lexapro for a little less than 2 months and still have too much hair loss. It is possible that it has slowed down but not enough to be considered normal hair loss. I have been to 2 dermatologists, family dr, OB GYN and an endocrinologist.

    My tests are all in normal range but a few… I was taking 40 mgs which is a very high dose so I feel it was the lexapro that caused the hair loss. The lexapro has caused me much more trouble than it helped…that is for sure. I am taking Viviscal, multi vitamins, vitamin B complex, and zinc everyday. I have lost so much and do not know when it will end.

  • Andrew January 7, 2016, 8:52 am

    26 year old male. I am experiencing pretty significant hair loss on Cipralex/Lexapro despite a low dosage. I started on 10mg of Cipralex and switched to 5mg after a month. At that time I noticed that my hair are not as thick as usual but did not pay too much attention to it since it was not listed as a SE.

    Now I’ve been two months on my meds and several people pointed out that I’d started losing hair (which suggests that it’s noticeable). I can’t be 100% sure that it’s caused by the Lexapro (especially considering low dosage and the fact that I can just be loosing hair cause of genetics) but the timing is pretty suspicious.

  • Anna February 4, 2016, 4:36 am

    36 y/o female on 10mg lexapro. Over 18 months, noticed gradual increase in hair loss. After 18 months, significant reduction in hair (used to wrap rubber band twice around pony tail, now same rubber band wrap three times because pony tail is so much thinner). Now will taper off Lexapro slowly over a month or so and will try another SSRI.

    After reading online, I expect hair to regrow as the lexapro slowly gets out of my system over several months (3-6 months). Feel relieved that as I get the lexapro slowly out of my system and eventually out of my system, I now will not lose anymore hair. The thought of continued hair loss and thinking even more is upsetting.

  • Geoegette May 3, 2016, 12:35 pm

    My hair became very brittle and felt like straw. I noticed thinning but never attributed it to Lexapro… I blamed my hair dresser. I have been off Lexapro for a year and my hair feels great and people are saying how nice it looks.

  • Jamie May 9, 2016, 1:32 am

    21 y/o female, 10 mg. I started Lexapro about a month or two ago, and have experienced my hair falling out in clumps when I shower and comb it. I noticed it maybe 3 weeks after I started taking it, but thought nothing of it until now due to my hair being naturally thin. It’s always shed quite a bit naturally, however, it has been falling out in alarming quantities recently.

    I clearly can rule out old age/menopause as a culprit, and high stress doesn’t explain it either because I’ve felt Lexapro has significantly improved my mood. I am so disappointed to be experiencing this side effect and will be consulting my Psychiatrist about it.

  • Rebecca May 23, 2016, 4:49 pm

    26 y/o female; 20 mg lexapro. I have been on lexapro for almost 3 months and have noticed a significant loss of hair. My hair has always been very thick and full. It has always shed like normal, but recently it has been falling out in clumps when I shampoo and brush my hair. My hair has gone from being able to wrap a hair band around it 3 times to be able to wrap it around 4 times.

    All of this hair loss as occurred in just THREE MONTHS. I have made an appointment with my family doctor to talk about switching medications. I went to the doctor about a month ago to discuss hair loss and all of my lab work came back normal thus ruling out any thyroid issues. Lexapro is the only Rx medication I am on, so I think it can be safely said that lexapro is the culprit to my hair loss.

  • Made June 5, 2016, 7:58 pm

    I started losing hair 2-3 weeks after beginning to take 10mg Lexapro daily. I have been taking it for 7 weeks now and have begun to reduce the dose by a quarter. The Lexapro has been very effective at treating the anxiety and depression at the lowest dose and I will monitor my symptoms as I reduce it again in one week, by one quarter. After reducing the dose by a quarter for 6 days I have not experienced a decline in my emotional health, and I have not yet noticed a reduction in hair loss.

  • Kim July 20, 2016, 1:57 pm

    I am starting my third week, and when I brushed my hair this morning, I was alarmed by how much hair came out in my brush. I will talk to my Dr. about this, as my hair is already thinning more than I would like.

  • Mary Ellen Jenkins July 29, 2016, 9:48 pm

    My doctor put me on Lexapro about 2 months ago and about a week ago I noticed my hair was falling out when I brushed it and when I washed it there was a lot more as my doctor put me on it to stop my depression and wanted to take me off ativan after for about 25 years. Well after telling my doctor about hair lost she took me off. I was taking 10 then 20 mg. Just went off so will see if it stops as that was really causing me anxiety.

  • Jo September 5, 2016, 6:31 am

    I have been noticing significant hair loss and just recently made the connection between the time it started and taking Lexapro. The loss is great enough that it is affecting my stress levels, so I will wean off of the Lexapro. Since it isn’t listed as a side-effect, it took awhile to suspect the drug. It is just a correlation, but to me it is worth seeing what happens when I stop. Previous experience has taught me that I can’t just stop taking Lexapro. I get terrible vertigo while it leaves my system.

  • El September 10, 2016, 4:13 pm

    I have been taking anti-depressants since I was 16 years old in high school. I probably started taking Lexapro in either around my Senior year of High School. So give or take I’ve been taking it about 8 years. I am 26 now. I never really thought twice about hair loss until now because I was always so young and I never noticed any “significant” hair loss as a result of the medication.

    However, recently I have been noticing more bald spots in my hair than usual and now when I look at my hair line in the mirror I noticed that it now looks like it is receding, especially when I look back each year back until college I can notice a gradual recession in my hairline. No man in my family has this except me. I’ve been noticing recently that my hairline is far more receded than all the other men in my family and it made me begin to wonder why.

    Baldness does not run in my family. I am also the only person in my family that takes antidepressants. Although, I never experienced any “significant” hair-loss within a timespan of 3 months, I am convinced that the lexapro may have “accelerated” pattern balding for me and I lost a significant amount of hair over the years compared to if I did not take lexapro at all.

    This worries me because not only am I an actor, I have an extremely weird shaped head and going bald or having a receding hairline at such an early age is the last thing I would want for my physically appear and I worry that I will go bald sooner than expected and it will hinder my acting career. I wish I could have noticed the hair loss sooner, but it happened way too gradually for me to notice. Now I don’t even know if my hairline will grow back to what it should be if I stop taking the lexapro, or if what I’ve lost of my hairline is gone forever.

    It’s very depressing and I don’t know what to do, but I do have an appointment with my psychiatrist on Tuesday to discuss this.

  • Amber September 15, 2016, 8:05 pm

    Hello, I’ve been on citalopram for 4-5 years. Since then, my hair has fallen out gradually. It was so gradual that I didn’t even know until it became noticeably thinner. I’ve talked with my psychiatrist, who refuses to blame the citalopram, my PCP, and a dermatologist. No one has figured out why my hair is slowly falling out. I’ve always thought it was the citalopram. I am convinced it put 30 pounds on me, too!

    They keep telling me my hair loss is due to stress, and yes I have plenty to be stressed about, but come on! I’m going to be bald soon when I once had long, thick, curly hair that I loved! They thought it may be hair dye, so I stopped dying my hair. So now I just have thin GRAYING hair!

    I’m only 35 years old! There are no females in my family with hair loss. In fact, most of the females in my family have thick hair. I really want my hair back, but I need an answer. I am going to start taking a multivitamin and see if that helps. I have also started using Women’s Rogaine Foam, but it’s only been a few weeks. No noticeable improvements yet…

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