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.