SSRIs and other antidepressants

Antidepressants rarely cause hair loss; in a million-user database, bupropion carried the highest risk and fluoxetine and paroxetine the lowest, but absolute risk is small and depression itself also sheds hair.

Prescription medicine, used off-label for hair Cost $ Safety: moderate

What it is

Prescription antidepressants. Bupropion is not an SSRI, but the cohort compared the drugs side by side.

How it works

Hair loss, when it occurs, is thought to be diffuse shedding (telogen effluvium). The mechanism is unknown.

What the studies show

In a US claims-database cohort of 1,025,140 new antidepressant users (2006-2014), every other antidepressant had a lower alopecia risk than bupropion (fluoxetine and paroxetine hazard ratio 0.68). Compared with fluoxetine, bupropion had a hazard ratio of 1.46, a number needed to harm of 242 over 2 years. Etminan 2018

Caveats: alopecia was identified from diagnosis codes, there was no placebo group, and depression and stress themselves are associated with shedding. Only one study was read, so confidence is limited.

How it's used in studies

Not applicable.

Side effects and safety

Do not stop an antidepressant abruptly; discontinuation symptoms occur.

Bottom line

A real but small signal. If shedding starts after a new antidepressant, check the usual causes (ferritin, thyroid, stress, postpartum) and talk to the prescriber. Discuss with a doctor.

Fun facts

Among a million antidepressant starters, bupropion users were about 46% more likely than fluoxetine users to be diagnosed with hair loss. Etminan 2018

Studies 1

Etminan M et al. Risk of hair loss with different antidepressants: a comparative retrospective cohort study. Int Clin Psychopharmacol. 2018

Design: cohort
People: 1,025,140
Duration: 2 years follow-up
Who: new antidepressant users in a US claims database, 2006-2014

Result: Bupropion had the highest alopecia risk (HR 1.46 vs fluoxetine, number needed to harm 242); fluoxetine and paroxetine lowest.

Read the study ↗