Is hair loss a side effect of Lexapro (escitalopram)?

Hair Loss as a Side Effect of Lexapro (Escitalopram)

Hair loss can occur as a rare side effect of Lexapro (escitalopram), and discontinuation of the medication typically leads to complete hair regrowth within a few months.

Evidence for Lexapro-Associated Hair Loss

While hair loss is not commonly listed among the frequent side effects of Lexapro, there is evidence supporting this association:

• SSRIs as a class have been documented to occasionally cause hair loss, though it occurs less frequently with escitalopram compared to other antidepressants 1
• A case report specifically documents citalopram (the racemic mixture containing escitalopram) causing diffuse hair thinning on the scalp after 3.5 months of treatment, with hair regrowth occurring after discontinuation 1
• Drug-induced hair loss is typically reversible and results from a toxic effect on the hair follicle matrix 2, 3

Mechanism of Hair Loss

When SSRIs like Lexapro cause hair loss, it typically manifests as:

• Telogen effluvium (increased shedding of resting hairs)
• Diffuse, non-scarring alopecia pattern
• Usually begins several months after starting the medication
• Generally affects the entire scalp rather than specific patches

Frequency and Risk Factors

• Hair loss from SSRIs like Lexapro is considered rare compared to other medications
• The exact incidence is not well-documented for escitalopram specifically
• For comparison, other psychotropic medications have higher documented rates:
  • Lithium: 12-19% of long-term users experience hair loss 4
  • Valproic acid: up to 12% in standard doses, and up to 28% with high concentrations 4

Management of Lexapro-Induced Hair Loss

If hair loss occurs while taking Lexapro, consider the following approach:

1. Confirm the association:

   • Rule out other common causes of hair loss (thyroid disorders, nutritional deficiencies, other medications)
   • Consider the temporal relationship between starting Lexapro and onset of hair loss

2. Treatment options:

   • If clinically appropriate, discontinuation of Lexapro is the most effective intervention
   • Switching to another antidepressant with lower association with hair loss may be considered
   • Hair regrowth typically occurs within a few months after discontinuation 1

3. Supportive measures while awaiting regrowth:

   • Gentle hair care practices
   • Avoiding harsh chemical treatments
   • Consideration of topical minoxidil 5% if appropriate

Important Considerations

• The therapeutic benefit of Lexapro for treating depression or anxiety must be weighed against the cosmetic impact of hair loss
• Hair loss from medications is usually completely reversible upon discontinuation 2, 3
• Patient distress from hair loss may lead to medication non-compliance if not addressed 4
• There is insufficient evidence to support the use of mineral supplements to prevent or treat SSRI-induced hair loss 4

Differential Diagnosis

When evaluating hair loss in a patient taking Lexapro, consider other potential causes:

• Other medications the patient may be taking
• Underlying medical conditions (thyroid disorders, iron deficiency)
• Stress-induced telogen effluvium (which may coincide with depression/anxiety)
• Other forms of alopecia (androgenetic alopecia, alopecia areata)

In conclusion, while hair loss is a possible side effect of Lexapro, it is relatively uncommon compared to other psychotropic medications and is typically reversible upon discontinuation of the medication.