Does taking Lexapro (escitalopram) and Adderall (amphetamine and dextroamphetamine) cause hair loss?

Hair Loss with Lexapro and Adderall

Hair loss is a rare but documented side effect of both escitalopram (Lexapro) and amphetamines (Adderall), though it occurs infrequently and is typically reversible upon discontinuation or dose reduction. 1, 2

Escitalopram (Lexapro) and Hair Loss

• Escitalopram can cause alopecia, though this is uncommon compared to other SSRIs. The mechanism appears related to telogen effluvium, where hair follicles prematurely enter the resting phase. 3

• Case reports document diffuse hair thinning occurring 3-4 months after starting citalopram/escitalopram, with complete hair regrowth within months of discontinuation. 3

• Among SSRIs, escitalopram/citalopram may have lower rates of hair loss compared to other agents like sertraline, though isolated cases still occur. 3, 4

• The hair loss is non-scarring and fully reversible, which is reassuring for patients experiencing this side effect. 1, 2

Amphetamines (Adderall) and Hair Loss

• Amphetamines have been cited as occasional causes of drug-induced alopecia, though this is not among the commonly reported adverse effects in clinical guidelines. 2

• Major clinical guidelines for ADHD treatment do not list hair loss as a primary adverse effect of amphetamine medications, suggesting it is quite rare. 5

• The most commonly documented adverse effects of amphetamines include decreased appetite, sleep disturbances, increased blood pressure/pulse, headaches, and irritability—but not alopecia. 5

Clinical Management Approach

If hair loss develops:

• Establish temporal relationship: Hair loss typically appears 2-4 months after medication initiation, consistent with telogen effluvium patterns. 3, 2

• Rule out alternative causes including thyroid dysfunction (particularly relevant as lithium and other psychotropics can cause hypothyroidism leading to hair loss), severe stress, illness, nutritional deficiencies, or androgenetic alopecia. 1, 6

• Consider medication adjustment: If hair loss is distressing and affecting compliance, options include:

  • Dose reduction of the suspected agent 1
  • Switching to an alternative SSRI (e.g., from escitalopram to fluoxetine, which may have different dopaminergic effects) 4
  • For ADHD, consider switching from amphetamine to methylphenidate, which is not documented to cause hair loss 5

• Reassure the patient that drug-induced alopecia is almost always completely reversible with discontinuation or dose reduction. 1, 3, 2

Important Caveats

• Hair loss from these medications is significantly less common than with mood stabilizers like valproic acid (12-28% incidence) or lithium (12-19% incidence). 1

• The therapeutic value of mineral supplements for drug-induced alopecia remains unclear and is not routinely recommended. 1

• Do not discontinue effective psychiatric treatment without careful consideration, as untreated depression or ADHD carries significant morbidity risks that typically outweigh cosmetic concerns. 5