Can Zoloft (sertraline) induce hair loss?

Can Zoloft Induce Hair Loss?

Yes, Zoloft (sertraline) can induce hair loss, though this is a rare adverse effect that typically resolves upon discontinuation of the medication. 1

Evidence from FDA Drug Label

The FDA label for sertraline explicitly documents alopecia (hair loss) as a sequela observed in overdose cases, confirming that sertraline can affect hair follicles. 1 Among 634 overdose cases where sertraline was the only drug ingested, 27 patients experienced sequelae including alopecia, decreased libido, diarrhea, and other effects. 1 While this data comes from overdose scenarios, it establishes a biological plausibility for hair loss at therapeutic doses.

Mechanism and Clinical Pattern

Hair loss from SSRIs like sertraline typically manifests as telogen effluvium, where hair follicles are pushed prematurely into the resting (telogen) phase, leading to diffuse shedding. 2, 3 This is distinct from the anagen effluvium seen with chemotherapy, which causes more rapid hair loss. 4, 5

The temporal relationship is important: drug-induced hair loss usually appears weeks to months after starting the medication, and the diagnosis requires excluding other common triggers such as:

• Fever, severe illness, or stress 3
• Hormonal changes or childbirth 3
• Nutritional deficiencies 2
• Other medications 6

Comparative Risk Among SSRIs

The risk of hair loss appears to vary among different SSRIs, with some evidence suggesting sertraline may have a lower risk compared to other agents in this class. 7 A case report documented hair loss with paroxetine that resolved when switched to sertraline, suggesting potential differences in individual SSRI propensity to cause alopecia. 7

Among psychotropic medications more broadly, mood stabilizers carry higher rates of alopecia (lithium 12-19%, valproic acid up to 28%) compared to antidepressants, where hair loss occurs only rarely. 6

Clinical Management Algorithm

When a patient on sertraline reports hair loss, follow this approach:

1. Establish temporal relationship: Confirm hair loss began after sertraline initiation (typically weeks to months later) 2, 3

2. Exclude alternative causes: Rule out thyroid dysfunction, iron deficiency, severe stress, recent illness, other medications, and androgenetic alopecia 4, 3

3. Assess severity and impact: Determine if hair loss is cosmetically significant and affecting quality of life 4

4. Consider management options:

   • If psychiatric condition is stable and alternative treatments exist: discontinue sertraline and monitor for hair regrowth over 3-6 months 6
   • If sertraline is providing significant psychiatric benefit: consider switching to a different SSRI (such as fluoxetine or escitalopram) that may have lower individual risk 7
   • If continuation is necessary: reassure patient that hair loss is typically reversible and monitor closely 2, 6

Important Caveats

Discontinuation or dose reduction almost always leads to complete hair regrowth, though this may take several months as the hair growth cycle normalizes. 6 The hair loss is not permanent or scarring in nature. 2

Do not confuse drug-induced telogen effluvium with alopecia areata, which is an autoimmune condition with distinct clinical features including patchy hair loss with exclamation mark hairs and yellow dots on dermoscopy. 4 Drug-induced hair loss from sertraline presents as diffuse thinning rather than discrete patches. 3

Patients should be counseled that while hair loss is a recognized side effect of sertraline, it occurs rarely and is reversible, allowing for informed decision-making about continuing versus switching therapy based on the balance of psychiatric benefit and cosmetic concern. 6, 7