Fluoxetine and Hair Loss
Yes, fluoxetine can cause hair loss, though this is a rare adverse effect that typically occurs 6 weeks after treatment initiation and resolves upon discontinuation of the medication. 1, 2
Evidence for Hair Loss as an Adverse Effect
The most commonly reported adverse events with fluoxetine in clinical practice include constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual dysfunction, and somnolence—but hair loss is not listed among these frequent side effects in major clinical guidelines. 3 However, case reports document this rare complication:
- Hair loss typically manifests 6 weeks after starting fluoxetine 20 mg/day, presenting as diffuse hair loss in the frontal scalp area. 1, 2
- The hair loss is reversible, with symptoms regressing after cessation of the drug. 1, 2
- Both male and female patients have been documented with this adverse effect, though the risk may be higher in females. 1, 2
Mechanism and Differentiation from Other SSRIs
The mechanism of SSRI-induced hair loss may relate to differences in dopamine reuptake inhibition among various SSRIs:
- Sertraline has been associated with hair loss in a patient who did not experience this side effect with fluoxetine, suggesting that sertraline's relatively greater dopamine reuptake inhibition compared to fluoxetine may play a role. 4
- Switching between SSRIs may prevent hair loss if it occurs with one agent, as the dopaminergic effects differ among these medications. 4
Clinical Management
If hair loss occurs during fluoxetine treatment:
- Discontinue fluoxetine, as this adverse effect resolves with cessation. 1, 2
- Consider switching to an alternative SSRI such as sertraline, escitalopram, or citalopram, though be aware that sertraline itself has also been associated with hair loss in isolated cases. 5, 4
- Question patients about hair loss during follow-up visits, as this side effect may not be spontaneously reported but can significantly impact quality of life and medication adherence. 1, 2
Important Caveats
While hair loss is documented with fluoxetine, it remains a rare side effect not captured in large-scale efficacy and safety trials. 3, 6 The evidence base consists primarily of case reports rather than systematic studies, so the true incidence is unknown. 1, 2 Clinicians should maintain awareness of this potential adverse effect and include it in informed consent discussions, particularly for patients who may be sensitive to cosmetic changes.