Can Zoloft (sertraline) cause hair loss?

Can Zoloft (Sertraline) Cause Hair Loss?

Yes, sertraline can cause hair loss, though it is a rare side effect that typically manifests as telogen effluvium with diffuse shedding. 1, 2

Evidence from FDA Drug Labeling

The FDA-approved sertraline label explicitly lists alopecia (hair loss) as a documented sequela in overdose cases, confirming this as a recognized adverse effect of the medication. 2 Among 634 overdose cases where sertraline was the only drug ingested, 27 patients experienced sequelae including alopecia. 2

Clinical Presentation

Hair loss from sertraline typically presents as:

• Telogen effluvium pattern: Hair follicles are pushed prematurely into the resting (telogen) phase, causing diffuse shedding rather than patchy loss 1
• Timing: Can occur within 2 weeks of starting treatment in some cases, though timing varies 3
• Reversibility: Hair loss typically improves after discontinuing sertraline and recurs if the medication is resumed 4, 3

Mechanism and Comparative Risk

Sertraline's unique dopamine reuptake inhibition properties may explain its hair loss potential compared to other SSRIs. 4 A case report documented a patient who experienced hair loss on sertraline but not on fluoxetine, with the different impacts on dopamine reuptake identified as a possible mechanism. 4 However, the exact mechanism remains incompletely elucidated, with psychotropic drugs generally thought to influence the telogen phase of hair follicles. 3

Differential Diagnosis

When a patient on sertraline reports hair loss, you must exclude alternative causes before attributing it to the medication:

• Thyroid dysfunction (particularly hypothyroidism) 1
• Iron deficiency 1
• Severe stress or recent illness 1
• Other medications (mood stabilizers like lithium and valproate cause hair loss in 12-28% of users, far more commonly than SSRIs) 5
• Androgenetic alopecia (pattern baldness) 1
• Alopecia areata (autoimmune condition with patchy loss, exclamation mark hairs, and yellow dots on dermoscopy) 6, 1

Management Strategy

If hair loss is cosmetically significant and affecting quality of life, switching to another SSRI is the most appropriate intervention. 1, 4

Switching Protocol:

• Gradually taper sertraline over 10-14 days to minimize discontinuation syndrome (dizziness, fatigue, myalgias, headaches, nausea, insomnia, anxiety, agitation) 6, 7
• Example taper: 100mg → 75mg (3-4 days) → 50mg (3-4 days) → 25mg (3-4 days) → discontinue 7
• Consider switching to fluoxetine or escitalopram, which have less dopamine reuptake activity and may have lower hair loss risk 4, 8
• Monitor closely during the first week after switching for discontinuation symptoms and early adverse effects 9, 7

Important Caveats:

• Hair loss from SSRIs is rare overall compared to mood stabilizers (lithium 12-19%, valproate up to 28%) 5
• Discontinuation or dose reduction almost always leads to complete hair regrowth 5
• Do not abruptly stop sertraline even if hair loss is distressing, as this can precipitate severe discontinuation syndrome 6, 7
• Assess severity and impact before making treatment changes—mild, non-distressing hair loss may not warrant switching medications if sertraline is otherwise effective 1

Clinical Bottom Line

While sertraline-induced hair loss is documented in FDA labeling and case reports, it remains uncommon. When it occurs, it is reversible with medication discontinuation, and switching to an alternative SSRI with different pharmacologic properties typically resolves the issue without recurrence. 4, 3, 8