Can Celexa (citalopram) cause hair loss?

Can Celexa (Citalopram) Cause Hair Loss?

Yes, Celexa (citalopram) can cause hair loss, though this is an infrequent adverse effect that typically presents as diffuse alopecia and is reversible upon discontinuation. 1

Evidence from FDA Drug Labeling

The official FDA prescribing information for citalopram lists alopecia as an "infrequent" adverse effect under Skin and Appendages Disorders, meaning it occurs in 1/100 to 1/1000 patients. 1 This classification places hair loss among recognized but uncommon side effects of the medication.

Clinical Presentation and Mechanism

• Hair loss from SSRIs like citalopram typically manifests as telogen effluvium, where hair follicles are pushed prematurely into the resting phase, leading to diffuse shedding across the scalp. 2

• The pattern is diffuse and non-scarring, with onset typically occurring 1-3 months after medication initiation. 3

• Hair regrowth occurs within 3-6 months after discontinuation, growing at approximately 1 cm/month as the body adjusts. 3

Comparative Risk Among SSRIs

• Drug-induced alopecia is relatively rare with citalopram compared to other SSRIs. 4 A 2019 case report emphasized that while hair loss is common among other SSRIs, it is specifically uncommon with citalopram. 4

• There may be differences in hair loss risk between various SSRIs, with sertraline showing dopaminergic effects that may contribute to hair loss in ways that fluoxetine does not. 5

• The overall incidence of hair loss with psychopharmaceuticals is well-documented, with antidepressants capable of causing alopecia on rare occasions. 6

Differential Diagnosis Requirements

Before attributing hair loss to citalopram, you must exclude:

• Thyroid dysfunction (TSH, free T4) - particularly important as hypothyroidism can be medication-induced. 2, 6
• Iron deficiency (ferritin, CBC). 2
• Recent severe stress, illness, fever, or hemorrhage - all triggers for telogen effluvium. 7
• Other medications the patient may be taking. 2
• Androgenetic alopecia - assess for pattern baldness versus diffuse thinning. 2

Management Algorithm

If hair loss is cosmetically significant and affecting quality of life: 8

1. Confirm the temporal relationship - hair loss beginning 1-3 months after citalopram initiation suggests drug causation. 3

2. Complete the differential diagnosis workup outlined above before discontinuing the medication. 2

3. Consider switching to another SSRI if citalopram is the likely culprit and psychiatric treatment must continue. The American Academy of Child and Adolescent Psychiatry recommends gradually tapering sertraline (and by extension, other SSRIs) over 10-14 days to minimize discontinuation syndrome. 2

4. Reassure the patient that hair loss is reversible - this is critical to prevent treatment non-adherence and psychiatric relapse. 4

5. Monitor for hair regrowth - expect improvement within 3-6 months after discontinuation or dose adjustment. 3

Critical Clinical Pitfalls

• Do not dismiss patient concerns about hair loss - while infrequent, this side effect can significantly impact quality of life and medication adherence. 4, 6

• Do not abruptly discontinue citalopram without tapering - SSRIs, particularly shorter-acting ones, can cause discontinuation syndrome characterized by dizziness, fatigue, sensory disturbances, and mood changes. 8

• Do not assume causation without excluding other triggers - telogen effluvium has multiple potential causes including stress, illness, and hormonal changes that may coincide with medication initiation. 7

• Recognize that citalopram has specific cardiac considerations - doses exceeding 40 mg/day can cause QT prolongation and should be avoided, which limits dose adjustment options. 8