Can Cymbalta (Duloxetine) Cause Hair Loss?
Yes, duloxetine (Cymbalta) can cause hair loss, though it carries a lower risk compared to bupropion and appears to have a moderate risk profile among antidepressants. For patients with a history of hair loss from citalopram (Celexa), switching to duloxetine may not eliminate the risk, as both medications can trigger alopecia through similar mechanisms.
Evidence for Duloxetine-Associated Hair Loss
A large retrospective cohort study of over 1 million antidepressant users found that duloxetine had a lower risk of hair loss compared to bupropion (HR=0.79,95% CI: 0.71-0.88), but a higher risk than fluoxetine and paroxetine 1
Among the antidepressants studied, bupropion had the highest risk of hair loss, while fluoxetine and paroxetine had the lowest risk 1
Duloxetine falls in the middle range of risk among serotonergic antidepressants for causing alopecia 1
Risk in Patients with Prior SSRI-Induced Hair Loss
Citalopram has been documented to cause alopecia, though it is considered relatively rare compared to other SSRIs 2
A case report documented diffuse hair thinning occurring 3.5 months after starting citalopram 20 mg daily, with complete hair regrowth occurring within months after discontinuation 2
Patients who experienced hair loss with citalopram may be at increased risk for similar reactions with duloxetine, as both medications can trigger telogen effluvium through serotonergic mechanisms 3, 4
Mechanism and Clinical Presentation
Antidepressant-induced alopecia typically occurs through telogen effluvium, where medications trigger premature transition of hair follicles from the growth (anagen) phase to the resting (telogen) phase 4
Hair loss from antidepressants usually presents as diffuse thinning rather than patchy baldness, and typically becomes noticeable 2-4 months after starting the medication 3, 4
The condition is generally reversible upon discontinuation or dose reduction of the offending medication 3, 5
Management Approach
If hair loss occurs with duloxetine in a patient with prior citalopram-induced alopecia, consider switching to fluoxetine or paroxetine, which have the lowest documented risk of hair loss among antidepressants 1
Bupropion should be avoided in patients with a history of antidepressant-induced hair loss, as it carries the highest risk (HR=1.46 compared to fluoxetine, with a number needed to harm of 242 over 2 years) 1
Before attributing hair loss to medication, exclude other common triggers including thyroid dysfunction, iron deficiency (check ferritin), vitamin D deficiency, zinc deficiency, recent illness, fever, stress, or hormonal changes 6, 4
Reassure patients that medication-induced alopecia is reversible, as this knowledge can reduce distress and improve adherence to alternative treatments 2
Clinical Pitfalls
Do not dismiss the complaint as trivial—medication-induced hair loss can significantly impact quality of life and lead to treatment discontinuation 3, 5
Hair loss may not be spontaneously reported by patients due to embarrassment, so specifically ask about this side effect during follow-up visits 3
The temporal relationship between medication initiation and hair loss onset (typically 2-4 months) is crucial for establishing causality 4, 2
Avoid assuming all hair loss is medication-related without ruling out other medical causes, particularly thyroid dysfunction, which can be induced by some psychotropic medications 3