Does Lexapro Cause Permanent Hair Loss?
No, Lexapro (escitalopram) does not cause permanent hair loss—when hair loss occurs with SSRIs like escitalopram or its parent compound citalopram, it is reversible and typically resolves within 3-6 months after discontinuation or dose adjustment. 1, 2
Mechanism and Clinical Pattern
Hair loss from SSRIs manifests as telogen effluvium, where hair follicles are prematurely pushed into the resting phase, causing diffuse, non-scarring shedding across the scalp. 1 This pattern differs from permanent scarring alopecia and typically begins 1-3 months after starting the medication. 1
The key distinction is that drug-induced alopecia from SSRIs is completely reversible upon withdrawal of the offending agent. 3, 2 In documented cases with citalopram (the parent compound of escitalopram), patients regained most of their hair within a few months after discontinuation. 2
Diagnostic Approach
Before attributing hair loss to Lexapro, you must exclude other causes:
- Thyroid dysfunction (check TSH and free T4) 1
- Iron deficiency (check ferritin levels) 1
- Nutritional deficiencies (vitamin D, zinc) 1
- Recent severe stress, illness, fever, or hemorrhage 1
- Other concurrent medications 1
- Androgenetic alopecia (pattern baldness versus diffuse thinning) 1
The diagnosis requires confirming the temporal relationship between medication initiation and hair loss onset. 1
Management Strategy
If hair loss is cosmetically significant and affecting quality of life:
Complete the differential diagnosis workup as outlined above 1
Consider switching to another SSRI if psychiatric treatment must continue, though note that other SSRIs can also rarely cause hair loss 4, 5
Taper gradually over 10-14 days rather than abruptly discontinuing, as SSRIs cause discontinuation syndrome (dizziness, fatigue, sensory disturbances, mood changes) 1
Provide reassurance that hair regrowth occurs within 3-6 months after discontinuation or dose adjustment 1, 2
Important Caveats
While drug-induced alopecia is common with some SSRIs, it is relatively rare with citalopram/escitalopram compared to other psychotropic medications 2, 5
Doses of citalopram exceeding 40 mg/day cause QT prolongation and should be avoided, which is relevant if considering dose adjustment 1
Early recognition and withdrawal of the offending agent helps alleviate patient distress and avoid treatment non-compliance 2, 4
The incidence of SSRI-induced alopecia is much lower than with mood stabilizers like lithium (12-19%) or valproic acid (up to 28%) 5, 6