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Hair is also called the crowning glory because plays an extremely important role in giving a person a unique physical appearance. Hair loss or any other kind of hair and scalp problems can evoke sense inferiority of lack self-esteem among patients since these problems are easily visible to all. Before understanding what hair loss is and a list of antidepressants that cause hair loss, it will be worthy to know some basic terms and phases of normal hair growth.
Hair Growth Phases
Each hair on the scalp can be at a different phase at a time. Right from hair growth to falling, hair goes through the following 4 phases:
Anagen Phase (Growing Phase) – This phase lasts for 2-7 years. Length of the hair depends on this phase
Catagen Phase (The Transition Phase) – This phase lasts for about 10 days. The hair follicle shrinks and detaches from the dermal papilla
Telogen Phase (Resting Phase) – This lasts for about 3 months. New hair begins to grow
Exogen Phase (New Hair Phase) – Old hair sheds and new hair continue to grow. About 50-100 hair are expected to shed daily during the phase
What Is Hair Loss?
Hair loss is also called alopecia in medical terms. Alopecia can occur due to a variety of causes, either singly or in combination. Although hair loss can be quite distressing, it is, in fact, one of the most common problems among both men and women.
Types Of Hair Loss
Hair loss types can be divided into 3 categories
1.Cicatricial
This is an irreversible type of hair loss in which the stem cell reservoir present in the middle of the hair shaft is destroyed completely. Causes for the cicatricial type of hair loss include:
- Fungal or bacterial infection of the hair follicles
- Discoid lupus erythematosus
- Scarring bullous disorders
- Lichen planopilaris
- Neoplastic disorders
2. Non-Cicatricial
This is often a reversible type of hair loss which can be divided further into the following types:
- Telogen Effluvium – It is also called shedding of hair. Patients complain of an increase in a number of hair on the shower drain or pillow. With telogen effluvium, people tend to shed around 150-400 hairs per days. Following are the causes for the shedding of hair can be
- After febrile illnesses
- Following childbirth
- Chronic systemic illnesses
- Poor diet
- Use of heparin and other medications
- Mental and emotional stress
- Endocrine disorders
- Surgical procedures and anesthesia
- Androgenetic Alopecia – There is progressive thinning of hair. It can begin anytime from puberty to old age. An “M-pattern†hair loss can be seen in both men and women. Strong family history is responsible in most cases.
- Alopecia Areata – This is characterized by patchy and recurrent hair loss. Alopecia areata is thought to be a T-lymphocyte mediated autoimmune disorder. It may also be associated with other autoimmune illnesses like thyroid disorders, SLE and diabetes.
- Traction Alopecia – In this type of hair breaks and is sparse in the frontal area. It is commonly seen in women with curly hair. Other causes include excessive stress on hair using rollers, hair ties, braids, and other devices.
3. Hair Shaft Abnormalities
These present with brittle hair which tends to break easily. Patients present with patchy or diffuse areas of short hair which do not grow beyond a certain length. Following are the causes of hair shaft abnormalities- Repeated trauma to the hair shaft as from blow drying, straightening, bleaching and coloring
- Inherited disorders
List Of Antidepressants That Cause Hair Loss
Hair loss is one of the commonest complaints after the use of prescription medications. Hair loss can also indirectly be linked to the medical conditions for which medications have been prescribed. Clinically, medication or drug-induced hair loss presents with a diffuse type of non-scarring and reversible hair loss. Women are more commonly affected than men. In drug-induced telogen effluvium, there is a premature interruption of hair growth.
Alopecia due to anti-depressants and other psychotropic medications usually begins 4 – 6 months after starting medications. Apart from hair loss, patients also complain of a change in hair texture after being on medications. Psychotropic medications and anti-depressants are often linked to hair loss as their side effect.
1. Lithium
Increases telogen shedding. It can also cause hypothyroidism and hyperthyroidism which also result in hair changes.
2. Sodium Valproate
Hair loss associated with this medicine is dose-dependent, which means reducing its dose also reduces hair loss. Transient hair loss is also reported among pediatric age groups.
3. Carbamazepine
Induced hair loss is a rare occurrence.
4. Fluoxetine
It is the most common antidepressant which causes hair loss. Hair shedding can increase for a few months to even a year after starting this medication.
5. Sertraline
Even a low dose of this medicine is associated with hair loss. Hair loss due to sertraline is unique as patients notice hair loss several years after starting this medicine. Hair loss due to this medicine is also dose-dependent. Stopping of medicine reduces hair loss.6. Tricyclic Antidepressant
Can occasionally cause hair loss
Medications Other Than Antidepressants That Can Cause Hair Loss
Anti-Coagulants – Low molecular weight heparin and warfarin
Cardio-Vascular Drugs – Beta blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), amiodarone (anti-arrhythmic drug)
Oral Contraceptives – Telogen effluvium can be observed if long term oral contraceptive therapy is interrupted. Progesterone based oral contraceptives can worsen androgenetic hair loss.
Retinoids – Commonly used in the treatment of skin diseases. Vitamin A may induce mild hair loss. Acitretin may change hair color and texture.
Antimicrobials – Anti-tubercular medications, anti-retroviral therapy medicines (for HIV), antibiotics and antifungal medications are associated with alopecia
Chemotherapy Drugs - Drug-induced hair loss is a relatively common finding among patients. Hair loss is diffuse, nonscarring and generally reversible in nature. In nearly all cases of drug-induced alopecia, hair loss is completely reversed after discontinuation of medicines.
Clinicians and psychiatrists need to keep monitoring patients for hair loss after beginning medications as this is the leading cause of non-compliance by most patients. Reducing the dose of antidepressants or complete cessation of these medications leads to complete hair growth.
