Prozac (Fluoxetine) and Hair Loss: What Patients Need to Know

By Dr. Alan J. Bauman, MD, ABHRS

Bauman Medical Group, Boca Raton, FL

As a board-certified hair restoration physician with over 25 years of experience treating hair loss in thousands of patients, I often encounter questions about how medications can impact hair health. One such medication is Prozac (fluoxetine), a commonly prescribed selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety, and other conditions. While Prozac is generally well-tolerated, hair loss—known medically as alopecia—has been reported as a rare side effect in some users. This page is designed to provide my patients with clear, evidence-based information on this topic, including potential causes and what steps you can take if you’re experiencing this issue. Remember, this is not a substitute for personalized medical advice—always consult your healthcare provider.

Understanding Hair Loss as a Side Effect of Prozac

Hair loss associated with Prozac is uncommon, affecting only a small percentage of users. In clinical trials and post-marketing reports, alopecia is listed as occurring in less than 1% of patients, but real-world case reports suggest it can be distressing when it does happen. The hair loss is typically diffuse, meaning it affects the scalp evenly rather than in patches, and it often presents as increased shedding rather than immediate baldness.

The most common form of this hair loss is telogen effluvium, a condition where a higher-than-normal number of hair follicles enter the resting (telogen) phase prematurely, leading to shedding 2-3 months later. Patients may notice more hair in their brush, shower drain, or pillow, with daily loss exceeding the normal 100-150 hairs. In some cases, it can involve the scalp, eyebrows, or even body hair.

Onset can vary widely: from as little as a few days to several months or even years after starting Prozac. The median time to onset in reported cases is around 8-9 weeks. Importantly, this side effect appears to be reversible in most cases—hair growth typically resumes within weeks to months after discontinuing the medication. However, in rare instances, recovery may take longer or require additional intervention.

Case reports highlight this variability. For example, a 30-year-old woman experienced frontal hair loss six weeks after starting 20 mg/day of fluoxetine, with full recovery after stopping the drug. Similarly, a 26-year-old man reported similar symptoms, marking the first documented male case, with resolution upon discontinuation. Another case involved a 49-year-old woman who noticed hair thinning after three months on fluoxetine, which persisted until the medication was stopped.

While more cases are reported in women, men can also be affected. Factors like dosage (typically 20-80 mg/day), duration of use, and individual sensitivity may play a role.

Potential Causes of Prozac-Induced Hair Loss

The exact mechanism behind Prozac-related hair loss isn’t fully understood, but research points to several possibilities:

• Disruption of the Hair Growth Cycle: Prozac may trigger telogen effluvium by acting as a physiological stressor, similar to illness or nutritional deficiencies, causing follicles to shift from the growth (anagen) phase to resting.
• Serotonin Imbalance: As an SSRI, Prozac increases serotonin levels in the brain. Elevated serotonin might interfere with hair follicle function, possibly by influencing melatonin production or other pathways involved in hair cycling.
• Individual Factors: Genetic predisposition, hormonal changes, or concurrent medications (e.g., other antidepressants or mood stabilizers) could heighten risk. Studies show fluoxetine has a lower risk compared to some antidepressants like bupropion but similar to paroxetine.
• Direct Follicle Effects: In rare cases, Prozac might directly affect hair follicles, leading to thinning or fallout, though more research is needed.

It’s crucial to rule out other causes of hair loss, such as thyroid disorders, iron deficiency, or androgenetic alopecia (pattern baldness), which may coincide with Prozac use. A thorough evaluation, including blood tests and scalp analysis, is essential.

Hair Loss from Other Psychiatric Medications

Beyond Prozac, many other medications used to treat mood disorders, anxiety, and related conditions can also cause hair loss as a rare side effect. This is often due to similar mechanisms, such as inducing telogen effluvium through physiological stress on the body or disruptions in hormone levels, serotonin pathways, or the hair growth cycle. Like with Prozac, hair loss from these drugs is typically reversible upon discontinuation or dose adjustment, though it may take several months for regrowth to become noticeable. The incidence varies by drug class and individual factors, with mood stabilizers showing higher rates in some cases (e.g., 12-19% for lithium). Always consult your physician before changing medications, as abrupt stops can exacerbate mental health symptoms.

Common categories and examples include:

• Antidepressants (SSRIs, TCAs, and Others): These are frequently associated with hair loss, though the risk is low.
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Citalopram (Celexa)
  • Paroxetine (Paxil)
  • Fluvoxamine
  • Bupropion (Wellbutrin)
  • Duloxetine (Cymbalta)
  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Clomipramine (Anafranil)
  • Doxepin (Sinequan)
  • Desipramine (Norpramin)
  • Trimipramine (Surmontil)
  • Amoxapine (Asendin)
  • Protriptyline (Vivactil)
  • Trazodone
  • Maprotilene
• Mood Stabilizers: Often used for bipolar disorder, these have a higher reported incidence of hair loss.
  • Lithium
  • Valproic acid (Depakene)
  • Divalproex sodium (Depakote)
  • Carbamazepine (Tegretol)
• Anti-Anxiety Agents and Antipsychotics: Some benzodiazepines and other agents can rarely cause alopecia.
  • Clonazepam (Klonopin)
  • Buspirone (BuSpar)
  • Haloperidol (Haldol)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)

If you’re on any of these medications and noticing hair thinning, a comprehensive evaluation at Bauman Medical can help determine if the drug is contributing and explore treatment options.

What Should You Do If You’re Experiencing Hair Loss on Prozac?

If you notice increased hair shedding while taking Prozac:

1. Consult Your Prescribing Doctor: Do not stop the medication abruptly without guidance, as this could worsen your underlying condition. Discuss alternatives like switching to another SSRI with a lower reported risk.
2. See a Hair Specialist: At Bauman Medical, we offer comprehensive diagnostics, including HairCheck measurements and trichoscopy, to assess the extent of loss and rule out other factors.
3. Supportive Treatments: Options may include minoxidil, low-level laser therapy (LLLT), nutritional supplements, or PRP (platelet-rich plasma) to promote regrowth while addressing the root cause.
4. Monitor and Track: Keep a journal of your symptoms and share it with your healthcare team.

Hair loss can be emotionally challenging, especially when tied to mental health treatment. Rest assured, most cases resolve, and effective therapies are available to restore your hair.

If you’re a patient at Bauman Medical or have concerns about medication-related hair loss, schedule a consultation today at www.baumanmedical.com/  or call our office.

If you or someone you know has hair loss, hair thinning, baldness, or eyebrow / eyelash concerns, click to start either a long-distance virtual consultation OR an in-person, in-office consultation with Dr. Bauman. You can also Ask Dr. Bauman a Question or simply call Bauman Medical Group  at +1-561-394-0024.

*Each individual's treatment and/or results may vary

References

Etminan, M., Sodhi, M., Procyshyn, R. M., Guo, M., & Carleton, B. C. (2018). Risk of hair loss with different antidepressants: A comparative retrospective cohort study. International Clinical Psychopharmacology, 33(1), 44-48.

Pejcic, A. V., & Paudel, V. (2022). Alopecia associated with the use of selective serotonin reuptake inhibitors: Systematic review. Psychiatry Research, 314, Article 114620. 

Kontoangelos, K., Economou, M., Peppou, L., Yiannopoulou, K. G., & Papageorgiou, C. (2019). Hair loss in a female patient after administration of fluoxetine: A case report and review of the literature. European Review for Medical and Pharmacological Sciences, 23(18), 8130-8132. 

O’Bryan, E. C., III, & Albanese, R. P. (2004). A case report of fluoxetine- and venlafaxine-induced hair loss. Primary Care Companion to The Journal of Clinical Psychiatry, 6(4), 181. 

Mermi, O., Atmaca, M., Kilic, F., Gurok, M. G., & Kuloglu, M. (2014). Fluoxetine induced hair loss: A case report. Düşünen Adam The Journal of Psychiatry and Neurological Sciences, 27(3), 266-269. 

Akyüz Karacan, F., et al. (2021). The first male case with fluoxetine induced hair loss and review of the literature. European Review for Medical and Pharmacological Sciences, 25(15), 5026-5028.

Kontoangelos, K., et al. (2019). Hair loss in a female patient after administration of fluoxetine: A case report and review of the literature. European Review for Medical and Pharmacological Sciences, 23(18), 8130-8132. 

Jenike, M. A. (1991). Severe hair loss associated with fluoxetine use. American Journal of Psychiatry, 148(3), 392. 

Mercke, Y., Sheng, H., Khan, T., & Lippmann, S. (2000). Hair loss in psychopharmacology. Annals of Clinical Psychiatry, 12(1), 35-42. 

Gupta, S. (2023). List of Antidepressants That Cause Hair Loss. Hers Blog. Retrieved from https://www.forhers.com/blog/antidepressants-and-hair-loss

Krans, B. (2022). 10 Types of Drugs That Could Cause Hair Loss. AARP. Retrieved from https://www.aarp.org/health/drugs-supplements/drugs-that-cause-hair-loss/

Arabiyat, S., Al-Ajlouni, Y., Alqatawneh, D., & AlShurbaji, A. (2015). Diffuse Hair Loss Induced by Sertraline Use. Case Reports in Psychiatry, 2015, Article ID 703453. 

Gupta, A. K., & Foley, K. A. (2023). Antidepressants and Hair Loss: What’s the Connection? Healthline. Retrieved from https://www.healthline.com/health/antidepressants-and-hair-loss