Can Prozac Can Hair Loss?

Answer

Hi Zeke and thank you for your question.

Seeing hair loss can definitely be stressful. Fortunately, true alopecia (hair loss) from antidepressants like SSRIs seems to be a very rare side effect, with much less than 1% of patients experiencing this.

Nevertheless, due to the fact that there have been several case reports filed with the FDA Adverse Event Reporting System (FAERS), a number of studies have looked into the association.

What Do The Studies Say?

The overall consensus is that hair loss with selective serotonin reuptake inhibitors (SSRIs), like Prozac, is an extremely rare side effect. One study, published in the journal 'Pharmacoepidemiology and Drug Safety', concluded the following:

Alopecia [hair loss] appears to be a rare ADR [adverse drug reaction] to SSRIs. The risk of alopecia seems to vary between the different SSRIs, and might be higher in women than in men.

It is interesting to note that this study found a statistically significant association (i.e. more likely to occur than just by chance) between hair loss and two different SSRIs, sertraline (Zoloft) and citalopram (Celexa), but not with the other SSRIs. The exact mechanism behind why hair loss can occur is unknown.

Another study, published in the journal 'International Clinical Psychopharmacology', reported similar results.

It noted that a non-SSRI antidepressant seemed to have the highest risk for hair loss (bupropion) and the two SSRIs that has the lowest risk were fluoxetine (Prozac) and paroxetine (Paxil).

Compared with bupropion, all other antidepressants had a lower risk of hair loss, with fluoxetine and paroxetine having the lowest risk.

So, it is certainly possible you are experiencing hair loss on Prozac, but again, it wouldn't be common as SSRIs, in general, have a very low risk of causing this side effect, and Prozac isn't among the SSRIs that studies have positively associated it with.

How To Tell If Prozac Is The Culprit

There is no accepted scientific method to determine whether or not hair loss is due to a drug, or other factors.

Likely the most reliable way to know if the hair loss is drug-induced, is to determine whether or not hair loss is reduced when the drug is stopped, and then, if there is a reappearance of the hair loss after restarting the drug.

Other methods include a 'hair pull' test, which can help determine if your hair loss is 'active' or simply normal physiological hair loss. This test involves counting extracted hairs (from a hair-pull of 50-60 hairs) and if more than 10% of the hair lock is extracted, this generally means you are experiencing 'active' hard loss (e.g. from a drug or other disease).

Overall, we can't be 100% sure if your hair loss is due to Prozac, or to other factors. You also have to consider that you could be experiencing a temporary hair loss from stress related to a life event or even from starting a new antidepressant.

Research suggests that about 15% of patients starting or changing their SSRI dose do experience a worsening amount of anxiety. In addition to stress, most side effects tend to occur when an SSRI is started for the first time.

Generally, these side effects gradually resolve and you’ll start to experience the positive antidepressant effects of the medication after being on the medication for 4-12 weeks. So, if the hair loss is related to antidepressant stress, you should eventually see a stress reduction, and then your hair should return to normal. 

When it comes to SSRIs, the best advice that I can give any patient starting a new drug is patience! If the breakthrough anxiety that you are experiencing is due to life circumstances, the fluoxetine will help, but it might take another month or two. In that time, I hope that your life situation improves.

Final Words

Good luck, and just remember that the medication is effective for many people, it just takes a while to help. As always, be sure to reach out to your doctor with any concerns as they have your complete medical history.