Citalopram can cause hair loss, though it’s a relatively rare side effect. Among the SSRI class of antidepressants, citalopram falls in the middle of the pack for hair loss risk, accounting for about 15.5% of SSRI-related hair loss reports in a systematic review. If you’ve noticed more hair in the shower drain or on your pillow since starting citalopram, the medication is a plausible explanation.
How Common Is Hair Loss With Citalopram?
Hair loss from citalopram is uncommon enough that it doesn’t appear as a frequent side effect in clinical trials. Case reports in the medical literature describe it happening, but large-scale data confirms it’s not something most people on the medication will experience.
A systematic review of SSRI-related hair loss found that fluoxetine was the most commonly implicated SSRI (38% of cases), followed by sertraline (28.2%), with citalopram third at 15.5%. Escitalopram, the closely related newer version of citalopram, accounted for 9.9%. A separate large retrospective study found that all SSRIs carried a roughly similar risk of hair loss when compared head to head, with paroxetine having the lowest risk and bupropion (a different type of antidepressant) having the highest. For bupropion specifically, about 1 in 242 users experienced hair loss over two years.
Why SSRIs Affect Hair Growth
Hair follicles cycle through three phases: active growth, a short transition period, and a resting phase. When the resting phase ends, the hair falls out and the cycle starts over. Medications like citalopram can push a larger-than-normal number of follicles into the resting phase at the same time, a process called telogen effluvium. Instead of the usual 50 to 100 hairs lost per day, you might notice significantly more shedding spread diffusely across your scalp rather than concentrated in one spot.
The exact reason SSRIs trigger this shift isn’t fully understood, but serotonin receptors exist on hair follicle cells. Altering serotonin levels throughout the body, which is what SSRIs do, may disrupt the normal growth cycle for a subset of people.
When Hair Loss Typically Starts
Drug-induced hair loss generally appears within the first three months of starting treatment. Some case reports document shedding as early as two weeks after beginning an SSRI, though one to three months is more typical. This delay exists because the follicles need time to transition into the resting phase and then release the hair. If you’ve been on citalopram for a year without any change in hair thickness, the medication is unlikely to suddenly start causing hair loss unless your dose recently increased.
How to Tell If Citalopram Is the Cause
The tricky part is that hair loss has many causes: genetics, stress, thyroid problems, iron deficiency, hormonal changes, and aging can all thin your hair independently of any medication. Depression itself can contribute to hair shedding through stress pathways. So noticing hair loss after starting citalopram doesn’t automatically mean the drug is responsible.
A few features help distinguish medication-related hair loss from other types. Drug-induced shedding is typically diffuse, meaning it thins evenly across your scalp rather than creating a receding hairline or a widening part (which points more toward genetic pattern hair loss). The timing matters too. If your hair loss started within a few months of beginning citalopram or changing your dose, that timeline fits. A doctor evaluating this will usually take a detailed medication history covering the three months before shedding began, check for family history of hair loss, and may run blood work to rule out thyroid or nutritional issues.
The only definitive way to confirm a medication is causing hair loss is to stop it for at least three months and watch for regrowth. That’s obviously a decision to make carefully, since stopping an antidepressant has its own consequences.
What Happens If You Stop or Switch
The good news is that SSRI-related hair loss is typically reversible. In documented cases, hair shedding stopped within weeks of discontinuing the medication, and normal growth resumed. One case report of sertraline-induced hair loss found that shedding resolved in about two weeks after stopping the drug. Full regrowth takes longer, since hair grows roughly half an inch per month, so expect several months before your hair density looks noticeably improved.
If citalopram is otherwise working well for you, stopping it entirely isn’t the only option. A dose reduction may help if the hair loss is dose-dependent. Switching to a different antidepressant is another possibility. Paroxetine consistently shows the lowest hair loss risk among SSRIs in comparative studies, and fluoxetine also ranks relatively low. Your prescriber can help weigh the tradeoffs between managing hair loss and maintaining effective treatment for depression or anxiety.
Comparing Antidepressants by Hair Loss Risk
- Lowest risk SSRIs: Paroxetine and fluoxetine have the lowest hair loss risk in large retrospective studies.
- Moderate risk: Citalopram, escitalopram, and sertraline fall in the middle range.
- Higher risk among antidepressants: Bupropion carries the highest risk overall, and fluvoxamine has the highest risk among SSRIs specifically.
These differences are relative. The absolute risk of significant hair loss from any individual antidepressant remains low. But if you’re someone who has already experienced shedding on citalopram, knowing which alternatives carry less risk can be useful information to bring to your next appointment.