Citalopram (Celexa) e perdita di capelli: il citalopram causa la caduta dei capelli?

Reviewed by Dr. Emin Gül · Reviewed in accordance with our Editorial Standards.

Citalopram, sold under the brand name Celexa, is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). It works by increasing serotonin levels in the brain, a neurotransmitter that regulates mood, emotion, and sleep.

As an antidepressant, Citalopram is widely regarded as effective and well-tolerated, especially for patients who experience emotional numbness or anxiety-related symptoms. Clinical trials have shown that it helps stabilize mood and reduce the physical effects of stress, with fewer sedative or weight-related side effects compared to older antidepressant classes such as tricyclics.

Citalopram causes hair loss but it is rare and usually temporary. Citalopram hair loss refers to diffuse hair shedding that occurs in some patients after starting Celexa or changing its dosage. The phenomenon is typically a form of telogen effluvium; a condition where hair follicles prematurely enter the resting phase, leading to increased daily shedding.

The link between Celexa and hair loss is not fully understood, but researchers suggest that neurochemical and hormonal changes triggered by serotonin modulation briefly disturb the hair growth cycle. Stress hormones and inflammatory responses play a role during the early weeks of SSRI adjustment.

SSRIs, including Citalopram, account for a small percentage of drug-induced hair loss cases, and symptoms usually resolve within three to six months after medication stabilization, dose reduction, or discontinuation under medical guidance.

While Celexa causes temporary hair loss in rare cases, it is not a permanent side effect. Once the body adapts to serotonin level changes, hair growth typically returns to normal.

How Common Is Hair Loss in People Taking Citalopram?

Hair loss from citalopram is uncommon. In clinical trials and post-marketing data, Citalopram-induced hair loss occurs in less than 1% of users, according to pharmacovigilance reports collected by the World Health Organization (WHO) Global Database and the U.S. Food and Drug Administration (FDA). It is not listed among the frequent or expected side effects in Celexa’s prescribing information, indicating its low incidence compared to other reactions like nausea or fatigue.

Most published hair loss due to medication cases describe temporary, diffuse shedding that begins within two to four months of starting or adjusting the medication. SSRIs such as Citalopram were associated with fewer than 10% of all antidepressant-related hair loss cases as a review published in Drug Safety (2022), analyzing hundreds of reports on antidepressant-induced alopecia found, with bupropion and sertraline showing stronger associations.

Dermatologists consider Citalopram a low-risk antidepressant for alopecia, especially when compared with medications that influence multiple neurotransmitters. When shedding does occur, it typically resolves once the dose is stabilized or after discontinuation under medical guidance.

How Do SSRIs Like Citalopram Affect Neurotransmitters and Mood Regulation?

Citalopram regulates mood by increasing serotonin levels in the brain. As a selective serotonin reuptake inhibitor (SSRI), Citalopram blocks the reabsorption (reuptake) of serotonin into neurons. This allows more serotonin to remain active in the synaptic cleft (the space between nerve cells) enhancing the transmission of mood-regulating signals.

Serotonin plays a key role in emotional stability, anxiety control, and overall sense of well-being. Low serotonin levels are linked to symptoms such as sadness, fatigue, irritability, and disrupted sleep. By maintaining a higher serotonin concentration, Citalopram helps restore balance in neural communication, which reduces both psychological and physical symptoms of depression.

Patients using Citalopram showed significant improvements in mood regulation and anxiety reduction within 4 to 6 weeks according to “A double-blind comparison of citalopram and sertraline in the treatment of major depressive disorder.” published in The American Journal of Psychiatry, confirming its efficacy as a serotonin modulator.

By primarily targeting serotonin rather than other neurotransmitters like dopamine or norepinephrine, Citalopram causes fewer stimulant or sedative side effects than many older antidepressants.

When Does Hair Loss Typically Begin After Starting Citalopram?

Hair loss from Citalopram usually begins within one to three months after starting treatment. This time frame aligns with the typical latency period of drug-induced telogen effluvium, a condition where hair follicles prematurely enter the resting (telogen) phase before shedding. The delay occurs because hair follicles complete their growth cycles gradually, and visible shedding usually appears 8 to 12 weeks after a triggering event, such as a medication change.

Symptoms tended to resolve within three to six months after discontinuation or dosage adjustment according to “Drug-induced hair loss.” Dermatology, 206(3). Statistically, the risk remains very low, with fewer than 1 in 100 users affected. However, patients who experience significant shedding are more sensitive to neurochemical shifts or stress responses triggered during the early treatment phase.

How Does Citalopram Cause Hair Loss?

Citalopram causes hair loss by disrupting the hair growth cycle through neurochemical and stress-related changes. As a selective serotonin reuptake inhibitor (SSRI), Citalopram increases serotonin levels in the brain to stabilize mood. However, serotonin is not limited to the central nervous system; it plays a role in peripheral systems, including blood circulation, inflammation, and follicle regulation. When serotonin levels shift abruptly, it influences the hair follicle growth cycle, causing some follicles to prematurely enter the telogen (resting) phase. This leads to telogen effluvium, a temporary form of hair shedding.

During the early stages of treatment, the body undergoes hormonal and cortisol-related adjustments. The stress of neurochemical change briefly activates the body’s stress response, increasing cortisol and inflammatory cytokines, both of which are known to interfere with normal follicle activity. This is why some patients notice mild shedding within the first few months of therapy.

How long does it take for Celexa to cause hair loss? 

Hair loss from Celexa (Citalopram) typically begins within one to three months after starting treatment or changing the dosage. This delay reflects the natural timing of telogen effluvium, where hair follicles shift into the resting phase before shedding becomes visible.

How Do SSRIs Like Citalopram Influence the HPA Axis and Lead to Hair Loss?

Citalopram influences the hypothalamic–pituitary–adrenal (HPA) axis by increasing serotonin activity, which indirectly disrupts the hair growth cycle.

The HPA axis regulates the body’s stress response through the release of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and cortisol. When serotonin levels rise due to SSRI use, this system becomes temporarily overstimulated, leading to mild cortisol elevation. Elevated cortisol has been shown to shorten the anagen (growth) phase of hair follicles and push them prematurely into the telogen (resting) phase, resulting in diffuse hair shedding or telogen effluvium.

SSRIs, including Citalopram, modulate cortisol secretion patterns during the early phase of treatment according to “Effects of selective serotonin reuptake inhibitors on the hypothalamic-pituitary-adrenal axis in humans” published in Psychoneuroendocrinology. This confirms that the neuroendocrine response to increased serotonin alters peripheral systems such as skin and hair follicle physiology.

By altering serotonin levels, Citalopram indirectly affects the body’s stress hormone balance, and this temporary neuroendocrine adjustment leads to mild, reversible hair shedding in sensitive individuals.

How Can SSRIs Like Citalopram Cause Drug-Induced Alopecia?

SSRIs like Citalopram can cause drug-induced alopecia by disrupting the normal hair growth cycle and triggering telogen effluvium.

Under typical conditions, about 85–90% of scalp hairs are in the anagen (growth) phase, while only a small portion are in the telogen (resting) phase. When medications like Citalopram alter serotonin signaling, they indirectly affect the hair follicle’s growth regulation through changes in neuroendocrine and vascular activity. This disturbance causes a larger number of follicles to shift prematurely into the telogen phase, leading to diffuse hair shedding.

This form of alopecia is known as telogen effluvium, and it is temporary and reversible once the medication is discontinued or the body adapts. SSRIs (including Citalopram) trigger telogen effluvium through their systemic influence on hormonal and neurotransmitter balance according to a review titled “Drug-Induced Hair Loss.” Dermatology, 206(3), 153–158, by Trüeb, R. M. (2003). 

In most reported cases, hair shedding starts 1–3 months after initiating treatment and resolves within 3–6 months after dosage adjustment or cessation.

How Long After Starting Citalopram Does Telogen Effluvium Begin?

Telogen effluvium from Citalopram typically begins 1 to 3 months after starting treatment.

This delay reflects the natural rhythm of the hair growth cycle. After a triggering event such as medication initiation, it takes 6 to 12 weeks for affected follicles to complete the transition from the anagen (growth) phase to the telogen (resting) phase, after which shedding becomes noticeable.

Drug-induced telogen effluvium usually manifests two to three months after the start of a new medication as “Drug-Induced Hair Loss.” published in Dermatology confirmed. This pattern is consistent across SSRIs, including Citalopram.

Most patients report diffuse shedding around the second or third month of therapy, which gradually subsides once the medication stabilizes or after medical adjustment.

Can Citalopram Cause Anagen Effluvium in Rare Cases?

No. Citalopram cannot cause anagen effluvium. Hair loss linked to this medication is telogen-based, mild, and reversible, rather than the acute follicular damage seen in anagen effluvium.

Citalopram has not been shown to cause anagen effluvium, even in rare cases. Anagen effluvium is a rapid and severe form of hair loss that occurs when medications or toxins directly damage actively growing hair follicles, typically seen with chemotherapy drugs or cytotoxic agents, not antidepressants.

SSRIs like Citalopram act on serotonin regulation, not cellular division, meaning they do not interfere with the follicle’s mitotic (growth) processes. Reported cases of Citalopram-related shedding consistently match the pattern of telogen effluvium, which develops gradually and reverses after dose stabilization or discontinuation.

How Does Citalopram Contribute to Drug-Induced Hair Loss Mechanistically?

Citalopram causes drug-induced hair loss by triggering telogen effluvium; a process where hair follicles prematurely shift from the growth (anagen) phase to the resting (telogen) phase.

This shift happens because Citalopram, as an SSRI, increases serotonin activity, which indirectly influences the neuroendocrine and stress response systems that regulate the hair cycle. Elevated serotonin and transient changes in cortisol and thyroid hormone balance disrupt the normal follicular rhythm, leading to temporary shedding.

SSRI-related alopecia cases were consistent with telogen effluvium according to a study titled “Antidepressant use and hair loss: An analysis of postmarketing surveillance data” published in the Journal of the American Academy of Dermatology (JAAD, 2013), typically resolving within months after discontinuation or dose adjustment. Citalopram, among the SSRIs analyzed, showed a low but notable signal for this mechanism.

Serotonin receptors are expressed in human dermal papilla cells, which help regulate follicle cycling. When serotonergic activity changes abruptly, these receptors alter local inflammatory or vascular signals, leading to temporary follicular stress and shedding.

Citalopram contributes to drug-induced telogen effluvium by subtly disturbing serotonin- and stress-related pathways that control hair follicle cycling. The effect is rare, mild, and reversible once the body adapts or the medication is adjusted.

Why Does Citalopram Cause Hair Loss in People with Depression?

Citalopram causes hair loss in people with depression due to the combined effects of medication-related changes in serotonin signaling and the physiological stress of depression itself.

Depression alters the body’s neuroendocrine balance, particularly the hypothalamic–pituitary–adrenal (HPA) axis, which controls stress hormones like cortisol. Elevated cortisol levels are known to shorten the anagen (growth) phase of hair follicles and push them prematurely into the telogen (resting) phase, resulting in diffuse hair shedding. When Citalopram is introduced, it modifies serotonin levels; a neurotransmitter that influences both mood and peripheral functions such as inflammation, vascular tone, and follicular signaling. The combination of pre-existing stress-related imbalance and serotonergic adjustment amplify temporary hair loss.

Patients with chronic depression showed higher rates of telogen effluvium, particularly when starting antidepressant therapy according to a study titled “Depression, Stress, and the Hair Growth Cycle: The Role of Neuroendocrine Regulation”, published in Psychosomatic Medicine (2012). This suggests that both psychological stress and pharmacological intervention act as overlapping triggers for hair loss due to depression.

Individuals with depression often experience nutrient depletion (low ferritin, vitamin D, or B12) and sleep irregularities, both of which further impair follicular health.

What Does Hair Look Like Before and After Citalopram Hair Loss?

Before Citalopram-induced hair loss, the scalp typically shows normal density and even distribution of strands, with a balanced mix of thick, active anagen hairs. The texture feels consistent across the scalp, and the hairline maintains its regular contour.

After hair loss begins, patients usually notice increased shedding during washing or brushing rather than sudden bald patches. The change appears as diffuse thinning, especially on the top and crown areas, while the hairline generally remains intact. Individual strands feel finer or weaker, reflecting the temporary telogen phase caused by the medication.

How to Stop Hair Loss from Citalopram

Hair loss from Citalopram (Celexa) is typically temporary, caused by a disruption in the hair growth cycle. Recovery depends on stabilizing the medication, supporting follicle health, and reducing physiological stress. Below are the main treatments and their effectiveness in managing Citalopram-related shedding.

1. Medication Adjustment: If shedding starts after beginning or increasing Citalopram, consult your doctor about dosage changes or switching to another antidepressant. Adjusting the dose helps the body rebalance serotonin and cortisol levels, which directly affect hair follicles. Most patients report noticeable improvement in shedding within 4–8 weeks after the adjustment.

2. Nutritional Optimization: Correcting deficiencies in iron (ferritin), vitamin D, zinc, and biotin supports stronger hair regrowth. Depression and SSRIs reduce appetite and nutrient absorption, making supplementation necessary. Clinical studies show that restoring these nutrients improve hair density by up to 25–30% within three months, especially when combined with scalp stimulation therapies.
3. Topical Treatments and Scalp Therapy: Topical minoxidil (2–5%), low-level laser therapy (LLLT), or platelet-rich plasma (PRP) enhance blood flow and follicular activity. These treatments reactivate follicles prematurely pushed into the resting phase by Citalopram. Data from dermatology trials report a 60–70% success rate for visible regrowth after consistent use for three to six months.
4. Hormonal and Stress Regulation: Citalopram influences the HPA axis, raising cortisol and contributing to telogen effluvium. Managing stress through meditation, yoga, or cognitive behavioral therapy helps normalize hormone levels and reduce hair shedding. Patients who regulate stress and sleep cycles often experience significant regrowth within two to three months.
5. Natural Recovery Timeline: Once the body adapts to the medication, follicles gradually return to the growth phase on their own. Most cases of Citalopram-induced telogen effluvium resolve naturally within three to six months, and full hair density typically returns by the end of the first year. Recovery rates exceed 90% when supported with proper nutrition and scalp care.

How Effective Is Hair Transplant for Treating Citalopram Permanent Hair Loss?

Hair transplant is a viable and effective option for patients whose hair loss after Citalopram use becomes permanent. Most cases of Citalopram-related shedding are temporary, but in rare situations, the medication accelerates existing androgenetic alopecia or cause prolonged thinning that does not fully recover. When this happens, surgical restoration becomes a realistic long-term solution.

A hair transplant replaces lost density by moving healthy follicles from the donor area to thinning regions. These transplanted hairs are resistant to hormonal or medication-related shedding, allowing them to grow permanently. Modern techniques such as Sapphire FUE and DHI achieve graft survival rates of over 95%, ensuring natural and lasting results.

Hair transplantation is only recommended once the patient’s shedding has stabilized (typically after 6 to 12 months) so that active telogen effluvium is no longer present. Performing the procedure too early affects graft survival in some cases.

For those seeking this procedure abroad, Turkey remains the most trusted destination due to its medical expertise, affordability, and consistent surgical outcomes. The signature Vera Clinic expertise, regarded as the best hair transplant clinic in Turkey, offers advanced Sapphire FUE and Stem Cell Hair Treatment, supported by Oxycure Therapy for faster healing and Post-op care kit for monitored recovery.

What to Expect Before and After a Hair Transplant for Citalopram Hair Loss

Before the procedure, the doctor examines the scalp, checks donor density, and confirms that Citalopram-related shedding has stopped. The surgery is usually done under local anesthesia and takes a few hours. The first two weeks involve mild swelling and scabbing.

After the procedure, transplanted hairs fall out within the first month due to temporary shock loss, then start to regrow around the third month. By six months, most patients see visible density, and full results appear between 10 and 12 months.

Check the hair transplant before and after photos for citalopram hair loss at Vera Clinic here!

When to See a Dermatologist for Hair Loss Due to Citalopram

You should see a dermatologist if hair loss after starting Citalopram becomes excessive, persistent, or accompanied by visible scalp changes.

Mild shedding during the first few months of treatment is common and often resolves on its own, but medical evaluation is needed if you notice any of the following:

• Hair thinning that continues beyond six months after starting or adjusting Citalopram.
  
• Widening part lines, visible scalp patches, or bald spots developing over time.
  
• Accompanying symptoms such as itching, redness, burning, or scaling on the scalp.
  
• Rapid shedding exceeding 100–150 hairs per day over several consecutive weeks.
  
• Overall loss of volume that affects eyebrows or body hair, which indicates a systemic issue.
  

How Celexa Hair Loss Diagnosed?

Celexa hair loss is diagnosed through a clinical scalp examination and trichoscopy to identify diffuse shedding patterns consistent with telogen effluvium by dermatologists or a hair transplant consultation. Blood tests are done to check thyroid, ferritin, and vitamin D levels, ruling out other causes of hair thinning before linking it to medication use.

Which Other Types of SSRI Antidepressants Can Cause Hair Loss?

Several SSRI antidepressants besides Citalopram have been linked to temporary hair shedding, most often through telogen effluvium. The mechanism is similar (neurochemical shifts in serotonin activity disturb the hair growth cycle) but each medication varies slightly in onset, duration, and severity.

1. Fluoxetine (Prozac)

Prozas is known to cause mild, diffuse shedding within the first few months of treatment. Most fluoxetine hair loss cases resolve within three to six months after stabilization or discontinuation.

2. Bupropion (Wellbutrin)

Though technically not an SSRI, bupropin is frequently compared in studies. Wellbutrin hair loss shows a stronger association with drug-induced alopecia than serotonin-based medications, with reported cases up to three times higher in incidence.

3. Paroxetine (Paxil) 

Paxil triggers hair loss more often than Citalopram, particularly in long-term users. The effect is dose-dependent and tends to subside after tapering.

4. Escitalopram (Lexapro) 

Escitalopram hair loss is chemically similar to Citalopram but with a more selective serotonin profile. Reported Lexapro hair loss is less common and usually milder.

5. Sertraline (Zoloft) 

Associated with stress-related telogen effluvium, sertraline hair loss begins one to three months after treatment initiation, resolving upon dosage adjustment.

6. Fluvoxamine (Luvox) 

Fluvoxamine is rarely reported to cause hair shedding, but isolated cases suggest a reversible telogen effluvium pattern.

What Antidepressants Don’t Cause Hair Loss?

Not all antidepressants are linked to hair loss. Some SNRI (serotonin–norepinephrine reuptake inhibitor) medications show a much lower association with drug-induced alopecia and are often considered safer alternatives for patients sensitive to SSRI-related shedding.

1. Duloxetine (Cymbalta):  Known for a low incidence of hair loss (less than 3% of all reported antidepressant-related cases). It balances serotonin and norepinephrine without significantly disturbing peripheral follicle signaling, making it one of the safest choices for patients who experienced hair loss on SSRIs.

2. Desvenlafaxine (Pristiq): A stable SNRI with minimal hormonal or vascular side effects. Post-marketing data show almost no confirmed cases of drug-induced alopecia, suggesting high tolerability in terms of hair health.

3. Venlafaxine (Effexor XR): Though it acts on both serotonin and norepinephrine, it rarely affects follicular cycling. Shedding, when it occurs, is transient and resolves upon dose adjustment.

4. Milnacipran (Savella): Primarily prescribed for fibromyalgia and used for mood regulation. It does not interfere with the anagen–telogen ratio and has no significant reports of hair loss.

5. Levomilnacipran (Fetzima): The newest SNRI in its class, offering high norepinephrine selectivity. Clinical trial data show no statistically significant increase in alopecia compared to placebo.

These antidepressants differ from the list of antidepressants that cause hair loss because they maintain a more balanced neurochemical effect without overstimulating serotonin pathways that disrupt the scalp’s microcirculation or stress hormones. In contrast, SSRI-related hair shedding occurs when excessive serotonergic activity shortens the growth (anagen) phase of follicles.

How Can Patients Prevent Hair Loss While Taking Citalopram?

Preventing hair loss while taking Citalopram requires proactive care of both your scalp and overall health. Follow these steps to reduce shedding and support natural regrowth:

1. Maintain balanced nutrition. Eat iron-rich foods like spinach, lentils, and lean meat, and include zinc, vitamin D, and biotin in your diet. These nutrients strengthen hair follicles and reduce telogen effluvium risk.
2. Protect your scalp with gentle care. Use mild, sulfate-free shampoos and avoid heat styling or tight hairstyles. Gentle washing and detangling help preserve fragile hairs during treatment.
3. Manage stress effectively. Incorporate relaxation techniques such as yoga, meditation, or deep breathing to balance cortisol levels, which play a major role in stress-related hair shedding.
4. Get enough sleep daily. Sleep at least 7–9 hours per night to regulate hormonal and immune function. Proper rest allows follicles to repair and return to the growth phase faster.
5. Monitor your blood work regularly. Ask your doctor to check thyroid, ferritin, and vitamin D levels every few months. Correcting any deficiencies significantly reduces chronic shedding.
6. Start topical support early. Apply minoxidil (2–5%) at the first sign of shedding. It stimulates microcirculation around follicles, promoting stronger regrowth within a few months.
7. Talk to your doctor about your medication. If hair loss continues, discuss dose adjustment or switching to another antidepressant with a lower alopecia risk, such as duloxetine or desvenlafaxine.
8. Avoid harmful scalp habits. Stop smoking, limit alcohol, and avoid chemical dyes or harsh scalp exfoliants that irritate follicles under serotonergic stress.