Amitriptyline Hair Loss | Causes, Treatment & Side Effects

Can medications cause hair loss? Yes, prolonged usage of certain drugs over months or even years can cause it in some cases. Amitriptyline is one such tricyclic antidepressant (TCA). Although doctors prescribe it to treat depression, anxiety, chronic pain, and migraines, it may cause hair thinning or loss in some users. 

As an older generation antidepressant, amitriptyline is typically prescribed when other, relatively safe antidepressants fail to help. 

This article explores the causes of amitriptyline related hair loss, treatment options, possible side effects, and management tips. 

What Is Amitriptyline?

Amitriptyline is a tricyclic antidepressant medication primarily used to treat depression by balancing brain chemicals. It specifically increases levels of serotonin and norepinephrine, which help regulate mood and emotions.

 

Does Amitriptyline Cause Hair Loss?

Yes, amitriptyline can cause hair loss, but in very rare cases. The medication’s information sheet lists hair loss as a rare potential side effect (1 in 1000 patients). However, research shows a weak connection between hair thinning and amitriptyline.

Another study that tested 100 drugs’ effect on diffuse pattern hair loss in women revealed that only 4 out of the 225 participants with female pattern hair loss were taking amitriptyline. However, it was not specified whether this was the only medication being used. 

Still, no direct causal link has been shown between this drug and hair loss in the above research. Furthermore, no cases have been reported in individuals without alopecia symptoms. This suggests amitriptyline can very rarely trigger or worsen hair loss in patients already predisposed to alopecia.

Mechanism Behind Amitriptyline Hair Loss

Prolonged use of amitriptyline can cause significant stress on hair follicles, disrupting the hair growth cycle in genetically susceptible individuals. This drug accumulation results in an early resting phase (telogen effluvium).

Forms Of Amitriptyline

Amitriptyline is available only as oral tablets, ranging from 10 milligrams (mg) to 150 mg in strength. A pharmacy can prepare an oral solution for people who cannot swallow tablets. Its common brand names include Elavil® and Vanatrip®.

What Are The Side Effects Of Amitriptyline?

Amitriptyline’s side effects range from mild to severe. More than 1 in 100 people suffer from these mild side effects:

• Constipation
• Dizziness
• Dry mouth
• Sleepiness 
• Difficulty urinating
• Headache
• Weight gain
• Nausea
• Fatigue
• Changes in sex drive
• Heart palpitations
• Appetite changes
• Orthostatic hypotension (low blood pressure due to changing body positions)
• Sweating
• Nightmares
• Tinnitus
• Hair loss

Severe amitriptyline side effects in females and males include:

• Enlarged breasts (in men and women)
• Numbness or tingling in hands and feet
• High Fever
• Increased risk of fractures
• Vision problems
• Agitation
• Skin rash
• Changes in behaviour
• Hallucinations
• Irregular heartbeat
• Suicidal thoughts

How To Diagnose Amitriptyline Hair Loss?

Identifying amitriptyline-induced hair loss requires observing several factors:

• Timing: Hair loss typically begins 2–4 months after starting the medication.
• Physical Examination: Diffuse thinning across the scalp rather than localized patches.
• Pull Test: A gentle hair pull test reveals an increased number of hairs, most of which are in the telogen phase.
• Exclusion: Ruling out other causes like nutritional deficiencies, hormonal imbalances, or other medications.
• Trichogram: A trichogram (a microscopic hair root analysis) can help confirm the diagnosis. More than 25% of telogen hairs in this test strongly suggest telogen effluvium.

Is Amitriptyline Hair Loss Permanent?

Amitriptyline hair loss (generally telogen effluvium) is reversible if you take timely measures to stop or slow down hair thinning or loss. The trick is to never discontinue your medication without the approval of your prescribing physician, as it can have serious negative consequences for your physical or mental health.

Given the typical duration of a hair growth cycle, reversing hair loss may take a long time, months or even years. However, not taking any action to stop drug-related hair loss may cause permanent damage due to the death of hair follicles.

Amitriptyline Hair Loss Treatments

Amitriptyline hair loss is mostly telogen effluvium, which is self-correcting. Some possible treatments are:

• Consult Your Health Provider: First, consult your physician to alter the medication dose or switch to an alternative medication.
• Minoxidil Lotions: Applying Minoxidil lotions may help by widening the scalp’s micro-capillaries so more blood flows to hair follicles.
• Laser Therapy: Low-level laser therapy can stimulate blood flow and cell division in weakened hair follicles.
• Supplement Support: Using a herbal, vitamin and mineral supplementation course may support follicle recovery.
• Hair Transplant Surgery: You may opt for hair transplant surgery as a last resort if hair thinning continues even after trying the above treatments.

How Can I Prevent Hair Loss While Taking Amitriptyline?

You can follow these general tips to prevent or lessen amitriptyline hair loss:

• Gently handle hair and avoid over-combing, brushing and scalp massages.
• Use mild shampoos and avoid excessive heat styling.
• Ensure a balanced diet rich in protein, fruits and vegetables to support hair health.
• High stress levels can independently contribute to hair loss, so managing stress can generally support hair health.

Frequently Asked Questions

How long after starting amitriptyline might hair loss occur?

You may start noticing hair loss within 2 to 4 months of starting the medication. However, this may vary from case to case.

Are there alternatives to amitriptyline that don’t cause hair loss?

You may opt for alternate medications with your healthcare provider’s supervision that do not carry amitriptyline’s hair loss side effects, such as Prozac (fluoxetine).

Can stress management reduce hair loss from amitriptyline?

You can’t reduce hair loss from amitriptyline through stress management techniques once it starts. But effective stress management beforehand may prevent the need for amitriptyline as an antidepressant.

How can I determine if my hair loss is due to amitriptyline?

To determine if your hair loss is due to amitriptyline, track the hair shedding process, typically 2–4 months after starting the medication. Check for diffuse thinning across the scalp rather than patches. 

Can a blood test confirm if amitriptyline is the cause of hair loss?

No specific blood test can confirm drug-induced hair loss. Lab work can rule out other causes like thyroid disorders, anemia, or deficiencies.