Does amitriptyline cause hair loss? This is a question many patients taking this widely prescribed tricyclic antidepressant understandably ask. Amitriptyline is used in the UK for depression, neuropathic pain, migraine prevention, and fibromyalgia, and like all medicines, it carries a profile of potential side effects. Hair loss (alopecia) is listed in amitriptyline's Summary of Product Characteristics, though its frequency is classified as 'not known'. Where it does occur, it is generally considered temporary and reversible. This article explains what the evidence shows, what to do if you notice shedding, and when to seek medical advice.
Summary: Amitriptyline can cause hair loss in some people, but the frequency is classified as 'not known' in UK prescribing information, and where it occurs it is generally temporary and reversible.
- Amitriptyline is a tricyclic antidepressant (TCA) licensed in the UK for depression, with off-label use for neuropathic pain, migraine prevention, and fibromyalgia.
- Hair loss (alopecia) is listed in amitriptyline's MHRA-reviewed Summary of Product Characteristics with a frequency of 'not known', meaning no reliable incidence figure can be calculated.
- Where hair loss occurs, it is typically consistent with telogen effluvium — a temporary, diffuse shedding that usually resolves within 3–6 months of removing the trigger.
- Depression and chronic pain — the conditions amitriptyline treats — can themselves cause hair shedding, making it difficult to attribute loss solely to the medication.
- Do not stop amitriptyline suddenly; any changes should be made gradually under medical supervision to avoid discontinuation symptoms.
- Suspected side effects can be reported to the MHRA via the Yellow Card scheme, open to both patients and healthcare professionals.
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Can Amitriptyline Cause Hair Loss?
Amitriptyline lists alopecia as a side effect of 'not known' frequency in its UK SmPC; where reported, hair loss is typically consistent with temporary telogen effluvium rather than permanent baldness.
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Amitriptyline is a tricyclic antidepressant (TCA) that has been used for decades to treat a range of conditions. In the UK, it is licensed for depression; its use for neuropathic pain, migraine prevention, and fibromyalgia is off-label, though widely supported by NICE guidance and established clinical practice. It works primarily by inhibiting the reuptake of serotonin and noradrenaline in the brain, increasing the availability of these neurotransmitters at synaptic junctions.
Hair loss (medically termed alopecia) has been reported in post-marketing experience with amitriptyline and is listed in its Summary of Product Characteristics (SmPC), reviewed by the Medicines and Healthcare products Regulatory Agency (MHRA). In many UK SmPCs for amitriptyline, the frequency of alopecia is listed as 'not known' (meaning it cannot be estimated from available data), rather than as a defined rare frequency. Causality has not been formally confirmed; the association is based on post-marketing reports and clinical case observations rather than controlled evidence.
Where hair loss has been reported in association with amitriptyline, it is generally considered consistent with telogen effluvium — a temporary, diffuse shedding of hair rather than permanent baldness. This form of hair loss occurs when a physiological or pharmacological stressor disrupts the normal hair growth cycle, pushing more hairs than usual into the resting (telogen) phase before they shed. In most reported cases, shedding improves after the trigger is removed, with visible regrowth typically occurring within 3–6 months, though individual responses vary.
Patients should be aware that depression and chronic pain — the very conditions amitriptyline is often prescribed for — are themselves associated with hair shedding, which can make it difficult to attribute hair loss to the medication alone.
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| Side Effect / Feature | Frequency | Severity | Management |
|---|---|---|---|
| Alopecia (hair loss) | Not known (cannot be estimated from post-marketing data; MHRA SmPC) | Usually mild; typically diffuse telogen effluvium, not permanent baldness | Raise with GP; do not stop amitriptyline suddenly; investigate other causes |
| Dry mouth | Very common | Mild to moderate | Sip water regularly; sugar-free gum; good oral hygiene |
| Drowsiness / sedation | Very common | Mild to moderate | Take at night; avoid driving until effect is known; review dose with GP |
| Constipation | Very common | Mild to moderate | Increase fluid and fibre intake; consider laxatives if persistent |
| Blurred vision | Common | Mild; usually transient | Inform GP if persistent; caution with driving and machinery |
| Weight gain / appetite changes | Common | Mild to moderate; may indirectly contribute to hair shedding | Monitor weight; maintain balanced diet with adequate protein and iron |
| Discontinuation symptoms (on stopping) | Common if stopped abruptly | Moderate; flu-like symptoms, sleep disturbance, irritability, rebound pain | Never stop suddenly; taper gradually under GP supervision only |
How Common Is Hair Loss as a Side Effect?
Hair loss frequency with amitriptyline is classified as 'not known' in UK prescribing data, meaning it is uncommon enough that no reliable incidence figure can be calculated from post-marketing reports.
According to the amitriptyline SmPC (available via the Electronic Medicines Compendium, emc), alopecia is listed with a frequency of 'not known', meaning a reliable incidence figure cannot be calculated from available post-marketing data. This contrasts with well-characterised common side effects — such as dry mouth, drowsiness, constipation, and blurred vision — which are experienced by a much larger proportion of patients.
Because hair loss may be delayed in onset — typically appearing 2–4 months after a trigger, consistent with the telogen effluvium lag — it can be difficult to attribute directly to amitriptyline without careful clinical assessment. Other factors that commonly contribute to hair shedding include:
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Iron deficiency or low ferritin — one of the most frequent and treatable causes of diffuse hair loss
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Thyroid dysfunction (both hypothyroidism and hyperthyroidism)
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Significant psychological or physical stress
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Hormonal changes, including those related to the menopause or the postpartum period
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Other medications, such as anticoagulants, retinoids, or certain antihypertensives
Given this complexity, it is not always straightforward to confirm that amitriptyline is the sole or primary cause of hair thinning. A thorough clinical evaluation is usually required before drawing conclusions. That said, if hair loss begins or worsens after starting amitriptyline, it is entirely reasonable to raise this with your GP or pharmacist and consider the medication as a possible contributing factor.
Why Some Medicines Affect Hair Growth
Medicines can disrupt the hair growth cycle by triggering telogen effluvium, where a pharmacological stressor prematurely shifts hairs into the resting phase, causing diffuse shedding 2–4 months later.
To understand why amitriptyline might be associated with hair loss in some individuals, it helps to appreciate the biology of the hair growth cycle. Hair follicles cycle through three main phases: anagen (active growth), catagen (transition), and telogen (resting and shedding). At any given time, approximately 85–90% of scalp hairs are in the anagen phase, with the remainder in telogen.
Certain medications can disrupt this cycle in two main ways:
- Anagen effluvium — where drugs (most commonly chemotherapy agents) directly damage rapidly dividing hair follicle cells, causing sudden and often dramatic hair loss.
- Telogen effluvium — where a drug or physiological stressor prematurely shifts hairs from the anagen phase into telogen, resulting in diffuse shedding approximately 2–4 months later.
The precise mechanism by which amitriptyline may contribute to telogen effluvium is not established. Various hypotheses have been proposed — including effects on neurotransmitter signalling and follicular cycling — but these remain speculative and are not supported by robust clinical evidence. It is also possible that indirect factors, such as changes in appetite, weight, or nutritional intake associated with amitriptyline use, could play a role in some individuals.
For further information on telogen effluvium and drug-induced hair loss, the British Association of Dermatologists (BAD) and the Primary Care Dermatology Society (PCDS) provide patient-facing and clinical guidance respectively.
What to Do If You Notice Hair Thinning or Shedding
Do not stop amitriptyline suddenly; instead, keep a record of shedding, review your diet, and consult your GP, who can investigate underlying causes and consider a dose adjustment if appropriate.
If you notice increased hair shedding or thinning after starting amitriptyline, it is important not to panic. In most cases, drug-associated telogen effluvium is temporary and reversible, with shedding typically improving within months of removing the trigger and visible regrowth occurring over 3–6 months.
Do not stop amitriptyline suddenly. Abruptly discontinuing tricyclic antidepressants can cause discontinuation symptoms, including flu-like feelings, sleep disturbance, irritability, and rebound pain. Any changes to your medication should be made gradually and only under medical supervision.
Instead, consider the following steps:
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Keep a record of when the hair loss started, how much hair you are losing (for example, on your pillow or in the shower), and any other symptoms you have noticed.
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Review your diet — ensure you are eating a balanced diet with adequate protein and iron-rich foods. Do not start iron or other supplements without first confirming a deficiency through a blood test, as unnecessary supplementation can be harmful.
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Minimise physical stress on your hair — avoid tight hairstyles, excessive heat styling, and harsh chemical treatments while shedding is occurring.
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Monitor for other symptoms — fatigue, weight changes, cold intolerance, or skin changes alongside hair loss may suggest an underlying thyroid problem or other systemic condition.
Seek prompt medical advice if you notice any of the following red flags:
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Scalp pain, tenderness, redness, scaling, pustules, or signs of scarring
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Rapidly progressive or patchy hair loss
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Loss of eyebrows or eyelashes
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Discrete bald patches rather than diffuse thinning
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Systemic symptoms such as unexplained weight loss, fever, or joint pain
These features may indicate a different type of alopecia — such as alopecia areata or a scarring condition — that requires prompt assessment by a GP or dermatologist, and should not be attributed to amitriptyline without proper evaluation.
If hair loss is significant, distressing, or accompanied by any of the above symptoms, arrange an appointment with your GP for a formal assessment.
Speaking to Your GP or Pharmacist About Side Effects
Your GP can arrange blood tests — including ferritin, thyroid function, and full blood count — to identify treatable causes of hair loss and conduct a medication review to assess amitriptyline's role.
Your GP or pharmacist is the most appropriate first point of contact if you are concerned about hair loss while taking amitriptyline. They can help determine whether the medication is likely to be a contributing factor and arrange any necessary investigations.
In UK primary care, the initial assessment for diffuse hair loss typically includes:
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Full blood count (FBC) — to check for anaemia and other haematological causes
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Serum ferritin — low ferritin is one of the most common and treatable causes of diffuse hair shedding
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Thyroid function tests (TSH) — to exclude hypothyroidism or hyperthyroidism
Additional tests (such as vitamin B12, vitamin D, or zinc) are generally only requested if there is a specific clinical indication based on your history or examination, rather than as a routine screen.
A medication review will also help identify whether any other drugs you are taking could be contributing, and a careful clinical history will explore the timeline of hair loss in relation to starting amitriptyline and any other relevant life events.
In line with NICE guidance on depression (NG222) and neuropathic pain management (CG173), your GP will weigh the benefits of continuing amitriptyline against the impact of side effects on your quality of life. If the medication is providing meaningful benefit — for example, significantly improving sleep, reducing pain, or stabilising mood — a dose reduction may be considered as a first step, rather than stopping the drug entirely.
You can also report suspected side effects directly to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk. This is open to both patients and healthcare professionals and helps build the national evidence base for drug safety. Your pharmacist can assist you in completing a report if needed.
Alternatives and Next Steps If Hair Loss Continues
If hair loss is felt to be related to amitriptyline, your GP may switch you to an alternative such as an SSRI for depression or duloxetine for neuropathic pain, guided by NICE recommendations.
If hair loss persists and is felt to be related to amitriptyline, your GP may consider switching to an alternative medication. The choice of alternative will depend on the underlying condition being treated. Note that amitriptyline is only licensed in the UK for depression; its use for neuropathic pain, migraine prevention, and fibromyalgia is off-label.
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For depression: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline or fluoxetine are recommended as first-line treatments by NICE (NG222) and have a different side effect profile. Hair loss has been reported with SSRIs too, though it remains uncommon.
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For neuropathic pain: NICE (CG173) recommends offering a choice of amitriptyline, duloxetine, gabapentin, or pregabalin as first-line options, depending on the specific pain condition and individual patient factors. Duloxetine is preferred first-line in painful diabetic neuropathy.
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For migraine prevention: Options such as propranolol or topiramate may be considered, guided by NICE guidance on headaches in over-12s and individual suitability. Amitriptyline is used in this context but is off-label.
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For insomnia or anxiety (off-label use): Alternatives may include sleep hygiene interventions, cognitive behavioural therapy for insomnia (CBT-I), or other medications as appropriate to the clinical situation.
If hair loss continues despite stopping or changing amitriptyline, or if there is any diagnostic uncertainty, a referral to a dermatologist may be warranted. A dermatologist can investigate other causes of alopecia — including androgenetic alopecia, alopecia areata, or scarring conditions — and may perform a scalp examination, trichoscopy, or scalp biopsy if required. Specialist referral is particularly important if hair loss is rapidly progressive, patchy, or associated with scalp inflammation.
In summary, while amitriptyline has been associated with hair loss in post-marketing reports, this side effect appears uncommon and is usually temporary and manageable. Open communication with your healthcare team is key — never adjust or stop your medication without professional guidance, and be reassured that effective alternatives and support are available.
Frequently Asked Questions
How long after starting amitriptyline might hair loss appear?
Hair loss associated with amitriptyline typically appears 2–4 months after starting the medication, consistent with the delayed pattern of telogen effluvium. This lag can make it difficult to connect the shedding directly to the drug without a careful clinical history.
Will my hair grow back if amitriptyline is causing the shedding?
In most cases, hair loss linked to amitriptyline is temporary, and visible regrowth typically occurs within 3–6 months of removing the trigger. Telogen effluvium — the type of shedding most commonly associated with medications — is generally reversible once the underlying cause is addressed.
Can I just stop taking amitriptyline if I think it's causing my hair loss?
No — you should never stop amitriptyline suddenly, as this can cause discontinuation symptoms including flu-like feelings, sleep disturbance, irritability, and rebound pain. Always speak to your GP first, who can supervise a gradual dose reduction if a change is appropriate.
Do other antidepressants also cause hair loss?
Yes, hair loss has been reported with other antidepressants, including SSRIs such as sertraline and fluoxetine, though it remains uncommon across the class. If amitriptyline is suspected as the cause, switching to an alternative does not guarantee the side effect will resolve, and your GP will weigh up the options with you.
What blood tests should I ask for if I'm losing hair while taking amitriptyline?
Your GP will typically check serum ferritin, thyroid function (TSH), and a full blood count, as iron deficiency and thyroid dysfunction are among the most common and treatable causes of diffuse hair shedding. These tests help rule out other causes before attributing hair loss to amitriptyline.
Is amitriptyline-related hair loss the same as pattern baldness?
No — amitriptyline-associated hair loss is typically diffuse shedding (telogen effluvium) rather than the patterned, progressive thinning seen in androgenetic alopecia (pattern baldness). Telogen effluvium affects the whole scalp evenly and is usually temporary, whereas pattern baldness follows a characteristic distribution and is not caused by medication.
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