Sir: Selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment for a wide variety of psychiatric disorders including mood and anxiety disorders. Hair loss with the SSRIs, tricyclic antidepressants (TCAs), and other classes of antidepressants has been anecdotally reported.1–6 We report a case of a 50-year-old white woman with bipolar disorder who developed hair loss while taking the SSRI citalopram. Significant hair loss can be a distressing side effect of antidepressants and should be monitored in treatment because it may lead to noncompliance and relapse. Case report. Ms. A, a 50-year-old divorced white woman with a DSM-IV diagnosis of bipolar disorder, is presently in outpatient treatment at a community mental health clinic. Her past psychiatric history was significant for multiple hospitalizations for both manic and depressive episodes. There was no prior history of suicide attempts, nor was there any comorbid alcohol or substance abuse. She had no significant ongoing medical problems. Her last psychiatric hospitalization was in August 1997, for depressive symptoms and suicidal ideation. At that time, she had lithium-related side effects and had poor tolerance to divalproex and carbamazepine. Results of her laboratory tests, including a complete blood count, electrolyte concentrations, liver and kidney tests, and thyroid hormone studies, were unremarkable. During her last hospitalization, she was started successfully on lamotrigine therapy and titrated to a dosage of 50 mg twice daily. In addition, she was treated with paroxetine, 20 mg daily, and clonazepam, 0.5 mg in the morning and 1 mg at night. Following discharge from the hospital, her compliance with the medication and outpatient visits was good. Treatment with clonazepam was subsequently successfully discontinued. One year later, owing to worsening depression, the paroxetine dosage was gradually increased to 40 mg daily on an outpatient basis. She then reported nightmares and continuing depressive symptoms. The patient was gradually switched to citalopram, which was started at 20 mg and then titrated to 40 mg with good symptom control. At her next visit a couple of months later, the patient reported losing clumps of hair while shampooing. She became increasingly anxious at this time and was placed on hydroxyzine, 25 mg 3 times daily. A dermatology consultation was obtained to rule out other causes of hair loss, but none were detected. As the hair loss appeared temporally related to the increase in citalopram dosage, the possibility of dosage reduction was considered, but the patient was reluctant because of good symptom control. A multivitamin formulated for adults aged 50 and over (Centrum Silver) was added in a dosage of 1 tablet daily with the provision that the antidepressant be switched if the hair loss persisted at the next visit 4 weeks later. The hair loss stopped with Centrum Silver use, and there have been no complaints about it for the past 5 months as the patient continues to monitor the condition. The patient remains compliant with all medications. There have been no side effects, such as the rash that has been reported with lamotrigine, nor has there been any recurrence of manic symptoms. To our knowledge, this is the first case report of hair loss associated with citalopram therapy. Citalopram selectively inhibits the reuptake of serotonin (5-hydroxytryptamine), which potentiates serotonergic neurotransmission and is associated with clinical antidepressant effects.7 In some cases, it appears that hair loss accelerates when the dose of the antidepressant is increased.2,6 Hair loss with citalopram therapy may be reversible with adjunctive Centrum Silver. An alternative explanation could be spontaneous resolution of the hair loss independent of the use of Centrum Silver. Significant hair loss is a distressing side effect that should be monitored and treated since it can lead to noncompliance, worsening of symptoms, and relapse.