Trichotillomania (hair-pulling disorder) is a complex condition, and no single medication is universally effective. However, several drugs have shown promise in clinical studies or case reports:
1. SSRIs (Selective Serotonin Reuptake Inhibitors)
Example: Fluoxetine, Sertraline
- Effectiveness: Mixed results. Common first-line due to their safety profile, but often ineffective alone.
- Used when: Trichotillomania coexists with anxiety or depression.
2. Clomipramine (Tricyclic Antidepressant)
- Effectiveness: Better evidence than SSRIs. One of the earliest drugs studied for trichotillomania.
- Mechanism: Strong serotonergic effect.
- Side effects: Anticholinergic (dry mouth, constipation, etc.).
3. N-acetylcysteine (NAC)
- Effectiveness: Promising results in randomized controlled trials.
- Mechanism: Glutamate modulator; helps reduce compulsive urges.
- Typical dose: 1200–2400 mg/day.
- Advantages: Over-the-counter in many countries, well-tolerated.
4. Olanzapine (Atypical Antipsychotic)
- Effectiveness: Some small studies suggest benefit, particularly in severe or treatment-resistant cases.
- Caveat: Risk of weight gain, metabolic side effects.
5. Topiramate
- Effectiveness: Some reports suggest improvement in hair-pulling urges.
- Mechanism: GABA/glutamate modulation.
- Side effects: Cognitive dulling, paresthesia.
6. Lamotrigine (Mood Stabilizer)
- Effectiveness: Mixed evidence, not a first-line treatment, but considered in co-occurring mood instability.
7. Other Investigated Agents:
- Inositol (mixed results, less commonly used)
- Dronabinol (a cannabinoid, small studies suggest potential benefit)
- Naltrexone (opioid antagonist; possible use in impulse control disorders)
Summary Table:
|
Drug |
Evidence Level |
Notes |
|
Clomipramine |
Moderate |
Historically used, better than SSRIs |
|
SSRIs |
Mixed |
May help with comorbid anxiety |
|
N-acetylcysteine |
Promising |
Good tolerability, OTC in many places |
|
Olanzapine |
Limited |
Use cautiously due to side effects |
|
Topiramate |
Emerging |
Off-label, some support |
|
Lamotrigine |
Unclear |
May help with comorbid bipolarity |
Clinical Note:
Behavioral therapy, especially Habit Reversal Training (HRT) or CBT, remains first-line treatment. Medications are often used as adjuncts when therapy alone is insufficient.
Would you like a chart comparing efficacy and side effects, or guidance for pediatric use?