Why do I keep pulling out my hair? Hint: It's called Trichotillomania

Edited by Brittany Albright MD, MPH

One condition that we treat regularly at Sweetgrass Psychiatry is trichotillomania. It can be debilitating and we are passionate about helping people with this relatively common condition. Trichotillomania, also known as hair-pulling disorder, is a mental health condition that involves recurrent, irresistible urges to pull out hair from the scalp, eyebrows, eyelashes, or other parts of the body. It can be common for affected individuals to spend hours per day hair pulling. Treatment for trichotillomania typically includes a combination of therapy, such as cognitive-behavioral therapy (CBT), and medication.

There is no specific medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of trichotillomania, but some medications have been used off-label to help manage symptoms. Some of the medications that may be prescribed include:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs, such as fluoxetine (Prozac) and sertraline (Zoloft), are commonly prescribed to treat depression and anxiety. They may also help manage the urges to pull hair in some people with trichotillomania.

2. Clomipramine (Anafranil): Clomipramine is a tricyclic antidepressant (TCA) that has been shown in some studies to be effective in treating trichotillomania. It is thought to work by increasing the levels of serotonin in the brain, which may help reduce hair-pulling urges.

3. N-acetylcysteine (NAC): NAC is an amino acid supplement that has shown some promise in treating trichotillomania. It is thought to work by modulating glutamate levels in the brain, which may help reduce hair-pulling urges.

4. Antipsychotic medications: Atypical antipsychotics, such as olanzapine (Zyprexa) and aripiprazole (Abilify), may be prescribed to help manage symptoms of trichotillomania in some cases. These medications are typically used to treat other mental health conditions, such as bipolar disorder and schizophrenia, but may also help reduce hair-pulling urges in some people.

5. Memantine is a medication primarily used to treat moderate to severe Alzheimer's disease. It works by blocking NMDA (N-methyl-D-aspartate) receptors in the brain, which helps regulate the activity of glutamate, an important neurotransmitter involved in learning and memory processes.

   There is limited evidence regarding the use of memantine for the treatment of trichotillomania. Some small studies and case reports have suggested that memantine may be helpful in reducing hair-pulling urges in some individuals with trichotillomania. The rationale behind this is that memantine's action on glutamate could potentially help regulate the imbalances in neurotransmitter systems thought to be involved in trichotillomania.

   However, more research is needed to confirm the effectiveness and safety of memantine for the treatment of trichotillomania.

6. Naltrexone is an opioid antagonist primarily used to treat alcohol and opioid dependence. It works by blocking the effects of opioids in the brain and reducing the rewarding effects of alcohol. Some researchers have investigated the use of naltrexone for treating impulse control disorders, including trichotillomania.

   There is limited evidence on the effectiveness of naltrexone for treating trichotillomania. Some small-scale studies and case reports have suggested that naltrexone might help reduce hair-pulling urges in some individuals. The rationale behind this is that naltrexone may modulate the brain's reward system, which could be involved in the development and maintenance of trichotillomania.

   However, the evidence is not strong or consistent enough to draw definitive conclusions about the effectiveness of naltrexone for trichotillomania. More research is needed to determine the potential benefits, optimal dosing, and safety of using naltrexone for this condition.

   Keep in mind that the effectiveness of these medications may vary from person to person, and some individuals may not respond to any of the medications listed above. A healthcare professional can help determine the most appropriate treatment plan based on an individual's specific needs and circumstances. If you or someone you know is struggling with trichotillomania or any other mental health issue, help is here. Reach out to your local Charleston area psychiatry experts at Sweetgrass Psychiatry at (843) 800-1303.