Treatment for Trichotillomania

The treatment for trichotillomania can involve several modalities. They could include psychotherapy, medications, group therapy, and supplements and combination of the above.

Before You Move On to Another Page This is not just a rehashing of current knowledge. At the bottom of the page is a section called Medicine Detective. The medicines used in the treatment of trichotillomania and other related conditions provide some clues as to alternative treatments. The alternatives involve dietary considerations more than medicine intake. Read on to find out what they are. (Or scroll down to Medicine Detective and skip the rest.)

First will be a review of many of the treatments for trichotillomania. As you consider these, there is a simple question. What if there were a better way. Most treatments for trichotillomania involve treating the disease to help the afflicted to get healthy.

What if the better way involved getting healthy to end the affliction. This novel approach is working for many. First, consider the standard treatments.

Studies show that by using a combination of treatments the success rate improves.

Psychotherapy Treatment for Trichotillomania

A form of psychotherapy called cognitive behavior therapy (CBT).

CBT involves habit reversal training and stimulus control. This involves learning what the emotions and triggers that initiate the pulling are. Then by substituting one behavior over an another, it is possible to reprogram the thinking.

ACT or Acceptance and Commitment therapy conditions people to accept the urges while not acting on them.

A blending of Acceptance and Commitment along with Stimulus Control in to Habit Reversal Training (HRT) is felt to be even more effective by some therapist.

A study released in 2006 on Combination SSRIs and HRT reports the benefits of combined therapy.

These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.

Sometimes elements of other therapies may be blended with CBT. This could include any combination of medication, therapy and group help.

Medical Treatment of Trichotillomania

Prescribed medications to treat trichotillomania include antidepressants.

Some of the drugs are listed below. Note that many drugs can have undesirable side effects. When we take multiple drugs, there is an increased chance of interaction. Some cannot tolerate any of the side effects.

Antidepressants for Treatment for Trichotillomania

Clomipramine (Anafranil)

Clomipramine works on both the serotonin and norepinephrine in our brain. It has been found to be beneficial.

Side effects: blurred vision, dry mouth, constipation, weight gain, sexual dysfunction, and may cause fine tremor and muscle twitching.

In higher doses it can cause seizures in 2% of users. There are several contraindications or reasons people cannot take Neuroleptics.

Naltrexone (Revia)

Naltrexone, an opioid antagonist, is used to treat alcohol and or opiate dependence. It may help with trichotillomania according to one study. Since trichotillomania is a co-morbidity with numerous other mental health diseases, if a sufferer also has alcoholism, this may help with both.

Side effects: nausea, insomnia, muscle aches, and headaches. non-steroidal anti-inflammatory drugs, and therefore liver enzymes should be frequently monitored.

Liver enzyme elevations are possible, especially in patients taking neuroeleptics

Neuroleptics for Treatment for Trichotillomania

Olanzapine (Zyprexa) one study found a significant reduction in pulling hair compared to a placebo.

Side effects: weight gain, Parkinson-like tremor, tardive dyskinesia, rigidity, bradykinesia, akathesia, dysphoria, sedation, and potential of developing diabetes and high cholesterol.

Lithium

Lithium, a medication used in bipolar disorder has had some beneficial outcomes for individuals with trichotillomania.

Side effects: acne, and skin rashes, loss of appetite, nausea, mild diarrhea, dizziness, hand tremors, weight gain, hypothyroidism (low levels of thyroid hormone), and increased white blood cell count. If you develop an increase in tremors or shaking, lack of coordination, muscle weakness, slurred speech, nausea, vomiting, diarrhea, or confusion, call your doctor. This may be a side effect of too much lithium in the body.

Selective Serotonin Re-uptake Inhibitors (SSRIs)

SSRIs: fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil). These are used for treating depression or OCD or both.

Fluoxetine (Prozac) has been studied in trichoillomania with mixed results.

In studies on the other SSRIs the results were also mixed and after several months they become ineffective.

Side effects: headache, sedation, mild anxiety, constipation, increased urinary frequency, weight gain, and sexual dysfunction, gastrointestinal distress.

Fluvoxamine (Luvox) has numerous interactions with other drugs.

Paroxetine's (Paxil's) has a short half-life.

Side effects: flu-like symptoms on discontinuation suicidal thoughts and behaviors.

Other Agents

A variety of other medications have shown early promise in the treatment of trichotillomania.

The Medicine Detective: Finding the Treatment for Trichotillomania

Looking at the actions of some medications can provide clues to alternatives that can be used in combination with other treatments. If some of the treatments are not available, the alternatives may help on their own.

By playing medication detective, you will find that some medicines affect the neurotransmitter, glutamate, may be beneficial in the treatment trichotillomania research. Glutamate appears to have a role in the area of the brain involved in compulsive, repetitive behaviors.

These medications include...

Lamotrigine (lamictal) (FDA-approved for bipolar disorder) is a sodium channel blocker that enhances the resistance of nerve cells to attack. It decreases energy demand for and reduces flow of glutamate.

Riluzole (Rilutek) (FDA-approved for ALS) is a glutamate release inhibitor.

Inositol (vitamin B 8) considered essential, it is similar to but different from glucose, has also been used in the treatment of trichotillomania.

More studies need to be conducted on this. There is evidence that increased inositol is found in the cerebral spinal fluid of those experiencing depressive restates.

The Everything Supplement

The amino acid N-Acetyl Cysteine or NAC does a combination of all of the above. Well, all except the therapy.

How does it work? Let the science answer the question.

N-acetylcysteine Augmentation in Serotonin Reuptake

Glutamine related brain function has been implicated in the pahtophysiology of obsessive-compulsive disorder (OCD). Studies show that N-acetylcysteine (NAC) helps this work better.

So this study examine how good the NAC works in a patient with the serotonin re-uptake inhibitor (SRI)-refractory OCD.

In this case the NAC was used in conjunction with fluvoxamine and resulted in a marked decrease in obsessive compulsive score and a significant improvement in OCD symptoms.

Of course, more research is needed. This adds further support to other studies that show that NAC is effective in numerous ways.

N-acetylcysteine in Treating Trichotillomania was a double blind placebo-controlled study.

The results: Fifty-six percent of patients "much or very much improved" with N-acetylcysteine use compared with 16% taking placebo.

Significant improvement was initially noted after 9 weeks of this treatment for trichotillomania.

The study indicated that the effect was a statistically significant reduction in trichotillomania symptoms. No adverse events occurred. This means, unlike any of the meds above, there are no negative side effects.

As you can see, this is the tip of the iceburg in searching out the treatment for trichotillomania.

More on N-Acetylcysteine and what you need to know.

Mental Neurological Home Page Everything about glutathione and the brain.

What is Trichotillomania takes a look at the condition. Is it a disease, condition. Is it psychological or mental. We have a different theory?

Cause of Trichotillomania looks at the background of Trich.

Etymology of Trichotillomania looks at the word history and origin or the term that is used to describe trichotillomania.

Trichotillomania Help will introduce you to some of the places you can get support and help.

Was there an error or omission in our Treatment for Trichotillomania page? Please let us know.

Need To Know

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