Pharmacotherapy for trichotillomania in adults

ABSTRACT

Introduction

Currently conceptualized as an obsessive compulsive and related disorder, trichotillomania, or hair-pulling disorder, is a common illness that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania also have other comorbid diagnoses. Treating trichotillomania with pharmacotherapy is complicated since there are currently no FDA-approved drugs for its treatment.

Areas covered

The databases PubMed, PsychINFO, CINAHL, Evidence-based Medicine Reviews, and Cochrane Database of Systematic Reviews were searched, yielding a total of 10 open trials and 10 controlled trials selected. This review aims to examine pharmacotherapeutic options for the treatment of trichotillomania in adults and makes recommendations for the assessment and management of the disorder.

Expert opinion

There is preliminary evidence that clomipramine, olanzapine, and N-acetylcysteine may be effective in cases of trichotillomania, however, given the paucity of controlled studies with large sample sizes, decisions regarding the use of drugs should be made on a case-by-case basis taking into account the severity of trichotillomania and the nature of psychiatric comorbidity.

KEYWORDS:

• Trichotillomania
• hair pulling
• treatment
• drugs
• pharmacotherapy

Article Highlights

• Medications from various drug classes have been studied in the pharmacological treatment of trichotillomania, but there is no clear indication that one should be used over another

• There is preliminary evidence that clomipramine, olanzapine, and N-acetylcysteine may be effective in cases of trichotillomania

• Treatment should be determined on a case-by-case basis and take into account the patient’s preferences, comorbidities, and severity of trichotillomania symptoms

• Given the encouraging preliminary data, lithium should be considered in patients with trichotillomania and bipolar disorder

Psychoeducation about the disorder, co-occurring disorders, and benefits and risks of treatment should be an integral part of illness management.

Declaration of interest

V Sharma reports personal fees from the Neuroscience Education Institute, grants from Assurex, Genome Canada, Sage Therapeutics, Stanley Medical Research Institute, and Sunovion Pharmaceuticals, and participation on the advisory boards for Sunovion Pharmaceuticals and Otsuka, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.