Treating Trichotillomania, or Compulsive Hair Pulling

Most humans pull, pluck, and pick at their hair, skin and nails in small amounts. But when these behaviors become excessive, they can cause a lot of suffering. They are given the name trichotillomania, or ‘trich’ for short, although this strictly applies to compulsive hair pulling. Victims are unable to resist urges to pull out their hair; there may be mounting tension before the act, and/or gratification and relaxation during the act. Often there is noticeable hair loss.

Both cognitive behavioral therapy and medication (e.g. clomipramine [Aanafril®], venlafaxine [Effexor®]) can be effective in trich, and a combination of these approaches may be best. Hypnosis and biofeedback have also proved successful, but are less commonly used. Just recently a study has been published in the Archives of General Psychiatry that reports the results of a study of N-acetylcysteine in the treatment of trich. N-acetylcysteine is an amino acid often taken as a supplement; it modifies the level of the neurotransmitter glutamate.

Fifty patients with trichotillomania (45 women, 5 men, average age 34) were enrolled in the double-blind study. Half of them were randomly allocated to take 1200 mg N-acetylcysteine daily for 6 weeks, followed by 2,400 mg daily for another 6 weeks; the other half took a placebo. Six different scales were used to assess the patients before and after 6, 9, and 12 weeks on study; one of them was the Massachusetts General Hospital Hair Pulling Scale (MSGHPS).

After 9 weeks those patients taking the supplement had significantly reduced hair-pulling. By 12 weeks 56% of them were “much or very much improved” with N-acetylcysteine use compared with 16% taking the placebo. There were no adverse effects of taking the supplement.

This result was similar in magnitude to that achieved with cognitive behavioral therapy and superior to other medications. N-acetylcysteine seems to represent a breakthrough in treating this troublesome disorder. But will the benefits last beyond 12 weeks? That remains to be seen.