Pharmacotherapy for trichotillomania

Hoffman, Jacob; Williams, Taryn; Rothbart, Rachel; Ipser, Jonathan; Fineberg, Naomi; Chamberlain, Samuel R.; Stein, Dan J.

doi:10.1002/14651858.cd007662.pub3

Cited by 11 publications

(11 citation statements)

References 97 publications

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“…S1 ). No additional studies were retrieved from the clinical trial registries or in manual searches with reference to the previous systematic reviews [ 31 – 38 ]. Ultimately, we reviewed 17 studies involving a total of 629 patients [ 39 – 55 ].…”

Section: Resultsmentioning

confidence: 99%

Mitochondrial modulators for obsessive–compulsive and related disorders: a systematic review and meta-analysis

2022

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It remains unclear whether mitochondrial modulators (MMs) are beneficial in the treatment of obsessive–compulsive and related disorders. Thus, in an attempt to answer this clinical question, we performed a systematic review and a random-effects meta-analysis of double-blind, randomized, placebo-controlled trials. The primary outcome was change in overall symptoms as measured using standardized rating scales. Other outcomes were response to treatment; improvement in anxiety-related scales scores, depression-related scale scores, Clinical Global Impression Severity Scale (CGI-S) scores, and Sheehan Disability Scale (SDS) scores; all-cause discontinuation; and individual adverse events. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. We reviewed 17 studies (n = 629, 72.62% female; duration = 2–20 weeks; mean age = 30.47 years) of MMs: eicosapentaenoic acid (K = 1), folic acid (K = 1), lithium (K = 1), N-acetylcysteine (K = 10), inositol (K = 3), and silymarin (K = 1). MMs outperformed placebo in overall improvement in symptoms (p < 0.01) and in improving anxiety-related scale scores (p = 0.05). Subgroup analysis of individual MMs revealed that although overall symptoms were better improved by N-acetylcysteine (p < 0.01) and lithium (p = 0.04), no MMs outperformed placebo in terms of improving anxiety-related scale scores. Neither pooled nor individual MMs outperformed placebo in improving response to treatment, depression-related scale scores, CGI-S scores, SDS scores, or all-cause discontinuation. N-acetylcysteine was no more associated with a higher incidence of individual adverse events including gastrointestinal symptoms, than placebo. In conclusion, N-acetylcysteine was beneficial in the treatment of obsessive–compulsive and related disorders. However, further study with larger samples is necessary to confirm this finding.

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Section: Resultsmentioning

confidence: 99%

Mitochondrial modulators for obsessive–compulsive and related disorders: a systematic review and meta-analysis

2022

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“…It is important to note that by ‘compulsivity’ we refer to a broad construct, not specifically to compulsions in OCD. Data indicate that OCD treatments such as selective serotonin reuptake inhibitors (SSRIs) appear to be ineffective for trichotillomania, whereas opioid antagonists or certain glutamate modulators, show promise in clinical trials for trichotillomania ( Hoffman et al, 2021 ). Evaluating effects of such non-SSRI treatments on trans-diagnostic compulsivity in BFRBs would be interesting in future work.…”

Section: Discussionmentioning

confidence: 99%

The role of compulsivity in body-focused repetitive behaviors

Grant

Chamberlain

2022

Journal of Psychiatric Research

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“…Selective serotonin reuptake inhibitors (SSRI) and clomipramines (serotonin–noradrenaline [NA] reuptake inhibitors) are used as first-line drugs for treating OCD ( Stein et al, 2019 ). Clomipramine has some benefits in trichotillomania treatment as well ( Hoffman et al, 2021 ).…”

Section: Variations Of Human Slitrk1 and Their Significancesmentioning

confidence: 99%

Developmental control of noradrenergic system by SLITRK1 and its implications in the pathophysiology of neuropsychiatric disorders

Hatayama

Aruga

2023

Front. Mol. Neurosci.

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SLITRK1 is a neuronal transmembrane protein with neurite development-and synaptic formation-controlling abilities. Several rare variants of SLITRK1 have been identified and implicated in the pathogenesis of Tourette’s syndrome, trichotillomania, and obsessive–compulsive disorder, which can be collectively referred to as obsessive–compulsive-spectrum disorders. Recent studies have reported a possible association between bipolar disorder and schizophrenia, including a revertant of modern human-specific amino acid residues. Although the mechanisms underlying SLITRK1-associated neuropsychiatric disorders are yet to be fully clarified, rodent studies may provide some noteworthy clues. Slitrk1-deficient mice show neonatal dysregulation of the noradrenergic system, and later, anxiety-like behaviors that can be attenuated by an alpha 2 noradrenergic receptor agonist. The noradrenergic abnormality is characterized by the excessive growth of noradrenergic fibers and increased noradrenaline content in the medial prefrontal cortex, concomitant with enlarged serotonergic varicosities. Slitrk1 has both cell-autonomous and cell-non-autonomous functions in controlling noradrenergic fiber development, and partly alters Sema3a-mediated neurite control. These findings suggest that transiently enhanced noradrenergic signaling during the neonatal stage could cause neuroplasticity associated with neuropsychiatric disorders. Studies adopting noradrenergic signal perturbation via pharmacological or genetic means support this hypothesis. Thus, Slitrk1 is a potential candidate genetic linkage between the neonatal noradrenergic signaling and the pathophysiology of neuropsychiatric disorders involving anxiety-like or depression-like behaviors.

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Pharmacotherapy for trichotillomania

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 11 publications

References 97 publications

Mitochondrial modulators for obsessive–compulsive and related disorders: a systematic review and meta-analysis

Mitochondrial modulators for obsessive–compulsive and related disorders: a systematic review and meta-analysis

The role of compulsivity in body-focused repetitive behaviors

Developmental control of noradrenergic system by SLITRK1 and its implications in the pathophysiology of neuropsychiatric disorders

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