Systematic Review: Pharmacological and Behavioral Treatment for Trichotillomania

Sapap3 and pathological grooming in humans: Results from the OCD collaborative genetics study

“…This grooming behavior appears similar in nature to that of wild-type mice but is much more frequent, leading to facial hair and skin removal in the absence of peripheral cutaneous defects [Welch et al, 2007]. Pathological grooming behavior has been hypothesized to be related to obsessive-compulsive disorder (OCD)-in humans and other animals-in terms of phenomenology and possible selective response to serotonergic drugs Rapoport et al, 1992;Bordnick et al, 1994;Overall and Dunham, 2002;Graf et al, 2003; but also see Bloch et al, 2007], and this behavior in Sapap3 mutant mice led Welch et al to perform a set of experiments testing the extent to which these mouse behaviors resemble OCD in humans. The Sapap3 mutant mice showed increased anxiety-like behavior in open field, dark-to-light emergence, and elevated zero maze tests, and 6-day fluoxetine treatment of these mice reduced both excessive grooming and anxiety-like behaviors [Welch et al, 2007].…”

Sustain Released Bupropion in the Treatment of Tricotillomania: Outpatient Follow Up Survey

“…To date, a range of pharmacological agents have been reported to be useful for the treatment of trichotillomanic behavior and related urges with the most convincing evidence coming from studies with SSRIs [11][12][13][14]21], followed by the mood stabilizers [23] and the opioid antagonist naltrexone [22]. A standard pharmacological approach for TTM, however, is far from being established, and in the case of SSRIs, a double blind study failed to show partial efficacy of SSRI treatment [14].…”

“…To date, a range of pharmacological agents have been reported to be useful for the treatment of trichotillomanic behavior and related urges with the most convincing evidence coming from studies with SSRIs [11][12][13][14]21], followed by the mood stabilizers [23] and the opioid antagonist naltrexone [22]. A standard pharmacological approach for TTM, however, is far from being established, and in the case of SSRIs, a double blind study failed to show partial efficacy of SSRI treatment [14]. It has been proposed that TTM is a heterogeneous disorder which overlaps with both OC spectrum disorders [6][7][8] and addictive disorders [22,23], and some authors have hypothesized that there are specific subtypes of tricotillomania with specific patterns of treatment response within this population [8].…”

“…The drop-out rates were high, and compliance rates were relatively low in order to measure intermediate and long term outcome [3]. Most of the patients became non responders to the SSRI treatment even when the dose of the treatment drug was increased to the upper limits [14].…”

“…OCD spectrum theory was not strong enough to explain the treatment response. Genetic studies [18][19][20], classification studies [9,17] and pharmacological treatment studies [11][12][13][14][21][22][23] brought the possibility of addictive behavior in trichotillomania.…”