Abstract
Objectives. Tricotillomania (TTM) is more common than expected. SSRI's are the treatment of choice in TTM. However, response rates are lower with SSRI's. The aim of our study is to explore other pharmacological interventions. Materials and Methods. Nine female TTM patients with SSRI treatment failure were included. Sample was treated with bupropion SR up to 450 mg/day. Results. Six out of nine patients responded well to bupropion SR. Massachusetts General Hospital Hair Pulling Scale (MGH) demonstrated a significant improvement at the twelve week point (f: 32.3, power: 1, lambda: 97.1, P .0001 ) and the response rates remained stable at sixteen-month follow up visit. Conclusions. Bupropion SR could be an alternative pharmacological treatment for TTM. Larger samples with double blind placebo controlled design are needed to confirm our preliminary report.
Highlights
Tricotillomania (TTM) is primarily a female dominated disorder [1], classified in the DSM-IV as an impulse control disorder with the essential feature being recurrent and maladaptive impulsive skin picking behavior
The response to the treatment remained statistically stable in the follow up period (7.9 ± 5.9) in Massachusetts General Hospital Hair Pulling Scale (MGH) scale. This was found to be a nonsignificant statistical result versus the twelve week results of the study. This is one of the first surveys to look at the use of bupropion in the treatment of TTM, in patients nonresponders to SSRI pharmacotherapy
The results of our study suggest that bupropion Sustained Release Bupropion (SR) is well tolerated and may be beneficial in reducing picking behavior
Summary
Tricotillomania (TTM) is primarily a female dominated disorder [1], classified in the DSM-IV as an impulse control disorder with the essential feature being recurrent and maladaptive impulsive skin picking behavior. A genetic link between the disorders had been identified, with increased rate of OCD among relatives with TTM [8]. OCD is currently classified as an anxiety disorder, and is characterized by recurrent intrusive thoughts (obsessions) and/or repetitive mental or behavioral rituals performed in response to obsessions or according to rigid rules (compulsions). OCD and TTM share overlapping co-morbidity, familial transmission and possible treatment response. Both are characterized by difficulties suppressing inappropriate repetitive behaviors, suggesting underlying dysregulation in inhibitory control processes [9]. Double blind studies demonstrated the effectiveness of the SSRI treatment in TTM [10,11,12,13]. 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]
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