Amino Acid for Hair-Pulling Disorder

A new study suggests that supplementation with the amino acid N-acetylcysteine may help reduce symptoms of trichotillomania, an impulse-control disorder that causes people to pull out hair from various body parts.

Treatment for trichotillomania may include cognitive behavioral therapy, medications and/or support groups. However, the effectiveness of these therapies varies among individuals.

Earlier research has found that N-acetylcysteine may have beneficial effects on compulsive disorders by acting on the glutamate system.

In this latest trial, 50 adults with trichotillomania were randomly assigned to receive either 1,200-2,400 milligrams of N-acetylcysteine or placebo daily for 12 weeks.

According to the findings, published in the Archives of General Psychiatry, hair pull-symptoms were "much or very much improved" in 56 percent of patients in the N- acetylcysteine compared with 16 percent taking placebo. No side effects were reported during the study.

Although these results are promising, additional studies are needed to fully understand the potential relationship between N-acetylcysteine and trichotillomania.

For more information about impulse-control disorders, please visit Natural Standard’s Medical Conditions database.

Comments

[George]

This is interesting. I had never heard of this particular impulse-control disorder. I wonder what the proposed mechanism is for N-acetylcysteine’s ability to reduce its symptoms.

[Joe]

It is very interesting that N-acetylcysteine may reduce symptoms of trichotillomania. I wonder if the patients were receiving it orally or IV? Oral liquid N-acetylcysteine supposedly has a horrible, rotten egg smell. It seems it would be extremely unpalatable to adhere to actually drinking it every day. It would also be difficult to disguise it regarding the placebo-control aspect of the study. I wonder if it comes in tablet or capsule form.

[Andrew]

I had not heard of this either. Based on some quick research, it looks like it might be caused by abnormalities in serotonin and dopamine (chemicals naturally in the nervous system) levels in the brain. However, it seems like there may be a combination of genetic and environmental factors, as is the case with many psych disorders.

[Madison]

The study said that modulation of the glutamate system in the nervous system may be useful in the control of a range of compulsive behaviors. Glutamate is an “excitatory” neuro-transmitter. So, it seems like by modulating it with N-acetylcysteine, there is an improvement in impulsive-control symptoms, which in this case, would be hair-pulling.

[Dana]

When I looked up N-acetylcysteine on Natural Standard, I found a link to an article from 2007 about a study on N-acetylcysteine use in gambling addiction. Apparently it also helped reduce the participants' urges to gamble. It is interesting how it seems to help with these addictive behaviors, such as trichotillomania and gambling.

[Cav]

Trichotillomania was a new one for me, too. I was curious, so I did some digging on NPR. Apparently, as Dana noted, there has been other research on how to help people with impulse disorders, such as gambling, stealing, fire-setting, etc. (Hair pulling seems pretty tame in comparison.) I read about a study at the University of Minnesota that was using naltrexone, a drug given to alcoholics to reduce their addiction, for impulse disorders. I don't know what the side effects of naltrexone are, but it is good to hear that there's a more natural option with promise.

[asr]

I had never heard of trichotillomania, but I can imagine having this condition would be difficult, so it's great that there's emerging treatment. I wonder how N-acetylcysteine compares to the other treatment options (cognitive behavioral therapy, medications, support groups).

[Sam S.]

I’ve heard that trichotillomania is a close cousin of obsessive-compulsive disorder. Do the same medications that help OCD symptoms also help trichotillomania? If so, I wonder if this new amino acid could have any impact on any other OCD symptoms. Perhaps this amino acid could work for impulse-control disorders other than trichotillomania. It seems that the study had a small sample size, more testing might be necessary before we know if the treatment is truly effective for many people with trich.

[PJ]

It is so nice to hear that there is some alternative therapy relief for trichotillomania. This can be a difficult condition for people to have – they might feel embarrassed by having bald spots on their eyebrows or on their head. Some people wear hats or scarves and find it difficult to explain to others why their hair is missing. I believe the prevalence of trichotillomania is quite low, so it’s great that this illness is getting some attention from complementary and alternative medicine.

[LB]

It seems that psychological disorders, such as trichotillomania, are treated with a myriad of medicines. Sometimes it seems a doctor or psychiatrist's job is finding the balance between a few different medicines that seem to have the most effect – and hope the effect remains constant over time. This new medication might add value as one additional variable for doctors to try in the quest to ease symptoms. I wonder what the glutamate system is and whether other medicines for trichotillomania also target this area.

[Kara]

Good point about the effect of medications remaining constant over time, LB. I grew up with a girl who had trichotillomania and also had OCD. She benefited from medications for her OCD, which seemed to help her trich as well. Even though this is not a very common disorder, it is good to see that researchers are trying to find answers.

[Nicole]

This is quite interesting, and as many of you have mentioned, it's great since trichotillomania and its treatment options are not commonly discussed. So they think that N-acetylcysteine may be beneficial by acting on the glutamate system. I know that glutamate is a major excitatory NT within the brain and glutamatergic dysfunction has also been linked with other diseases like OCD, alcoholism and schizophrenia. I wonder if N-acetylcysteine may have beneficial effects with these conditions as well. Any thoughts?

[Jasmine]

As described in the study, N-acetylcysteine is a serotonergic medication, which may modulate the activity of glutamate, which is the excitatory transmitter. The compulsive behavior of pulling hair may be caused by this excitatory neurotransmitter. I'm not sure why people have this disorder, but it can also be exacerbated by stress, anxiety or environmental status.

[Josie]

Dana, it's interesting that you found that study about N-acetylcysteine and gambling because I would not have thought that trichotillomania and gambling would receive the same type of pharmacotherapy. The study: "N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: a pilot study," states that treatment with NAC helps to "restore extracellular glutamate concentration in the nucleus accumbens." This is the reward system part of the brain, and it would be interesting to see if treatment with NAC could help to significantly curb these type of addictions.

[RG]

The study claims that the symptoms of trichtotillomania were “much or very much improved” with the use of amino acid N-acetylcysteine. This is not very clearly defined. How were the trichotillomania symptoms measured or monitored? I am assuming improvement meant the patients pulled their hair less. But it is not clear what is meant by “much or very much” in this case.

[Dana]

Nicole, I found that participants are currently being recruited for a study involving N-acetylcysteine and alcoholism called "N-Acetylcystein in Alcohol Dependence." http://clinicaltrials.gov/ct2/show/NCT00568087 I think it's great that researchers are further exploring the effects on this amino acid on addictive and compulsive disorders. I wonder if the outcome of this study will be promising.

[Nicole]

Thanks Dana. I'll look out for that study once it is completed. I too think it is wonderful that researchers are looking into N-acetylcysteine's application to other addictive and compulsive disorders. RG, I agree with your thoughts about the details regarding symptom improvement in pts with trichtotillomania (very vague - doesn't provide much information). Future research with a larger sample size and more definite symptom improvement scale may help solidify where N-acetylcysteine falls in terms of treatment options.

[Adele]

N-acetylcysteine for trichtotillomania seems promising, given that 56% of patients felt improvement. It would be nice to see other studies with a larger number of patients, perhaps multiple doses rather than a range (1,200 vs 2,400) of N-acetylcysteine, compared to current therapies and different treatment periods. I wonder if these patients continue to experience "improvements" with longer treatment with N-acetylcysteine or if it kind of leveled off at a certain week.

[Haley]

Psychiatric disorders are very difficult to effectively treat because they are so patient-specific, so it is always nice to hear about new therapy options. The most effective management of trichotillomania to date, based on a systematic review published in Biological Psychiatry in 2007, is habit reversal therapy (HRT). This being said, I would like to see another study done in which N-acetylcsteine is compared to HRT rather than just placebo before I make any conclusions about this amino acid therapy.

[zz]

This is a very interesting study on a topic that I am not too familiar with. Upon some research, I found that trichotillomania, or TTM, is usually defined as habit behavior that is in between mental disorders (i.e. obsessive compulsive disorder) and physical disorders (stereotypic movement disorder). Currently, some antidepressants are used along with behavioral therapy to treat trichotillomania.

It would be great if more research can be done to find a definitive relationship between trichotillomania and N-acetylcysteine because, as many people know, antidepressants are highly associated with many undesirable side effects. This study indicates no significant adverse events with taking N-acetylcysteine.

[bbm]

I wonder if these patients were also taking prescription medications to treat trichotillomania. N-acetylcysteine could be an adjunct treatment option when selective serotonin reuptake inhibitors aren't producing the patient's desired results.

[Lydia]

This is interesting news that N-acetylcysteine may be a possible treatment for trichotillomania. I think I may have a friend with this disorder and did not realize until now that this may be what she has. It is quite difficult for her to cover up her bald spots, and this is especially embarrassing since she is a girl. It looks like this product is quite promising. However, I am sure that the product will still need to be paired with behavioral therapy, as with any psychological disorder.

[Robert]

I always thought that hair-pulling disorder was more of a psychological disorder. It’s interesting that the people in this study found relief with the amino acid N-acetylcysteine. Now I’m starting to think that this disorder might be due to some sort of mineral or dietary deficiency. The use of this amino acid is promising because there were no side effects reported.

[Stacy]

I have trichotillomania and OCD. I take Lexapro for the OCD ,and it helps tremendously, but it does nothing for the trich. I had taken Prozac previously and again it helped with the OCD but not the trich. I want to try amino acid therapy. Maybe that would help with both and get me off these drugs.

[tj]

I am going to try this and talk to my Dr. I've had trich since age 14. I take Lamictil for other issues but gave up on dealing with the trich 26 years later because behavioral stuff didn't work and meds weren't successful. Will let ya know.