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Pharmacotherapy for trichotillomania

  1. Rachel Rothbart1,
  2. Taryn Amos2,
  3. Nandi Siegfried2,
  4. Jonathan C Ipser2,
  5. Naomi Fineberg3,
  6. Samuel R Chamberlain4,
  7. Dan J Stein2,*

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 8 NOV 2013

Assessed as up-to-date: 31 JUL 2013

DOI: 10.1002/14651858.CD007662.pub2

How to Cite

Rothbart R, Amos T, Siegfried N, Ipser JC, Fineberg N, Chamberlain SR, Stein DJ. Pharmacotherapy for trichotillomania. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD007662. DOI: 10.1002/14651858.CD007662.pub2.

Author Information

  1. 1

    University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada

  2. 2

    University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa

  3. 3

    Queen Elizabeth II Hospital, National Obsessive Compulsive Disorders Treatment Service, Welwyn Garden City, Hertfordshire, UK

  4. 4

    University of Cambridge, Department of Psychiatry, Cambridge, UK

*Dan J Stein, Department of Psychiatry and Mental Health, University of Cape Town, Education Centre, Valkenberg Hospital, Private Bage X1, Observatory, Cape Town, 7925, South Africa.

Publication History

  1. Publication Status: New
  2. Published Online: 8 NOV 2013




  1. Top of page
  2. Abstract
  3. Plain language summary


Trichotillomania (TTM) (hair-pulling disorder) is a prevalent and disabling disorder characterised by recurrent hair-pulling. The effect of medication on trichotillomania has not been systematically evaluated.


To assess the effects of medication for trichotillomania in adults compared with placebo or other active agents.

Search methods

We searched the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (to 31 July 2013), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years); EMBASE (1974 to date); MEDLINE (1950 to date) and PsycINFO (1967 to date). Two review authors identified relevant trials by assessing the abstracts of all possible studies.

Selection criteria

We selected randomised controlled trials (RCTs) of a medication versus placebo or active agent for TTM in adults.

Data collection and analysis

Two review authors independently performed the data extraction and 'Risk of bias' assessments, and disagreements were resolved through discussion with a third review author. Primary outcomes included the mean difference (MD) in reduction of trichotillomania symptoms on a continuous measure of trichotillomania symptom severity, and the risk ratio (RR) of the clinical response based on a dichotomous measure, with 95% confidence intervals (CIs).

Main results

We identified eight studies with a total of 204 participants and a mean sample size of 25. All trials were single-centre trials, and participants seen on an outpatient basis. Seven studies compared medication and placebo (n = 184); one study compared medication and another active agent (n = 13). Duration of the studies was six to twelve weeks. Meta-analysis was not undertaken because of the methodological heterogeneity of the trials. The studies did not employ intention-to-treat analyses and were at a high risk of attrition bias. Adverse events were not well-documented in the studies.

None of the three studies of selective serotonin reuptake inhibitors (SSRIs) demonstrated strong evidence of a treatment effect on any of the outcomes of interest. The unpublished naltrexone study did not provide strong evidence of a treatment effect. Two studies, an olanzapine study and a N-acetylcysteine (NAC) study, reported statistically significant treatment effects. One study of clomipramine demonstrated a treatment effect on two out of three measures of response to treatment.

Authors' conclusions

No particular medication class definitively demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on three individual trials, albeit with very small sample sizes.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Drug treatments for chronic hair-pulling (trichotillomania)

Trichotillomania (TTM) (hair-pulling disorder) is a common and disabling condition characterised by repeated hair-pulling leading to hair loss. TTM can be associated with much distress and impairment for people with the condition. This systematic review of randomised controlled trials (RCTs) set out to review the evidence for medication in treating TTM. The findings are based on eight studies (which included a total of 204 people). Not enough evidence was found to conclude definitively that any particular medication is effective in the treatment of TTM. Furthermore, side effects related to medications were not well-documented in the majority of the studies. Because of differences in the way the included studies were carried out, we were unable to combine their results to draw more conclusive evidence. However, an early trial found some evidence for the efficacy of clomipramine, and two recent trials reported statistically significant treatment outcomes with olanzapine and N-acetylcysteine. More research is needed to find an optimal treatment for TTM.