Alzheimer's Drug may be a Potential Treatment for Hair-Pulling Disorder

Highlights:

Trichotillomania is a mental health condition where you compulsively pull out your own hair and often has severe negative effects on your mental health and well-being
A recent study shows that memantine could be the next treatment for hair-pulling and skin-picking
Memantine is a drug commonly used for the symptoms of Alzheimer’s disease and helped reduce trichotillomania when compared to a placebo

A recent study conducted at the University of Chicago Medicine has found that a drug commonly used to treat symptoms of Alzheimer’s disease significantly reduced symptoms of adults who experience compulsive hair-pulling and skin-picking.

Trichotillomania | Hair Pulling Disorder - Causes, Symptoms, Diagnosis, Treatment & Complications
Trichotillomania (TTM) is a hair pulling disorder where a person urges to pull out hair from their scalp, eyelashes, and eyebrows. Hair pulling is an impulse control disorder which can result in noticeable hair loss in adults and adolescents.

‘A recent study suggests that a drug used for symptoms of Alzheimer’s disease can also help those suffering from hair-pulling and skin-picking.’

Alzheimer’s Drug Could be the Treatment for Hair-Pulling and Skin-Picking

Memantine treatment was associated with significant improvements in trichotillomania patients when compared to a placebo. Trichotillomania is a disorder where individuals cannot resist the urge to pull out their hair. Treatment with memantine was also seen to improve excoriation disorder, also called dermatillomania, which is a skin-picking disorder where you cannot stop picking at your skin.

“No medication is currently approved by the U.S. Food and Drug Administration for the disorders, which can cause obvious hair loss and skin damage, emotional distress and reduced ability to function socially or at school or work”, said lead author Jon Grant, MD, professor of psychiatry and behavioral neuroscience at the University of Chicago Medicine.

“A person’s self-esteem is greatly impacted by these behaviors, so they may not go for interviews for a better job, for example. They may not have the social life they want,” Grant said.

Trichotillomania and skin-picking disorder are regarded as two separate disorders, but they have many similarities. Cognitive behavioral therapy is a first line of treatment, but finding therapists well-versed in the disorders can be difficult.

“People often feel that they have to educate the clinician,” Grant said.

Researchers narrowed it down to memantine based on earlier findings by Grant and others that revealed, in individuals with either disorder, disorganized areas of white matter in certain parts of the brain controlling motor habits.

Causes of Hair Loss
Worried about your hair loss? Before you leap into a course of treatment, look at what might be causing your hair to fall.

Regulating Glutamine Might be the Answer

The study suggests the involvement of the neurotransmitter glutamate, which has also been a leading theory of the neurobiology behind the obsessive-compulsive disorder.

“When it comes to drugs, we don’t have a lot of options about what might modulate glutamate in the brain,” he said.

Researchers selected memantine, which is approved to address memory loss and deficits in thinking in people with Alzheimer’s disease and has been used off-label for various psychiatric disorders. It is well-tolerated by patients and has few serious side effects.

While Grant was investigating memantine for trichotillomania and skin-picking disorder, another patient of his was prescribed the drug for a separate reason.

The study conducted at the University of Chicago involved 100 adults with trichotillomania or skin-picking disorder who were enrolled in the double-blind trial of memantine or a placebo for eight weeks.

Trichotillomania: Hair Loss From Pulling Your Hair
Trichotillomania is an Impulse control disorder, which occurs when a person suffers from stress overload and anxiety. The sufferer starts pulling hair from scalp, eyelashes to cope with stress.

How the Study was Conducted

Researchers assessed patients every two weeks using the National Institute of Mental Health Trichotillomania Symptom Severity Scale, which they modified for skin-picking because there is no commonly used measurement for the disorder.

They also recorded changes using four other self-reported and clinician-observed accounts of symptoms and behaviors. Patients were seen virtually because of the COVID-19 pandemic.

Seventy-nine participants completed the study. Two dropped out after reporting dizziness while taking the medication.

After eight weeks, 26 of the 43 study participants taking memantine saw significant improvement, compared to three of the 36 taking a placebo. Six people in the memantine group and one in the placebo group had complete relief of symptoms.

Does Stress Cause Hair loss?
Hair loss due to stress can be a cause for anxiety. Stress causes telogen effluvium, trichotillomania, or alopecia areata.

Memantine Might be at Par with Behavioral Therapy

An analysis found that memantine is more effective than other treatments studied thus far, including behavioral therapy, the drug olanzapine which is used to treat schizophrenia and bipolar disorder, the drug clomipramine used to treat obsessive-compulsive disorder, and N-acetylcysteine which is an over-the-counter supplement.

The comparisons suggest that memantine might be considered a first-line treatment equal to behavioral therapy in the treatment process for these conditions, according to the study.

Grant said the results point to several additional areas for research, including combining memantine with behavioral therapy or with N-acetylcysteine, which showed promise in previous studies led by Grant. Longer-term use of memantine and different doses also are potential avenues for study, he said.

“The results did show that the medication helped more than the placebo, for which I was very pleased, but it tells me that there's still a lot more to do," Grant said. "Even though the results were promising, it was still a very small minority of people in terms of complete remission of symptoms.”

Still, some study participants indicated they intended to seek memantine prescriptions from their primary physicians to continue on the drug.

The author concludes by saying that some people came in thinking that nothing would be able to help them but it was different seeing the result in the end.

References:

Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder - (https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220737)

Source-Medindia