Double-Blind, Placebo-Controlled Study of Memantine in Trichotillomania and Skin Picking Disorder Summary Aim: Trichotillomania and skin picking disorder are underrecognized and often disabling conditions in which people repeatedly pull their hair or pick their skin, causing noticeable hair loss or tissue damage. To date, there is a significant shortage of evidence-based treatments for these conditions. In this study, the authors sought to determine whether memantine, a glutamate modulator, is more effective than placebo in reducing hair pulling and skin picking behavior. Methods: One hundred adults with trichotillomania or skin picking disorder (86 women; mean age, 31.4 years [SD=10.2]) were enrolled in a double-blind trial of memantine (dosage range, 10–20 mg/day). or placebo for 8 weeks. Participants were assessed with measures of pulling and pinching severity. The results were examined using a linear mixed effects model. The prespecified primary outcome measure was treatment-related change on the NIMH Trichotillomania Symptom Severity Scale, modified to include skin picking. Results: Compared with placebo, memantine treatment was associated with significant improvements in NIMH Scale, Sheehan Disability Scale, and Clinical Global Impressions Severity Scale scores in terms of treatment by time interactions. At the end of the study, 60.5% of participants in the memantine group improved very or very much, compared to 8.3% in the placebo group (number needed to treat = 1.9). Adverse events did not differ significantly between treatment arms. Conclusions: This study found that memantine treatment resulted in statistically significant reductions in hair pulling and skin picking symptoms compared to placebo, with relatively high efficacy (based on number needed to treat) and was well tolerated. The glutamate system may be a beneficial target in the treatment of compulsive behaviors. |
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New research at the University of Chicago Medicine has found that a drug commonly used to treat the symptoms of Alzheimer’s disease effectively reduces the symptoms of adults who experience compulsive hair pulling and skin picking.
Skin picking disorder is related to obsessive-compulsive disorder, in which the person cannot help but perform a particular action. It can be triggered by: boredom, stress or anxiety or negative emotions, such as guilt or shame.
Treatment with the drug memantine was associated with significant improvements compared to a placebo for patients with trichotillomania (a disorder in which people cannot resist pulling out their hair) and skin picking disorder (also known as of excoriation ).
Currently, the U.S. Food and Drug Administration (FDA) has not approved any medications for the disorders, which can cause hair loss and noticeable skin damage, emotional distress, and reduced ability to function socially. at school or at work, said lead author Dr. Jon Grant, a professor of psychiatry and behavioral neuroscience at the University of Chicago Medicine.
“A person’s self-esteem is greatly affected by these behaviors, so they may not attend interviews for a better job, for example. They may not have the social life they want,” Grant said.
Trichotillomania and skin picking disorder are considered two separate diagnoses, but they have many similarities. Cognitive behavioral therapy is a first-line treatment, but finding therapists well-versed in the disorders can be difficult, he said. “People often feel like they have to educate the doctor,” Grant said.
The researchers focused on 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 that control motor habits.
The findings suggested the involvement of the neurotransmitter glutamate, a leading theory of the neurobiology behind obsessive-compulsive disorder, Grant said. When it comes to medications, "we don’t have many options for what might modulate glutamate in the brain," she said.
Grant selected memantine, which is approved to treat memory loss and thinking deficits in people with Alzheimer’s disease and has been used off-label for several psychiatric disorders. It is well tolerated by patients and has few serious side effects, he said.
While Grant was researching memantine for trichotillomania and skin picking disorder, another patient of his was prescribed the drug for a different reason. “It kind of came by chance,” he said. “One day the patient said to me, ’Wow, that stopped me from pulling my hair out.’”
The new University of Chicago study 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. The 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 measure for the disorder.
They also recorded changes using four other self-reported and clinician-observed accounts of symptoms and behaviors. Patients were seen virtually due to 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 who took memantine experienced significant or very significant improvement, compared with three of the 36 who took a placebo. Six people in the memantine group and one in the placebo group experienced complete relief of symptoms.
One analysis found that memantine is more effective than other treatments studied so far, including behavioral therapy, the drug olanzapine (used to treat schizophrenia and bipolar disorder), the drug clomipramine (used to treat obsessive-compulsive disorder) and N-acetylcysteine (an over-the-counter supplement).
The comparisons suggest that memantine could be considered a first-line treatment equal to behavioral therapy in the process of treating these conditions, according to the study.
Grant said the results point to several additional areas for research, including combining memantine with behavioral therapy or N-acetylcysteine, which showed promise in previous studies led by Grant. Long-term use of memantine and different doses are also possible avenues of study, he said.
"The results showed that the drug helped more than the placebo, so I was very pleased, but it tells me there is still a lot more to do," Grant said. "Although 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 care physicians to continue taking the medication, Grant said. "Some people came in thinking, ’Nothing has been able to help me.’ Some of them saw in the end that this one is different,” he said.
