Wednesday, February 22, 2023

Memantine May Reduce Symptoms of Hair-Pulling, Skin-Picking Disorder

Patients with trichotillomania (also known as hair-pulling disorder) and/or excoriation (skin-picking) disorder may experience symptom improvements while taking the Alzheimer's medication memantine, a report published today in AJP in Advance suggests.

Trichotillomania and excoriation disorder are characterized by repetitive behaviors focused on the body and intrusive urges that are believed to be driven in part by the glutamate system. Memantine, which is approved by the FDA for moderate to severe Alzheimer’s disease, works by regulating the activity of glutamate.

To test the safety and effectiveness of memantine compared with placebo in patients with trichotillomania and/or excoriation disorder, Jon E. Grant, M.D., M.P.H., of the University of Chicago and colleagues recruited 100 adults (86 women, average age 31 years) with a current primary DSM-5 diagnosis of trichotillomania (n=53), excoriation disorder (n=43), or both (n=4). These participants were assigned to either memantine or placebo for eight weeks. Those in the memantine group were started on 10 mg/day; the dosage was increased to 20 mg/day at week two for the remaining six weeks.

Grant and colleagues evaluated the participants using the NIMH Trichotillomania Symptom Severity Scale—a 6-item, 20-point scale that assesses the frequency of pulling and/or picking, intensity of urges, subjective distress, and interference in daily activities—every two weeks for eight weeks. The researchers also used the Sheehan Disability Scale and Clinical Global Impressions (CGI) severity scale to evaluate the participants’ functioning and other symptoms, respectively.

At baseline, the participants’ average NIMH Trichotillomania Symptom Severity Scale score was 12. After two weeks, the participants in the memantine group experienced about a 4-point drop in their severity scores, compared with a less than 2-point decrease in severity scores the placebo group. Scores in the memantine group continued to gradually decline over the next six weeks, whereas the placebo group saw no further improvement.

At the end of the study, 60.5% of participants in the memantine group were “much or very much improved,” compared with 8.3% in the placebo group, based on the CGI scale. Six participants in the memantine group (10.9%) stopped pulling/picking completely by the end of the trial, whereas only one (2.2%) of the participants in the placebo group achieved complete symptom remission.

The authors noted that cognitive-behavioral therapy (CBT) has shown benefit for trichotillomania and skin-picking disorder and should be considered in conjunction with medication.

“Memantine constitutes a promising treatment option for trichotillomania and skin-picking disorder—conditions that have a relative paucity of evidence-based pharmacological intervention options,” Grant and colleagues concluded. “[W]hether some individuals would have responded to a higher dosage [of memantine] merits further evaluation.”

For related information, see The Journal of Neuropsychiatry and Clinical Neurosciences article “An fMRI Pilot Study of Cognitive Flexibility in Trichotillomania” and the Psychiatric News article “N-Acetylcysteine May Help Patients Resist Urge to Pick Skin.”

(Image: iStock/triocean)

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