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N-acetylcysteine in trichotillomania as an alternative treatment option

Year 2013, Volume 35, Issue 4 (2013): Supplement, 50 - 57, 14.02.2014

Etem Erşan

Abstract

 

Abstract

We aimed to examine trichotillomania (TTM), a rarely seen disorder, and N-acetylcysteine (NAC), an agent used as a treatment option, in the light of literature in the present study. Trichotillomania is the compulsive urge to pull out one’s own hair persistently and leading to noticeable hair loss. Contrary to what is expected, it is a more frequently detected disorder characterized by compulsive hair pull-outs and of great importance not only due to physical appearance but also due to its associated psychosocial problems. Metabolic functions of N-acetylcysteine are effective either as antioxidant (forming up glutathione which is an endogenous antioxidant) or as glutamatergic agent. Due to these effects, N-acetylcysteine was administrated in as oxidative stress related schizophrenia and bipolar disorders as well as trichotillomania characterized by compulsive symptoms and in eating nail. Administration of N-acetylcysteine in cases with psychiatric disorders was reported in clinical researches such as case report and open label studies. In the literature, the efficiency of N-acetylcysteine in the treatment of trichotillomania was demonstrated in 3 studies as case report, double blind and placebo controlled researches. N-acetylcysteine may be a promising and ideal treatment option in the mono or combined treatment of diseases such as trichotillomania due to its efficiency, and cost affectivity, but it also does not lead to adverse effects.

Keywords: Trichotillomania, N-acetylcysteine, glutamate, antioxidants

Keywords

Trichotillomania N-acetylcysteine glutamate antioxidants

References

  • Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: Current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci 2011; 36: 78-86.
  • Dodd S, Dean O, Copolov DL, Malhi GS, Berk M. N-acetylcysteine for antioxidant therapy: Pharmacology and clinical utility. Expert Opin Biol Ther 2008; 8: 1955-62.
  • Sansone RA, Sansone LA. Agomelatine: A novel antidepressant. Innov Clin Neurosci 2011; 8: 10-4.
  • Mayer M, Noble M. N-acetyl-L-cysteine is a pluripotent protector against cell death and enhancer of trophic factor-mediated cell survival in vitro. Proc Natl Acad Sci USA 1994; 91: 7496-500.
  • Dean O, Van den Buuse M, Copolov D, Berk M, Bush A. N-acetyl-cysteine treatment inhibits depletion of brain glutathione levels in rats: Implications for schizophrenia. Int J Neuropsychopharmacol 2004; 7: 262.
  • Lavoie S, Murray MM, Deppen P, Knyazeva MG, Berk M, Boulat O, Bovet P, Bush AI, Conus P, Copolov D, Fornari E, Meuli R, Solida A, Vianin P, Cuénod M, Buclin T, Do KQ. Glutathione precursor, N-acetyl-cysteine, improves mismatch negativity in schizophrenia patients. Neuropsychopharmacology 2008; 33: 2187-99.
  • Ersan S, Bakir S, Erdal Ersan E, Dogan O. Examination of free radical metabolism and antioxidant defence system elements in patients with obsessivecompulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30: 1039Ozdemir E, Cetinkaya S, Ersan S, Kucukosman S, Ersan EE. Serum selenium and plasma malondialdehyde levels and antioxidant enzyme activities in patients with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33: 62-5.
  • Selek S, Herken H, Bulut M, Ceylan MF, Celik H, Savas HA, Erel O. Oxidative imbalance in obsessive compulsive disorder patients: A total evaluation of oxidant-antioxidant status. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 487-91.
  • McFarland K, Lapish CC, Kalivas PW. Prefrontal glutamate release into the core of the nucleus accumbens mediates cocaine-induced reinstatement of drugseeking behavior. J Neurosci 2003; 23: 3531-7.
  • Odlaug BL, Grant JE. N-acetyl cysteine in the treatment of grooming disorders. J Clin Psychopharmacol 2007; 27: 227-9.
  • Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry 2007; 68: 170-1.
  • Carlsson ML. On the role of prefrontal cortex glutamate for the antithetical phenomenology of obsessive compulsive disorder and attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25: 5
  • Chakrabarty K, Bhattacharyya S, Christopher R, Khanna S. Glutamatergic dysfunction in OCD. Neuropsychopharmacology 2005; 30: 1735-40.
  • Dinan TG. Inflammatory markers in depression. Curr Opin Psychiatry 2009; 22: 32Drexhage RC, Knijff EM, Padmos RC, Heul-Nieuwenhuijzen Lv, Beumer W, Versnel MA, Drexhage HA. The mononuclear phagocyte system and its cytokine inflammatory networks in schizophrenia and bipolar disorder. Expert Rev Neurother 2010; 10: 59-76.
  • Knackstedt LA, LaRowe S, Mardikian P, Malcolm R, Upadhyaya H, Hedden S, Markou A, Kalivas PW. The role of cystine-glutamate exchange in nicotine dependence in rats and humans. Biol Psychiatry 2009; 65: 841-5.
  • Mardikian PN, LaRowe SD, Hedden S, Kalivas PW, Malcolm RJ. An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: A pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31: 389-94.
  • LaRowe SD, Mardikian P, Malcolm R, Myrick H, Kalivas P, McFarland K, Saladin M, McRae A, Brady K. Safety and tolerability of N-acetylcysteine in cocaine-dependent individuals. Am J Addict 2006; 15: 105-10.
  • Berk M, Copolov D, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Judd F, Katz F, Katz P, Ording-Jespersen S, Little J, Conus P, Cuenod M, Do KQ, Bush AI. N-acetyl cysteine as a glutathione precursor for schizophrenia-a double-blind, randomized, placebo-controlled trial. Biol Psychiatry 2008; 64: 361Berk M, Copolov DL, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Bush AI. N-acetyl cysteine for depressive symptoms in bipolar disorder-a doubleblind randomized placebo-controlled trial. Biol Psychiatry 2008; 64: 468-75.
  • Grant JE, Kim SW, Odlaug BL. N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: A pilot study. Biol Psychiatry 2007; 62: 652-7.
  • Berk M, Jeavons S, Dean OM, Dodd S, Moss K, Gama CS, Malhi GS. Nailbiting stuff? The effect of N-acetyl cysteine on nail-biting. CNS Spectrums 2009; 14: 357-60.
  • Sadock BJ, Sadock VA. Kaplan&Sadock’s Concise Textbook of Clinical Psychiatry. Third edition, Philedelphia: Lippincott Williams&Wilkins 2008; 367
  • Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: A current review. Clin Psychol Rev 2010; 30: 181-93.
  • Konkan R, Şenormancı Ö, Sungur MZ. Klinik Psikofarmakoloji Bülteni 2011; 21: 268-77.
  • Sadock BJ, Kaplan HI, Sadock VA. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. edition, Lippincott Williams&Wilkins. Philedelphia USA 2007; 781-3.
  • Franklin ME, Flessner CA, Woods DW, Keuthen NJ, Piacentini JC, Moore P, Stein DJ, Cohen SB, Wilson MA; Trichotillomania Learning Center-Scientific Advisory Board. The child and adolescent trichotillomania impact project: Descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr 2008; 29: 493-500.
  • Amerikan Psikiyatri Birliği. Mental bozukluklarin tanısal ve sayımsal el kitabı. Dördüncü baskı yeniden gözden geçirilmiş tam metin (DSM-IV-TR). Köroğlu E, çev. editörü. Ankara: Hekimler Yayın Birliği; 2007.
  • Lochner C, Grant JE, Odlaug BL, Woods DW, Keuthen NJ, Stein DJ. Dsm-5 field survey: Hair-Pulling Disorder (Trichotillomania). Depress Anxiety 2012; 29: 1025-31.
  • Papazisis G, Tzellos T, Kouvelas D. Practice corner: Managing trichotillomaniano need to pull your hair out. Evid Based Med 2008; 13: 66-7.
  • Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin psychiatry 1991; 52: 415-17.
  • Grant JE, Levine L, Kim D, Potenza MN. Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry 2005; 162: 2184-8.
  • Matsunaga H, Kiriike N, Matsui T, Oya K, Okino K, Stein DJ. Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder. Compr Psychiatry 2005; 46: 43-9.
  • Woods DW, Flessner CA, Franklin ME, Keuthen NJ, Goodwin RD, Stein DJ, Walther MR; Trichotillomania Learning Center-Scientific Advisory Board. The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry 2006; 67: 1877-88.
  • Chamberlain SR, Fineberg NA, Blackwell AD, Clark L, Robbins TW, Sahakian BJ. A neuropsychological comparison of obsessive-compulsive disorder and trichotillomania. Neuropsychologia 2007; 45: 654-62.
  • Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, Pittenger C, Leckman JF, Coric V. Systematic review: Pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry 2007; 62: 839-46.
  • Swedo SE, Rapoport JL. Annotation: Trichotillomania. J Child Psychol Psychiatry 1991; 32: 401-9.
  • Walsh KH, McDougle CJ. Trichotillomania. Presentation, etiology, diagnosis and therapy. Am J Clin Dermatol 2001; 2: 327-33.
  • Stanley MA, Breckenridge JK, Swann AC, Freeman EB, Reich L. Fluvoxamine treatment of trichotillomania. J Clin Psychopharmacol 1997; 17: 278-83.
  • Stein DJ, Bouwer C, Maud CM. Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania. Eur Arch Psychiatry Clin Neurosci 1997; 247: 234-6.
  • Bhatia MS, Sapra S. Escitalopram in trichotillomania.Eur Psychiatry 2004; 19: 239Lafleur DL, Pittenger C, Kelmendi B, Gardner T, Wasylink S, Malison RT, Sanacora G, Krystal JH, Coric V. N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Psychopharmacology 2006; 184: 254-6.
  • De Sousa A. An open-label pilot study of naltrexone in childhood-onset trichotillomania. J Child Adolesc Psychopharmacol 2008; 18: 30-3.
  • Stein DJ, Hollander E. Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry 1992; 53: 123-6.
  • Stein DJ, Bouwer C, Hawkridge S, Emsley RA. Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders. J Clin Psychiatry 1997; 58: 119-22.
  • Potenza MN, Wasylink S, Epperson CN, McDougle CJ. Olanzapine augmentation of fluoxetine in the treatment of trichotillomania. Am J Psychiatry 1998; 155: 1299-300.
  • Ninan PT, Rothbaum BO, Marsteller FA, Knight BT, Eccard MB. A placebocontrolled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000; 61: 47-50.
  • McElroy SL, Keck PE. Gabbard’s treatments of psychiatric disorder. E Albayrak (çev.), Ankara: Veri Medikal Yayıncılık 2009; 880-2.
  • Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Arch Gen Psychiatry 2009; 66: 756-63. 5 Rodrigues-Barata AR, Tosti A, Rodríguez-Pichardo A, Camacho-Martínez F. Nacetylcysteine in the Treatment of Trichotillomania. Int J Trichology 2012; 4: 176

N-acetylcysteine

Year 2013, Volume 35, Issue 4 (2013): Supplement, 50 - 57, 14.02.2014

Etem Erşan

Abstract

Bu yazıda, günlük pratikte sık karşılaşılan bir bozukluk olmayan trikotillomani (TTM) ve tedavisinde kullanılan N-asetilsistein’in (NAC) literatür ışığında gözden geçirilmesi amaçlanmıştır. Trikotillomani kişinin tekrarlayıcı olarak ve belirgin saçsız alanlar oluşturacak şekilde saçlarını yolmasıdır. Trikotillomani sanıldığının aksine daha sık görülen, kompulsif saç yolmalarla karakterize sadece fiziksel görünüm açısından değil yaşattığı psikososyal sorunlar nedeniyle önemli bir ruhsal bozukluktur. N-Asetilsistein metabolik fonksiyonlarını, ya antioksidan (endojen antioksidan olan glutatyon oluşturarak) ya da glutamaterjik düzenleyici olarak gösterir. Bu etkileri nedeniyle N-Asetilsistein; oksidatif stres ile ilişkili şizofreni, bipolar gibi bozukluklarda, ayrıca kompulsif belirtiler ile karakterize trikotillomani, tırnak yeme gibi bozukluklarda kullanılmıştır. N-Asetilsistein’in psikiyatrik hastalıklarda kullanımı; olgu sunumu, açık-etiketli pilot çalışmalar ve çalışmalar gibi klinik araştırmalarla bildirilmiştir. Literatürde NAsetilsistein’in trikotillomani tedavisinde etkinliği; 3 çalışmada olgu sunumu ve çift-kör, plasebokontrollü araştırmalar ile gösterilmiştir. N-Asetilsistein gerek etkinliği, gerek ucuz olması ve yan etkilere yol açmaması nedeniyle; Trikotillomani gibi hastalıkların tekli ya da kombine tedavisinde umut verici ve ideal bir tedavi seçeneği olabilir.

Keywords

Trikotillomani N-asetilsistein glutamat antioksidanlar

References

  • Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: Current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci 2011; 36: 78-86.
  • Dodd S, Dean O, Copolov DL, Malhi GS, Berk M. N-acetylcysteine for antioxidant therapy: Pharmacology and clinical utility. Expert Opin Biol Ther 2008; 8: 1955-62.
  • Sansone RA, Sansone LA. Agomelatine: A novel antidepressant. Innov Clin Neurosci 2011; 8: 10-4.
  • Mayer M, Noble M. N-acetyl-L-cysteine is a pluripotent protector against cell death and enhancer of trophic factor-mediated cell survival in vitro. Proc Natl Acad Sci USA 1994; 91: 7496-500.
  • Dean O, Van den Buuse M, Copolov D, Berk M, Bush A. N-acetyl-cysteine treatment inhibits depletion of brain glutathione levels in rats: Implications for schizophrenia. Int J Neuropsychopharmacol 2004; 7: 262.
  • Lavoie S, Murray MM, Deppen P, Knyazeva MG, Berk M, Boulat O, Bovet P, Bush AI, Conus P, Copolov D, Fornari E, Meuli R, Solida A, Vianin P, Cuénod M, Buclin T, Do KQ. Glutathione precursor, N-acetyl-cysteine, improves mismatch negativity in schizophrenia patients. Neuropsychopharmacology 2008; 33: 2187-99.
  • Ersan S, Bakir S, Erdal Ersan E, Dogan O. Examination of free radical metabolism and antioxidant defence system elements in patients with obsessivecompulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30: 1039Ozdemir E, Cetinkaya S, Ersan S, Kucukosman S, Ersan EE. Serum selenium and plasma malondialdehyde levels and antioxidant enzyme activities in patients with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33: 62-5.
  • Selek S, Herken H, Bulut M, Ceylan MF, Celik H, Savas HA, Erel O. Oxidative imbalance in obsessive compulsive disorder patients: A total evaluation of oxidant-antioxidant status. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 487-91.
  • McFarland K, Lapish CC, Kalivas PW. Prefrontal glutamate release into the core of the nucleus accumbens mediates cocaine-induced reinstatement of drugseeking behavior. J Neurosci 2003; 23: 3531-7.
  • Odlaug BL, Grant JE. N-acetyl cysteine in the treatment of grooming disorders. J Clin Psychopharmacol 2007; 27: 227-9.
  • Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry 2007; 68: 170-1.
  • Carlsson ML. On the role of prefrontal cortex glutamate for the antithetical phenomenology of obsessive compulsive disorder and attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25: 5
  • Chakrabarty K, Bhattacharyya S, Christopher R, Khanna S. Glutamatergic dysfunction in OCD. Neuropsychopharmacology 2005; 30: 1735-40.
  • Dinan TG. Inflammatory markers in depression. Curr Opin Psychiatry 2009; 22: 32Drexhage RC, Knijff EM, Padmos RC, Heul-Nieuwenhuijzen Lv, Beumer W, Versnel MA, Drexhage HA. The mononuclear phagocyte system and its cytokine inflammatory networks in schizophrenia and bipolar disorder. Expert Rev Neurother 2010; 10: 59-76.
  • Knackstedt LA, LaRowe S, Mardikian P, Malcolm R, Upadhyaya H, Hedden S, Markou A, Kalivas PW. The role of cystine-glutamate exchange in nicotine dependence in rats and humans. Biol Psychiatry 2009; 65: 841-5.
  • Mardikian PN, LaRowe SD, Hedden S, Kalivas PW, Malcolm RJ. An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: A pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31: 389-94.
  • LaRowe SD, Mardikian P, Malcolm R, Myrick H, Kalivas P, McFarland K, Saladin M, McRae A, Brady K. Safety and tolerability of N-acetylcysteine in cocaine-dependent individuals. Am J Addict 2006; 15: 105-10.
  • Berk M, Copolov D, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Judd F, Katz F, Katz P, Ording-Jespersen S, Little J, Conus P, Cuenod M, Do KQ, Bush AI. N-acetyl cysteine as a glutathione precursor for schizophrenia-a double-blind, randomized, placebo-controlled trial. Biol Psychiatry 2008; 64: 361Berk M, Copolov DL, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Bush AI. N-acetyl cysteine for depressive symptoms in bipolar disorder-a doubleblind randomized placebo-controlled trial. Biol Psychiatry 2008; 64: 468-75.
  • Grant JE, Kim SW, Odlaug BL. N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: A pilot study. Biol Psychiatry 2007; 62: 652-7.
  • Berk M, Jeavons S, Dean OM, Dodd S, Moss K, Gama CS, Malhi GS. Nailbiting stuff? The effect of N-acetyl cysteine on nail-biting. CNS Spectrums 2009; 14: 357-60.
  • Sadock BJ, Sadock VA. Kaplan&Sadock’s Concise Textbook of Clinical Psychiatry. Third edition, Philedelphia: Lippincott Williams&Wilkins 2008; 367
  • Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: A current review. Clin Psychol Rev 2010; 30: 181-93.
  • Konkan R, Şenormancı Ö, Sungur MZ. Klinik Psikofarmakoloji Bülteni 2011; 21: 268-77.
  • Sadock BJ, Kaplan HI, Sadock VA. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. edition, Lippincott Williams&Wilkins. Philedelphia USA 2007; 781-3.
  • Franklin ME, Flessner CA, Woods DW, Keuthen NJ, Piacentini JC, Moore P, Stein DJ, Cohen SB, Wilson MA; Trichotillomania Learning Center-Scientific Advisory Board. The child and adolescent trichotillomania impact project: Descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr 2008; 29: 493-500.
  • Amerikan Psikiyatri Birliği. Mental bozukluklarin tanısal ve sayımsal el kitabı. Dördüncü baskı yeniden gözden geçirilmiş tam metin (DSM-IV-TR). Köroğlu E, çev. editörü. Ankara: Hekimler Yayın Birliği; 2007.
  • Lochner C, Grant JE, Odlaug BL, Woods DW, Keuthen NJ, Stein DJ. Dsm-5 field survey: Hair-Pulling Disorder (Trichotillomania). Depress Anxiety 2012; 29: 1025-31.
  • Papazisis G, Tzellos T, Kouvelas D. Practice corner: Managing trichotillomaniano need to pull your hair out. Evid Based Med 2008; 13: 66-7.
  • Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin psychiatry 1991; 52: 415-17.
  • Grant JE, Levine L, Kim D, Potenza MN. Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry 2005; 162: 2184-8.
  • Matsunaga H, Kiriike N, Matsui T, Oya K, Okino K, Stein DJ. Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder. Compr Psychiatry 2005; 46: 43-9.
  • Woods DW, Flessner CA, Franklin ME, Keuthen NJ, Goodwin RD, Stein DJ, Walther MR; Trichotillomania Learning Center-Scientific Advisory Board. The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry 2006; 67: 1877-88.
  • Chamberlain SR, Fineberg NA, Blackwell AD, Clark L, Robbins TW, Sahakian BJ. A neuropsychological comparison of obsessive-compulsive disorder and trichotillomania. Neuropsychologia 2007; 45: 654-62.
  • Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, Pittenger C, Leckman JF, Coric V. Systematic review: Pharmacological and behavioral treatment for trichotillomania. Biol Psychiatry 2007; 62: 839-46.
  • Swedo SE, Rapoport JL. Annotation: Trichotillomania. J Child Psychol Psychiatry 1991; 32: 401-9.
  • Walsh KH, McDougle CJ. Trichotillomania. Presentation, etiology, diagnosis and therapy. Am J Clin Dermatol 2001; 2: 327-33.
  • Stanley MA, Breckenridge JK, Swann AC, Freeman EB, Reich L. Fluvoxamine treatment of trichotillomania. J Clin Psychopharmacol 1997; 17: 278-83.
  • Stein DJ, Bouwer C, Maud CM. Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania. Eur Arch Psychiatry Clin Neurosci 1997; 247: 234-6.
  • Bhatia MS, Sapra S. Escitalopram in trichotillomania.Eur Psychiatry 2004; 19: 239Lafleur DL, Pittenger C, Kelmendi B, Gardner T, Wasylink S, Malison RT, Sanacora G, Krystal JH, Coric V. N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Psychopharmacology 2006; 184: 254-6.
  • De Sousa A. An open-label pilot study of naltrexone in childhood-onset trichotillomania. J Child Adolesc Psychopharmacol 2008; 18: 30-3.
  • Stein DJ, Hollander E. Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry 1992; 53: 123-6.
  • Stein DJ, Bouwer C, Hawkridge S, Emsley RA. Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders. J Clin Psychiatry 1997; 58: 119-22.
  • Potenza MN, Wasylink S, Epperson CN, McDougle CJ. Olanzapine augmentation of fluoxetine in the treatment of trichotillomania. Am J Psychiatry 1998; 155: 1299-300.
  • Ninan PT, Rothbaum BO, Marsteller FA, Knight BT, Eccard MB. A placebocontrolled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000; 61: 47-50.
  • McElroy SL, Keck PE. Gabbard’s treatments of psychiatric disorder. E Albayrak (çev.), Ankara: Veri Medikal Yayıncılık 2009; 880-2.
  • Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Arch Gen Psychiatry 2009; 66: 756-63. 5 Rodrigues-Barata AR, Tosti A, Rodríguez-Pichardo A, Camacho-Martínez F. Nacetylcysteine in the Treatment of Trichotillomania. Int J Trichology 2012; 4: 176
There are 46 citations in total.

Details

Primary Language English
Journal Section Reviews
Authors

Etem Erşan

Publication Date February 14, 2014
Published in Issue Year 2013Volume 35, Issue 4 (2013): Supplement

Cite

AMA Erşan E. N-acetylcysteine in trichotillomania as an alternative treatment option. CMJ. February 2014;35(4):50-57.