Olanzapine Treats Trichotillomania

Olanzapine is a safe and effective treatment for trichotillomania

June 2010

Olanzapine is a safe and effective treatment for trichotillomania, or hair loss caused by compulsive pulling, according to results of a small study published online April 20 in the Journal of Clinical Psychiatry.

Dr. Michael Van Ameringen, of McMaster University Medical Center, Ontario, Canada, led a randomized, double-blind, placebo-controlled trial to determine whether a dopaminergic treatment such as that used in tics and Tourette's syndrome would be effective against trichotillomania.

The researchers report that 85% of olanzapine-treated patients (11 of 13) and 17% of placebo-treated patients (2 of 12) were considered responders according to the primary outcome measure, the Clinical Global Impressions-Improvement (CGI-I) scale.(p = 0.001).

A total of 25 patients recruited between August 2001 and December 2005 received flexible-dose olanzapine (2.5 to 20.0 mg/d) or placebo for 12 weeks. Follow-up was completed in February 2006.

Secondary outcome measures included the CGI-Severity of Illness (CGI-S) scale, the Yale-Brown Obsessive Compulsive Scale for Trichotillomania (TTM-YBOCS), and the Massachusetts General Hospital Hair Pulling Scale (MGH).

The mean changes in secondary outcome measures from baseline to end point were also significant for the olanzapine group.

There were no significant changes in other secondary outcome measures.

Overall, 21 patients (84%) reported at least one adverse event, such as dry mouth, fatigue, and increased appetite. These events didn't cause any participants to withdraw, but they were all significantly more prevalent in the olanzapine group.

At the end of treatment, the mean dose of olanzapine was 10.8 mg/d. The average time to treatment response was 8.2 weeks for olanzapine-treated patients and 0.0 weeks for placebo-treated patients.

While the sample size was small in this study, the authors say that it is the largest randomized controlled trial in trichotillomania in the psychiatric literature.

They told Reuters Health that "although we believe the efficacy of olanzapine seen in this study is related to its dopaminergic properties, one could not rule out the possibility that the potential benefits of olanzapine may have been due to the 5-HT2A blockade associated with atypicals," They did not, however, comment on the possibility of using alternative medications.

No significant metabolic effects were observed with olanzapine. Metabolic effects have been found with the use of atypical antipsychotics, and may be a "potential limitation."

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