Using NAC with Trichotillomania

The use of NAC with Trichotillomania: Trichotillomania is a psychiatric condition characterized by repetitive hair puling that produces noticeable hair loss. The preferred treatments and those most studied in the past have been cognitive behavior therapy and SSRIs (Sertraline). Both have shown improvements in patients with a combined CBT and SSRI the most beneficial (2). A recent study in 2009 showed promise with using N-acetylcysteine for the treatment of trichotillomania (1). NAC is a non-essential amino acid that is precursor to glutathione (the “mother” of all antioxidants that mops up free radicals in the brain) in our bodies that appears to restore the extracellular glutamate concentration in the nucleus accumbens. Therefore, offering promise in the reduction of compulsive behavior in patients. NAC is used for acetaminophen toxicity, chronic bronchitis as well as a mucolytic agent by inhalation in Mucomist I use NAC daily in my practice for my Hashimoto’s patients as a precursor for glutathione and to decrease inflammation. I had never used NAC for trichotillomania until recently. I had a patient in her 20’s present with a history of trichotillomania that developed while pregnant two years ago. When she came to see me she had completely plucked her eyebrows and eyelashes out. No prior history whatsoever of trichotillomania. I was at a loss for what to do. On exam she had barely any eyelashes left on top or bottom and a few stray eyebrows. Exam otherwise was completely normal. She explained how plucking felt “good” and there was no pain involved with it. She has no prior psych history. She is unsure what provokes the plucking but was clearly seeking help with stopping this clearly physically scaring condition. A recent article that Dr. Kalb was familiar with discussed the research on using NAC during a double blind placebo controlled study for trichotillomania (1). The study showed that using NAC (1200-2400 mg/d) had led to statistically significant reductions in trichotillomania symptoms. We started her on NAC 1200 mg daily as well as an herbal anxiety control supplement. On her 12-week f/u appointment she reported pain with plucking for the first time and therefore a decreased desire to pluck. Her eyelashes and eyebrows were growing back in as well. She continues to take NAC as well as the herbal anxiety control. 1. 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 Jul;66(7):756-63. 2. Dougherty DD, Loh R, Jenike MA, Keuthen NJ. Single modality versus dual modality treatment for trichotillomania: sertraline, behavioral therapy, or both? J Clin Psychiatry. 2006 Jul;67(7):1086-92.