Memantine effective for Trichotillomania and skin-picking disorder

Memantine therapy had a reasonably high effectiveness and was well tolerated in individuals with Trichotillomania and skin-picking condition, says an article published in the American Journal of Psychiatry.

Underrecognized and frequently crippling disorders like trichotillomania and skin-picking disorder cause people to pluck or pick at their skin or hair repeatedly, causing obvious hair loss or tissue damage. There are very few evidence-based therapies available for these illnesses as of right now. Jon Grant and crew conducted this study to see if memantine, a glutamate modulator, may reduce hair pulling and skin picking better than a placebo.

In a double-blind study with memantine (dosing range, 10-20 mg/day) or placebo for 8 weeks, 100 persons with trichotillomania or skin-picking disorder (86 women; mean age, 31.4 years [SD=10.2]) were included. Measures of the intensity of the tugging and plucking were used to evaluate the participants. An analysis of the outcomes was done using a linear mixed-effects model. The NIMH Trichotillomania Symptom Severity Scale was amended to include skin picking as the major outcome measure, and treatment-related improvement on this scale represented success.

The key findings of this study were :

Regarding treatment-by-time interactions, memantine therapy was linked to significantly better scores than placebo on the NIMH scale, Sheehan Disability Scale, and Clinical Global Impressions severity scale.

At the study's conclusion, 60.5% of memantine group participants were "much or very much improved," as opposed to 8.3% of placebo group participants (number required to treat=1.9).

The treatment arms did not substantially vary in adverse events.

This study discovered that memantine medication was well tolerated, had a relatively high effectiveness (based on number needed to treat), and reduced hair pulling and skin-picking symptoms statistically significantly more than placebo. It could be advantageous to focus on the glutamate system while treating obsessive behaviors.

Reference:

Grant, J. E., Chesivoir, E., Valle, S., Ehsan, D., & Chamberlain, S. R. (2023). Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder. In American Journal of Psychiatry (Vol. 180, Issue 5, pp. 348–356). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.ajp.20220737