Summary: Memantine, a drug commonly prescribed to treat symptoms of Alzheimer’s disease, reduces symptoms in adults with hair and skin pulling disorders.
Source: University of Chicago
New research from the University of Chicago Medicine has found that a drug commonly used to treat symptoms of Alzheimer’s disease effectively reduces symptoms in adults who pull their hair out and scratch their skin.
Treatment with the drug memantine has been associated with significant improvements over placebo for patients with trichotillomania (a disorder in which individuals cannot resist the urge to pull their hair out) and skin (also known as excoriation disorder).
No drugs are currently approved by the United States Food and Drug Administration for the disorder, which can cause obvious hair loss and skin damage, emotional distress, and reduced ability to function socially, in school or at work, said lead author Jon Grant, MD, a professor of psychiatry and behavioral neuroscience at the Medical University of Chicago.
“A person’s self-esteem is greatly affected by these behaviors, so they may not show up for interviews for a better job, for example. They may not have the social life they want,” Grant said.
Trichotillomania and the skin disorder are considered two separate diagnoses, but they have many similarities. Cognitive-behavioral therapy is a first-line treatment, but finding therapists familiar with the disorders can be difficult, he said.
“People often feel like they have to educate the clinician,” Grant said.
The researchers looked at memantine based on previous findings by Grant and others that found, in people with either disorder, disorganized areas of white matter in parts of the brain controlling motor habits.
The findings suggested the involvement of the neurotransmitter glutamate, a leading neurobiology theory behind obsessive-compulsive disorder, Grant said.
When it comes to drugs, “we don’t have a lot of options on what might modulate glutamate in the brain,” he said.
Grant selected memantine, which is approved to treat memory loss and thinking deficits in people with Alzheimer’s disease and has been used off-label for various psychiatric disorders. It is well tolerated by patients and has few serious side effects, he said.
While Grant was investigating memantine for trichotillomania and the skin disorder, another of his patients was prescribed the drug for a separate reason.
“It came about a bit by chance,” he said. “One day the patient said to me, ‘Wow, that stopped me from pulling my hair.'”
The new study from the University of Chicago involved 100 adults with trichotillomania or skin disorder who were enrolled in the double-blind trial of memantine or a placebo for eight weeks.
The researchers assessed the patients every two weeks using the National Institute of Mental Health’s Trichotillomania Symptom Severity Scale, which they modified for the skin swab because there is no is no commonly used measure for disorder.
They also recorded changes using four other accounts of self-reported symptoms and behaviors observed by clinicians. Patients were seen virtually due to the COVID-19 pandemic.
Seventy-nine participants completed the study. Two dropped out after reporting dizziness while taking the drug.
After eight weeks, 26 of the 43 study participants taking memantine showed significant or very significant improvement, compared with three of the 36 taking a placebo. Six people in the memantine group and one in the placebo group had complete symptom relief.
An analysis found memantine to be more effective than other treatments studied so far, including behavioral therapy, the drug olanzapine (used to treat schizophrenia and bipolar disorder), the drug clomipramine (used to treat obsessive -compulsive) and N-acetylcysteine (an over-the-counter supplement).
The comparisons suggest that memantine could be considered a first-line treatment equal to behavioral therapy in the process of treating these conditions, according to the study.
Grant said the results point to several areas for additional research, including combining memantine with behavioral therapy or with N-acetylcysteine, which has shown promise in previous Grant-led studies. Longer-term use of memantine and different doses are also potential avenues of study, he said.
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“The results showed the drug helped more than the placebo, which I was very happy with, but it tells me there’s still a lot to do,” Grant said. “Although the results were promising, it was still a very small minority of people in terms of complete remission of symptoms.”
Still, some study participants indicated they intended to seek memantine prescriptions from their primary physicians to continue taking the drug, Grant said.
“Some people came in thinking, ‘Nothing could help me.’ Some of them saw at the end that this one was different,” he said.
About this neuropharmacology research news
Author: Cassandra Belek
Source: University of Chicago
Contact: Cassandre Belek – University of Chicago
Picture: Image is in public domain
Original research: Access closed.
“Double-Blind, Placebo-Controlled Study of Memantine in Trichotillomania and Skin Picking Disorder” by Jon Grant et al. American Journal of Psychiatry
Abstract
Double-Blind, Placebo-Controlled Study of Memantine in Trichotillomania and Skin Disorder
Objective:
Trichotillomania and skin picking disorder are underrecognized and often disabling conditions in which individuals repeatedly pull at their hair or scratch at their skin, resulting in noticeable hair loss or tissue damage. To date, there is a severe shortage of evidence-based treatments for these conditions. In this study, the authors sought to determine whether memantine, a glutamate modulator, is more effective than placebo in reducing hair-pulling and skin-picking behavior.
Methods :
One hundred adults with trichotillomania or skin disorder (86 women; mean age: 31.4 years (SD=10.2)) participated in a double-blind trial of memantine (dose range: 10-20 mg/day) or placebo for 8 hours. weeks. Participants were assessed with measures of pulling and picking severity. The results were examined using a linear mixed-effects model. The prespecified primary outcome was treatment-related change on the NIMH Trichotillomania Symptom Severity Scale, modified to include skin swab.
Results:
Compared to placebo, treatment with memantine was associated with significant improvements in scores on the NIMH scale, the Sheehan Disability Scale, and the Clinical Global Impressions Severity Scale in terms of treatment interactions and the time. At the end of the study, 60.5% of participants in the memantine group were “much or much improved”, compared with 8.3% in the placebo group (number needed to treat = 1.9). Adverse events did not differ significantly between treatment arms.
Conclusion :
This study found that memantine treatment resulted in statistically significant reductions in hair pulling and hair removal symptoms compared to placebo, with relatively high efficacy (based on the number needed to treat) and that it was well tolerated. The glutamate system may prove to be a beneficial target in the treatment of compulsive behaviors.