A Randomized, Double-Blind, Placebo-Controlled Trial of Olanzapine in the Treatment of Trichotillomania

Background: Trichotillomania has been considered as part of the obsessive-compulsive disorder spectrum; however, trichotillomania treatment with obsessive-compulsive disorder medications has largely been unsuccessful.

Objective: To determine whether a dopaminergic treatment as used in tics and Tourette’s syndrome would be effective in trichotillomania.

Method: Twenty-five participants with DSM-IV trichotillomania participated in a 12-week, randomized, double-blind, placebo-controlled trial of flexible-dose olanzapine for trichotillomania. Recruitment occurred between August 2001 and December 2005, and follow-up was completed in February 2006. The primary outcome measure was the Clinical Global Impressions-Improvement (CGI-I) scale, and secondary measures of efficacy included the Yale-Brown Obsessive Compulsive Scale for Trichotillomania (TTM-YBOCS) and the Clinical Global Impressions-Severity of Illness (CGI-S) scale.

Results: Eleven of 13 participants (85%) in the olanzapine group and 2 of 12 (17%) in the placebo group were considered responders according to the CGI-I (P’ ‰=’ ‰.001). There was a significant change from baseline to end point in the TTM-YBOCS (P’ ‰<‘ ‰.01) and the CGI-S (P’ ‰<‘ ‰.001). The mean’ ‰±’ ‰SD dose of olanzapine at end point was 10.8′ ‰±’ ‰5.7 mg/d. Twenty-one of 25 patients (84%) reported at least 1 adverse event, but no adverse events resulted in early withdrawal from the study.

Conclusion: Olanzapine seems to be a safe and effective treatment for primary DSM-IV trichotillomania.

Trial Registration: clinicaltrials.gov Identifier: NCT00182507

J Clin Psychiatry

Submitted: February 9, 2009; accepted May 15, 2009.

Online ahead of print: April 20, 2010 (doi:10.4088/JCP.09m05114gre).

Corresponding author: Michael Van Ameringen, MD, Anxiety Disorders Clinic, 1F Clinic, McMaster University Medical Centre, Hamilton Health Sciences, Box 2000, Hamilton, Ontario, L8N 3Z5, Canada ([email protected]).