Medication Options for Trichotillomania ..
Over the last couple of weeks I’ve been talking with my doctor about trying medication (again) for my severe trichotillomania, which has been persisting since age 14. (I am now about to turn 30, so this has been going on over half my life.) In the past I tried Cymbalta, and Zoloft, and Naltrexone. After 4 months on Cymbalta, I didn’t notice much of a reduction in my pulling urges, or in my OCD symptoms, either. So I discontinued that. Discouraged, I didn’t try another medication until last year, when I tried Zoloft. After a few months of this, I didn’t like the sexual dysfunction side effects and discontinued that medication as well - I was not seeing any benefit from this medication either. I gave Naltrexone a shot for 3 months and didn’t notice any improvement with that either.
I have been doing Cognitive Behavior Therapy for 1.5 years now - it shouldn’t have been for this long, but I had several interruptions in the treatment (changing of doctors due to them leaving, going on pregnancy leave, etc)
At this point in time I feel that I’ve somewhat exhausted some of the CBT methods to the point where they aren’t as meaningful, so I am going to try the combination of CBT and medicine now.
After reviewing more choices, my choice now seems to lie between Clomipramine (which seems to have show the highest success rate for Trich) and Welbutrin, which has also been shown to be effective for some. I’ve been going back and forth between these 2 for some time. It’s hard to decide … I’d like to go for the Clomipramine because of it’s documented success rate - however, I have other additional problems as well, including anxiety, attention deficit disorder and depression - all of which Welbutrin can impact positively. The clomipramine focuses solely on the OCD-like symptoms… less on the depression and concentration issues.
Then again, do I really want to be on one of these long-term? I feel as if I don’t, but the attention issues are certainly a problem that will persist for some time. If the Welbutrin does help with that, then perhaps I would want to continue taking it for at least a few years. The clomipramine I’d be more likely to want to discontinue sooner, probably. My OCD symptoms alone aren’t bothersome enough to really interfere in my life, but I am skeptical that a year on medication and some CBT will cure a life-long problem. So then.. perhaps it WOULD be better to stay on a medication long-term (a few years)… and if so, it might as well be one that’s beneficial in other ways… like the Welbutrin.
The sexual side effects, well… I’ve decided that this time.. that’s not worth it. A few years ago I was younger and that sort of thing seemed more important … orgasms were something I refused to give up then. This happens to be a good time to try again though, because I am not in a relationship, for the first time in awhile… so I feel that any sexual dysfunction now wouldn’t be as much of an issue.
So then.. I guess the decision has been made… I hope it is a good one. I will begin on Welbutrin (Bupropion) .. 100mg… today. At the moment I am still with a shaved head to avoid all temptation of pulling. In a few months, the bald spots currently present, should be filling in… and by then, hopefully the medication and the CBT will be working well.
I hope this will help me… here goes.
I am now seeing Hannah Reese at MGH. It won’t be for all that long - she’s taking a leave in November… I was hoping I’d be able to use that as a goal to be feeling good by… but who knows really. It’s still as bad as ever… :[