Sanitywarp.org:: Diary of a Trichster

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.

Tags: cognitive behavioral therapy, trichster, zoloft, naltrexone, welbutrin, clomipramine, ocd, depression, medication, cymbalta, trich, ttm, trichotillomania, Uncategorized by Isis
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wish I was able to update a little more often. but there’s so little time sometimes, and then when there is… the last thing I want to do is write about my hair-pulling problem…

anyway, I went off the Zoloft because of a few things. 1, I was starting to feel a little “weird” …  a side effect of being on anti-depressants.  The sexual dysfunction issue was a problem.  I thought I didn’t mind it at first but it started to get to me.  And finally, I wasn’t noticing any change in the hair pulling frequency… although the Dr. recommended that I try doubling the dose to get the desired effect… I just didn’t want to do that.

Then I spiraled into an uncontrollable and very fast decline over the last month which has left me with about 30% of my hair intact. At first I tried to disguise this as a mowhawk, but the mowhawk only lasted about a week before that was half gone, too.  It was so bad in this last week that it’s all right in front of my crown and pretty impossible to hide even by wearing a headband in front.  I pulled so much there that it caused these weird, irritated and itchy little bumps on my scalp. (wtf??) … the skin is all sore and scaly feeling there.  :[  I’m trying not to be too hard on myself, as I’m going through a very traumatic and trying time.  (I lost my father at the end of Jan… then a whole bunch of other bad shit started happening… getting evicted… loosing what I thought were good friends… etc etc)   even my therapist (the lovely Dr Sarah Markowitz at MGH)  agreed that now may not be the best time to be very concerned over the hair stuff.  so… we’re going to work on more pressing issues for awhile and then get back to the hair issue.

In the meantime… I’m now trying Naltrexone.  My partner is actually on Naltrexone to fight his alcoholism.  My Harvard psychology professor recommended that as an option awhile back… and now I’m trying it.  It’s an opiod blocker … helps with addictions… what I’m hoping it will do is decrease the urge to pull, and also take away the pleasurable feeling that I am addicted to.  It’s been 3 days, and the first 2 days I was extremely tired.  But already the pleasurable feeling seems to be decreasing, so that’s a good sign.I guess we’ll see how this goes…… here’s hoping for some better results than the anti-depressants…

Tags: trauma caused by pulling, relapse, pulled all day, zoloft, anti-depressants, naltrexone, trichster, bald spots, trich, medication, ttm, trichotillomania, pulling, stress by Isis
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after speaking with my therapist and voicing my hope that perhaps combining medication with the therapy would have better results, we have decided to start by trying the SSRI medication, Zoloft.   I had wanted to start with Anafril, however since I take some mild stimulants for my ADHD symptoms and I am in school for awhile,  the latter was chosen as apparently clomipramine/Anafril has a bit of a stimulant as well and they wouldn’t be great to mix.I am started on 60mg (Doc says that for diseases such as OCD and Trich, rather than say, depression, which these are also commonly prescribed for, a much higher dose is needed for it to have any effect…), I am only to take 30mg for the first week… which I started today.  Next week it will be bumped up to the full dose.  From there, it will be several weeks before it begins to work.   I am sure I will notice a decrease in libido, which is the main reason I stopped Celexa a few years ago, but that is not as important to me as it was then.  What is important to me now is getting a grip on this horrible monster.   I broke down in front of the bathroom mirror last night and cried when I noticed the new, large bare patch that was creeping right up the crown and close to my forehead, in plain view.  It’s spread and spread since starting with the sides, to the top, and now to the front.  It’s a creeping disease…  and it seems like nothing will stop it.but I made a pact with myself and knew that it could still be beatable.  even after so many long years of having this (3/4’s of my whole life even), I can still overcome it if I try really hard, and with the help that I’m getting now.  maybe even one day I can go off of the medication, although I am prepared to accept now that I may need to take it for several years until I’m at that point.I just want to stop hiding, I want to be proud of my hair again.  and I want my boyfriend to see me the way I deserve to be seen, with a long head of beautiful hair, instead of a mangled mess that is clearly the sign of a disease.  …I want the confidence to know that there is nothing I need to hide anymore, nothing to be embarrassed over ….. nothing that would scream, “this girl has a problem” if anyone were to accidently see …so… here’s to day 1… of what I hope will be a transformation… and if it’s not… then I will have to move along the list of medications, until I find the one that’s right.  but I am hoping high for Zoloft.

Tags: cognitive behavioral therapy, zoloft, SSRI's, treatmeant, mgh trich clinic boston, trich, ttm, trichotillomania, medication by Isis
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