The People's Perspective on Medicine

Can Naltrexone Overcome Obsessions Like Hair Pulling (Trichotillomania)?

Millions of people suffer from trichotillomania aka trich or hair pulling. Will naltrexone help overcome obsessions? What about naltrexone for alcoholism?

Don’t you just love medical terminology? Hair pulling is straightforward. You immediately understand what it means. But no, doctors have to use Greek or Latin. You get the tongue twister trichotillomania because the Greek word for hair is thrix. The Greek word to pull is tillein and the Greek for madness is mania. The French dermatologist Francois Henri Hallopeau put them all together in 1889 to describe compulsive hair pulling and voila: trichotillomania. We prefer to shorten that to trich.

It is estimated that 4% of the people in the United States suffer from obsessive hair pulling. That’s according to researchers writing in Seminars in Cutaneous Medicine and Surgery (June, 2013).  If you do the math, that translates into more than 13 million Americans dealing with trichotillomania. Adolescents are most susceptible to trich, but adults can also be affected by the urge to pull hair from the scalp, eyebrows, eyelashes, beard, mustache or even the genital area. Will a drug like naltrexone overcome obsessions like trich? This reader says it just might help.

Using Naltrexone to Overcome Obsessions:

Q. I use naltrexone off label to help me control trichotillomania [hair pulling]. It has been a godsend and helped me more than I ever thought possible. I’ve struggled with the disorder for almost 40 years and naltrexone has been the most helpful.

A. Trichotillomania involves compulsively pulling out hair from the scalp, eyebrows or other parts of the body. It can be quite challenging to treat.

The FDA has not approved any medications for this condition. Cognitive behavioral therapy (CBT) may be effective.

NAC and Inositol for Trichotillomania?

Dietary supplements such as NAC (N-acetylcysteine) and Inositol may also be helpful (Archives of General Psychiatry, July, 2009).

The authors of this study summarized their results:

“Fifty-six percent of patients “much or very much improved” with N-acetylcysteine use compared with 16% taking placebo (P = .003). Significant improvement was initially noted after 9 weeks of treatment.


“This study, the first to our knowledge that examines the efficacy of a glutamatergic agent in the treatment of trichotillomania, found that N-acetylcysteine demonstrated statistically significant reductions in trichotillomania symptoms. No adverse events occurred in the N-acetylcysteine group, and N-acetylcysteine was well tolerated. Pharmacologic modulation of the glutamate system may prove to be useful in the control of a range of compulsive behaviors.”

NAC can be purchased over the counter in health food stores or pharmacies.

Another dietary supplement, inositol, may also be beneficial. This natural substance is found in plants and people. It has been used for obsessive-compulsive disorder. One study published in the journal International Clinical Psychopharmacology (March, 2017) suggested some modest benefit from inositol. NAC seems more effective, however.

Will Naltrexone Overcome Obsessions?

Naltrexone is approved for treating addictions such as alcoholism. Some research supports the use of naltrexone to treat conditions such as compulsive hair pulling, shop lifting and other behavioral addictions (European Addiction Research, online, Sept. 7, 2017). A somewhat similar condition, skin picking, may benefit from a combination of treatments.

An article in the American Journal of Psychiatry (Nov. 2012) offered this advice:

“Clinical evaluation of patients with skin picking disorder entails a broad physical and psychiatric examination, encouraging an interdisciplinary approach to evaluation and treatment. Approaches to treatment should include cognitive-behavioral therapy (including habit reversal or acceptance-enhanced behavior therapy) and medication (serotonin reuptake inhibitors, N-acetylcysteine, or naltrexone).”

Naltrexone and Alcohol:

The FDA has approved the use of naltrexone for people trying to give up alcohol.

Megan shares her experience with naltrexone:

“For me, the key has been to use the Naltrexone along with cognitive therapy and meditation for my anxiety. I also had to cut the doses in half because the full dose makes me sick (nausea, dizziness). Based on my experience I’d recommend naltrexone to anyone who is looking for a solution to end their drinking problem. Search for another doctor if your present doctor will not prescribe it to you. Most doctors have not even read the research behind this drug and are in the dark regarding naltrexone.”

Share Your Story:

If you have had an experience with trichotillomania, please share your story below in the comment section. Have you discovered something that worked? We would love to hear from you.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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My daughter has suffered from trich for the last 3 years. It started with eyelashes then progressed to her hair where she pulled out around 90% of her hair and needed to wear a full wig. We tried behavior therapy, anti-depressants, NAC. Nothing was working until recently she was prescribed Naltrexone and this has been a God sent answer to prayer. Starting on this medication, she says her urge to pull diminished immediately. She has been on it for a month now and her eyelashes have come back in and her hair has grown enough to where she looks like she just has a short cut and no longer has to wear a wig. So amazing.

My daughter has suffered from trichotillomania since 3rd grade. It seems the exaggerated emphasis on end-of-the-grade testing from the beginning of the school year and the stress that ensued caused the onset of the disorder. She began by pulling her eyelashes and then moved to her eyebrows and hair. We tried NAC, but it didn’t seem to work for her. In her 9th grade year, she said the feeling had subsided, and her hair began to grow back, and she was doing great until recently (11th grade) when she experienced some stress with some classes at school. She heard of a drug called Clomipramine that was having some success at combating this disorder. We have not heard of Naltrexone because we have just come back into dealing with trich. Do you have any information on Clomipramine or do you have a preference of one over the other? Thank you so much for any light you can shed on this.

Clomipramine is used to treat obsessive-compulsive disorder, and trichotillomania is a form of OCD. We don’t have any data specifically on its efficacy for trich.

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