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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Caedmon on April 12, 2006, at 22:55:53
Any ideas?
My Sx are mainly pulling my eyebrow hairs and skin picking and rubbing of my face and neck. It's really bothering me in conjunction w/ acne. My acne meds cause some degree of skin peeling and increased epithelial turnover. So, I end up rubbing off dead skin cells or "finding" tags of dead skin. (Acne meds are 100mg bid minocycline, also benzaclin qam and tazorac qpm.) This in turn causes more acne, since I've got my stupid hands all over my face half the day. The hair pulling is less bothersome, in fact it probably keeps me somewhat groomed, lol.
I know there's like, nothing. Prognosis is poor. But I'd be willing to give almost anything a shot. For the record I'm not sure if my TTM fits within an OCD spectrum problem, or is more of a motor tic (this is my inclination... not preceded by obessions or anxiety) or exists by itself (as it does in most people w/ TTM).
I've heard serotonergics could help. They don't from what I've been on. I've heard antipsychotics could help. I love my Risperdal (which I take prn for manic episodes), but it's never done anything in that area and I'm too scared to try anything more hardcore such as haloperidol.
Naltrexone you think?
I'm a 23-yr-old male. BP-II, social phobia, binge eating, and the trich. And assorted oddities. I take Parnate 10 now titrating up to 30 mg, Topamax 100mg, diazepam 10mg. Supplements: fish oil 3 g epa/dha, multivitamin, 1/3 B-complex, Vitamin E 400IU, Vitamin C 500mg, Ginkgo biloba 60mg bid.
If you read my entire post and bother to reply, I would like to take you out for drinks. Thanks,
- C
Posted by Caedmon on April 12, 2006, at 22:59:23
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
Er, I guess the skin picking is technically dermatillomania, whatever. They often go together.
- C
Posted by xbunny on April 13, 2006, at 4:33:18
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
> My Sx are mainly pulling my eyebrow hairs and skin picking and rubbing of my face and neck.
My symptoms are continually twisting, knotting and then pulling out my hair, I think this falls under the spectrum to TTM. I have found no meds have ever effected this. I have taken various antipsychotics and they havent had an effect, neither benzos nor antidepressants. I have never considered taking something specifically for hair pulling though. These days I am resigned to the fact that its something I must live with. I think I am getting better though when I was younger I used to continually pull large chunks out to the point where the hair at the front of my head now grows distorted however now I am can usually get away with small knots and I dont always have to pull them out.
Best regards Bunny
Posted by Crazy Horse on April 13, 2006, at 5:51:35
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
> Any ideas?
>
> My Sx are mainly pulling my eyebrow hairs and skin picking and rubbing of my face and neck. It's really bothering me in conjunction w/ acne. My acne meds cause some degree of skin peeling and increased epithelial turnover. So, I end up rubbing off dead skin cells or "finding" tags of dead skin. (Acne meds are 100mg bid minocycline, also benzaclin qam and tazorac qpm.) This in turn causes more acne, since I've got my stupid hands all over my face half the day. The hair pulling is less bothersome, in fact it probably keeps me somewhat groomed, lol.
>
> I know there's like, nothing. Prognosis is poor. But I'd be willing to give almost anything a shot. For the record I'm not sure if my TTM fits within an OCD spectrum problem, or is more of a motor tic (this is my inclination... not preceded by obessions or anxiety) or exists by itself (as it does in most people w/ TTM).
>
> I've heard serotonergics could help. They don't from what I've been on. I've heard antipsychotics could help. I love my Risperdal (which I take prn for manic episodes), but it's never done anything in that area and I'm too scared to try anything more hardcore such as haloperidol.
>
> Naltrexone you think?
>
> I'm a 23-yr-old male. BP-II, social phobia, binge eating, and the trich. And assorted oddities. I take Parnate 10 now titrating up to 30 mg, Topamax 100mg, diazepam 10mg. Supplements: fish oil 3 g epa/dha, multivitamin, 1/3 B-complex, Vitamin E 400IU, Vitamin C 500mg, Ginkgo biloba 60mg bid.
>
> If you read my entire post and bother to reply, I would like to take you out for drinks. Thanks,
>
> - CHey C,
I'm hoping and thinking the Parnate may help..seriously. As your dose gets higher of course. This illness sounds at least related to ocd, which i have, but is currenty nonexistant due partially to the Parnate, the other Cognitive behavioral therapy. I'm not a huge advocate of "talk therapy" but for ocd it really helped and i think for trichotillomania it could be very helpful too. If you do it, find a very good counselor...I've wasted a hell of a lot of $ on crappy ones. Good luck!Crazy Horse (a.k.a Tyler)
Posted by Caedmon on April 13, 2006, at 9:53:46
In reply to Re: Meds for trichotillomania? » Caedmon, posted by Crazy Horse on April 13, 2006, at 5:51:35
Thanks Tyler/Crazy Horse
>I'm hoping and thinking the Parnate may help..seriously.>
Let us hope so. I've tried brief therapy on the issue but never felt like it was going anywhere. I've never had a lot of luck with therapy as a way of actually treating my psych problems, I usually benefit from general reflection/ venting when I'm there. Part of it is that my cognitive skills go down the drain as part of my social phobia, and any time I'm with a ther. and on the spot like I usually am, I'm just pretty much unable to process the information from the session. I've started to jokingly refer to this as "counseling amnesia".
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11475941&query_hl=2&itool=pubmed_docsum
states that:
"There are few studies of the pharmacological treatment of patients with psychogenic excoriation. Case studies, open trials and small double-blind studies have demonstrated the efficacy of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in psychogenic excoriation. Other pharmacological treatments that have been successful in case reports include doxepin, clomipramine, naltrexone, pimozide and olanzapine."Naltrexone is the only one w/ a mechanism of action that would be new to me.
- C
Posted by Colleen D. on April 13, 2006, at 11:14:15
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
Klonopin has helped me very much with my skin-picking and hair-pulling. Good luck!
Colleen
MDD, GAD, OCD and SP
Posted by Phillipa on April 13, 2006, at 15:49:28
In reply to Re: Meds for trichotillomania? » Caedmon, posted by Colleen D. on April 13, 2006, at 11:14:15
I pick my cuticles all the time from anxiety. When it's down I don't do it. Love Phillipa
Posted by med_empowered on April 13, 2006, at 16:37:48
In reply to Re: Meds for trichotillomania?, posted by Phillipa on April 13, 2006, at 15:49:28
hi! The treatments I've heard of as having success with this sort of thing vary wildly--the SRI drugs, TCAs, old-school and newer antipsychotics, the benzos...in some people where its closely related to OCD, you see improvement once the OCD gets better, which could be with any number of drugs from the antipsychotics up to Dexedrine.
Maybe upping the diazepam could help? Some people do find the benzos help, and it seems like they'd be prett well-tolerated, so at least side effects wouldn't be a problem. Topomax apparently also help some people (I imagine other mood-stabilizers would, too); that might be an option worth exploring.
Posted by ed_uk on April 13, 2006, at 16:39:31
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
Hi C
Would you be interested in trying low-dose naltrexone or a more standard dose?
Regards
Ed
Posted by tygereyes on April 13, 2006, at 19:31:13
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
I tweeze my eyebrows obsessively and pop pimples (which is why the Parnate acne is so devastating and I am going off of it). It's all related to my Body Dysmorphic Disorder, though, moreso than simple OCD.
But yeah. CBT and exposure therapy is FAR more efficacious (though not nearly as simple) as taking a few pills every day...
Posted by Caedmon on April 14, 2006, at 16:24:48
In reply to Re: Meds for trichotillomania?, posted by med_empowered on April 13, 2006, at 16:37:48
I have tried CBT for this in the past, no success, but that isn't to say that it couldn't help if I gave it another go. I'm in therapy now. I haven't brought this up as a topic of conversation really. I'll bring it up and see what she says.
I'm really ignorant on the naltrexone question because I'm not entirely sure what kinds of effects it would have or anything. I am seeing my derm. next before my pdoc so whatever I asked for she is the next doctor in line to petition.
Could gabapentin help with this, where it has some nerve-end analgesic action? I was curious about gabapentin just in general, for insomnia, maybe this is worth a try?
Ed do you know what doses of naltrexone would probably be appropriate for something like this?
On my own I'm still going to try to see if increased diazepam or the Parnate titration does anything.
Thanks for your input you guys!
- C
Posted by ed_uk on April 15, 2006, at 16:04:19
In reply to Re: Meds for trichotillomania?, posted by Caedmon on April 14, 2006, at 16:24:48
Hi C
You should turn your babblemail on :)
>Ed do you know what doses of naltrexone would probably be appropriate for something like this?
It hasn't recieved much study as far as I know. Naltrexone comes as 50mg tablets. Perhaps you could try 1/4 of a tablet.
Kind regards
Ed
Posted by tygereyes on April 15, 2006, at 19:12:43
In reply to Re: Meds for trichotillomania? » Caedmon, posted by ed_uk on April 15, 2006, at 16:04:19
What about opiates? Opiates are being used for treatment-refractory OCD.
Posted by Caedmon on April 15, 2006, at 22:27:25
In reply to Re: Meds for trichotillomania? » Caedmon, posted by ed_uk on April 15, 2006, at 16:04:19
Okay I think my babblemail is turned on. Sorry folks, I'm new. :)
Tygereyes I will have to ask about an opiate too, I although naltrexone is probably going to be a more likely drug? I don't know.
Does anyone have any thoughts on gabapentin (Neurontin)?
- C
Posted by yxibow on April 16, 2006, at 3:55:19
In reply to Meds for trichotillomania?, posted by Caedmon on April 12, 2006, at 22:55:53
> Any ideas?
>
> My Sx are mainly pulling my eyebrow hairs and skin picking and rubbing of my face and neck. It's really bothering me in conjunction w/ acne. My acne meds cause some degree of skin peeling and increased epithelial turnover. So, I end up rubbing off dead skin cells or "finding" tags of dead skin. (Acne meds are 100mg bid minocycline, also benzaclin qam and tazorac qpm.)
This is good that you have not been given Accutane in the mix as that has definite psychological side effect possibilities.
This in turn causes more acne, since I've got my stupid hands all over my face half the day. The hair pulling is less bothersome, in fact it probably keeps me somewhat groomed, lol.
>
> I know there's like, nothing. Prognosis is poor. But I'd be willing to give almost anything a shot. For the record I'm not sure if my TTM fits within an OCD spectrum problem, or is more of a motor tic (this is my inclination... not preceded by obessions or anxiety) or exists by itself (as it does in most people w/ TTM).
>
> I've heard serotonergics could help. They don't from what I've been on. I've heard antipsychotics could help. I love my Risperdal (which I take prn for manic episodes), but it's never done anything in that area and I'm too scared to try anything more hardcore such as haloperidol.
Antipsychotics generally are better on a continual basis, at least for a 30 day episode or more (as in BP). As far as old line antipsychotics, Orap (pimozide) has been used for tics, which as you mentioned TTM does fall into the OC Spectrum range. It of course carries the usual greater risk of TD. Though very high dose Risperdal is nearly the same as its chemical cousin Haloperidol which is just a molecule switch. Orap has also been used in TTM in combination with SRI/SSRIs. Clonidine (Catapres) as well.Something more lower down in the spectrum might help, since you mentioned BP as well, such as Seroquel or Zyprexa which both have been approved for BP, though one has to consider the lipid profile of course, especially with the complication of binge eating.
>
> Naltrexone you think?There has been a case report of Naltrexone in combination with Prozac although the explanation isn't entirely clear.
> I'm a 23-yr-old male. BP-II, social phobia, binge eating, and the trich. And assorted oddities. I take Parnate 10 now titrating up to 30 mg, Topamax 100mg, diazepam 10mg. Supplements: fish oil 3 g epa/dha, multivitamin, 1/3 B-complex, Vitamin E 400IU, Vitamin C 500mg, Ginkgo biloba 60mg bid.
>
> If you read my entire post and bother to reply, I would like to take you out for drinks. Thanks,
>
> - CCBT though in combination with any of the above probably holds a higher chance of efficacy than drug treatment alone. This of course holds true for most all OC Spectrum disorders.
Posted by Caedmon on April 16, 2006, at 12:26:28
In reply to Re: Meds for trichotillomania? » Caedmon, posted by yxibow on April 16, 2006, at 3:55:19
Good tip on the clonodine, thanks. I have a lot of ideas now. I think I need to do at least a few therapy sessions with this, I have some serious impulse control problems. (Overeating, trich, etc.)
This is the end of the thread.
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