Medication for Trichotillomania: What the Research Shows

If you’ve ever searched for a pill that stops hair pulling, you’re far from alone. Trichotillomania medication is one of the things people with trich ask about most. Trichotillomania is a condition in which people feel strong urges to pull out their own hair, and it affects about 1 in 50 people.

This guide sets out what’s known: which medicines have been tested, what the trials found, what the side effects are, and how medication fits alongside therapy. It’s for adults thinking about medication for themselves and for parents wondering about it for a child. It doesn’t give doses. Any decision about a medicine belongs with a doctor or pharmacist who knows your health.

Is any medication approved for trichotillomania?

No. No medicine is approved specifically for trichotillomania in the US, where the Food and Drug Administration (FDA) decides which medicines can be sold for which conditions. The UK’s NHS (National Health Service) says antidepressants are not usually prescribed for trich. It points instead to habit reversal training, a type of talking therapy, as the usual treatment.

So when a doctor prescribes something for trich, they are usually using it “off-label”. That means a medicine licensed for one condition, such as depression or Alzheimer’s disease, is prescribed for another. Off-label prescribing is legal and common. The UK medicines regulator says doctors who prescribe off-label should be satisfied there’s enough evidence, explain their reasons, and tell you about common and serious side effects.

The evidence is thin. A 2021 Cochrane review (Cochrane is an independent network that pools results from the best-designed studies) found just 12 trials of medication for trich, all lasting 5 to 13 weeks. The reviewers concluded there wasn’t enough evidence to confirm or rule out any medicine, though a few looked promising in adults.

What do doctors sometimes prescribe for trich?

The medicines tested for trich fall into a few groups:

• SSRIs (selective serotonin reuptake inhibitors), the most widely used type of antidepressant, such as fluoxetine and sertraline.
• Clomipramine, an older tricyclic antidepressant that is also used for OCD (obsessive-compulsive disorder).
• Glutamate modulators, which act on glutamate, one of the brain’s chemical messengers. The two studied for trich are N-acetylcysteine (NAC), an amino acid, and memantine, a prescription medicine used for Alzheimer’s disease.
• Antipsychotics, such as olanzapine, which is mainly used for schizophrenia and bipolar disorder.
• Others, including naltrexone, which blocks the body’s opioid system, and supplements such as inositol.

A doctor may also prescribe an antidepressant for depression or anxiety alongside trich. That’s a separate, reasonable goal, even if the pulling itself doesn’t change much. Our guide to trichotillomania and anxiety looks at how the two overlap.

What does the research show?

Therapy based on habit reversal still has the strongest evidence of anything tried for trich. Among medicines, NAC (in adults) and memantine have the most encouraging results. Clomipramine and olanzapine helped in small single trials, and SSRIs haven’t shown a clear benefit.

NAC. In a 2009 trial of 50 adults, 56% were much or very much improved after 12 weeks on NAC, compared with 16% on a dummy pill (a placebo). The Cochrane review rated this the strongest evidence for any medicine, and a 2026 review of 30 trials also found strong support for NAC. But a similar trial in 39 children and teenagers aged 8 to 17 found no difference between NAC and a dummy pill. We cover the details in our guide to NAC for trichotillomania.

Memantine. A 2023 trial gave memantine or a dummy pill to 100 adults with trich, skin picking or both, for 8 weeks. Of the 79 who finished, 61% on memantine were much or very much improved, compared with 8% on the dummy pill. The researchers noted the trial was short and only included people with mild to moderate symptoms, and it hasn’t yet been repeated.

Clomipramine. In tiny trials, clomipramine did better than a dummy pill and than desipramine, a similar antidepressant. A 2007 review found habit reversal did better still.

Olanzapine. In a 2010 trial of 25 adults, 85% improved on olanzapine over 12 weeks, compared with 17% on a dummy pill. It’s a single small trial, and olanzapine’s side effects (see below) mean doctors weigh it carefully.

SSRIs. A 2007 review of the blinded trials found no evidence that SSRIs reduce pulling more than a dummy pill. If an SSRI didn’t stop your pulling, that fits what the research found. It isn’t a sign that you failed or that nothing will help.

Others. Two trials of naltrexone found little or no difference from a dummy pill. Two supplements, inositol and the antioxidant silymarin, were each tested in one trial and showed little or no difference either.

What are the side effects?

It depends on the medicine. These are the main side effects listed by the NHS and reported in the trials. They’re not complete lists, so always read the leaflet and ask your pharmacist.

• Antidepressants (SSRIs and clomipramine): common side effects include feeling sick, headaches, dry mouth, sleep problems, feeling dizzy or drowsy, weight gain and sexual problems. Many ease after a couple of weeks. In one small clomipramine trial, 3 in 10 people stopped taking it because of side effects.
• Olanzapine: sleepiness in the day, putting on weight or feeling hungrier, and dizziness are common. It can raise blood sugar, which leads to diabetes in fewer than 1 in 100 people, so you’d usually have blood tests before and during treatment. In the trich trial, 21 of 25 people reported at least one side effect, although no one left the study because of them.
• Memantine: common side effects include headaches, dizziness, balance problems, feeling sleepy, constipation and high blood pressure. In the trich trial, people on memantine didn’t have more side effects than people on the dummy pill.
• NAC: in the adult trial, no one stopped because of side effects. In the children’s trial, 1 in 20 on NAC stopped because of side effects, compared with none on the dummy pill.

Always tell your doctor and pharmacist about every medicine and supplement you take, including NAC. Some medicines don’t mix well with others.

Can children take medication for trichotillomania?

Medication is rarely the starting point for children, because the evidence is so thin. The only medication trial in children with trich, of NAC, found no benefit. Its authors said children should be referred for behavioural therapy before anyone considers medicine, because behavioural therapy has worked in both children and adults.

The NHS says antidepressants usually aren’t recommended for depression in under-18s, and memantine isn’t usually recommended under 18. A doctor may still consider one, for example when a young person also has depression, but should explain why.

Pulling in toddlers and very young children often stops on its own. Our guide on whether trichotillomania goes away covers how pulling changes over time. If you’re a parent, The Parent’s Guide to Trichotillomania is about understanding what your child is going through.

Should I try medication or therapy?

For most people, therapy based on habit reversal is the place to start, because it has the most research behind it. Habit Reversal Training (HRT) teaches you to notice when and where you pull, and to do something else with your hands when an urge comes. A 2007 review found it worked better than clomipramine or SSRIs, and a 2026 review of 30 trials again found habit reversal at the core of the most effective approaches.

Medication can still have a place. Some people add it when therapy hasn’t helped enough, when therapy is hard to find, or when depression or anxiety makes therapy hard to engage with. There’s very little research on combining the two for trich. The lead researcher of the memantine trial has said he’d like to study memantine alongside behavioural therapy.

You can read how habit reversal works in our guide to Habit Reversal Training. For every treatment option and the evidence behind each, see our guide to trichotillomania treatment.

How do I talk to a doctor about medication?

Bring it up plainly, say what you’ve already tried, and ask about the evidence and the side effects. A family doctor (a GP in the UK and Ireland) can talk it through and refer you on if needed. A psychiatrist, a medical doctor who treats mental health conditions, may know the trich research better.

Questions worth taking with you:

1. Which medicine are you suggesting, and what did trials in trich find?
2. Is it licensed for trich, or would it be off-label?
3. What side effects should I look out for, and when should I contact you?
4. How long should I try it before we decide whether it’s helping?
5. How does it fit with therapy?
6. Does it interact with anything else I take, including supplements?
7. Is it safe if I’m pregnant, trying to get pregnant or breastfeeding?

If your doctor hasn’t heard of trichotillomania, that’s common and it isn’t your fault. It’s fine to bring this page with you. Our complete guide to trichotillomania is also a good one to share.

When should I get help?

Get help if pulling is causing you distress, taking up a lot of your time, or affecting your work, school or relationships. You don’t need to wait until it’s “bad enough”, or to have decided about medication first.

A doctor can talk through medication with you. For therapy, look for someone who understands hair pulling. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory. Our guide to finding a therapist who understands trich explains what to ask on a first call.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 000 or go to your nearest emergency department.

• Lifeline — 13 11 14 (www.lifeline.org.au)

Questions people ask

Sources

1. Hoffman, J., Williams, T., Rothbart, R., Ipser, J.C., Fineberg, N., Chamberlain, S.R. & Stein, D.J. (2021). Pharmacotherapy for trichotillomania. Cochrane Database of Systematic Reviews, 9, CD007662.
2. Fisak, B., Shorb, C., Patel, D. & Ezcurra, V. (2026). The efficacy of psychotherapeutic and pharmacological interventions for trichotillomania: A review and meta-analysis. Journal of Psychiatric Research, 197, 264–274.
3. Bloch, M.H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R., Nudel, J., Pittenger, C., Leckman, J.F. & Coric, V. (2007). Systematic review: Pharmacological and behavioral treatment for trichotillomania. Biological Psychiatry, 62(8), 839–846.
4. Grant, J.E., Odlaug, B.L. & Kim, S.W. (2009). N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Archives of General Psychiatry, 66(7), 756–763.
5. Bloch, M.H., Panza, K.E., Grant, J.E., Pittenger, C. & Leckman, J.F. (2013). N-Acetylcysteine in the treatment of pediatric trichotillomania: A randomized, double-blind, placebo-controlled add-on trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 231–240.
6. Grant, J.E., et al. (2023). Double-blind placebo-controlled study of memantine in trichotillomania and skin-picking disorder. American Journal of Psychiatry.
7. Bender, E. (2023). Alzheimer’s drug may ease hair pulling, skin-picking disorders. MDedge Psychiatry.
8. Van Ameringen, M., Mancini, C., Patterson, B., Oakman, J. & Bennett, M. (2010). A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. Journal of Clinical Psychiatry, 71(10), 1336–1343.
9. NHS. Trichotillomania (hair pulling disorder).
10. NHS. Antidepressants.
11. NHS. Side effects of olanzapine.
12. NHS. Memantine.
13. OCD-UK. Clomipramine.
14. Medicines and Healthcare products Regulatory Agency (2014). Off-label or unlicensed use of medicines: prescribers’ responsibilities. GOV.UK.