In 2011, a 12-week pilot study was conducted with 14 women (mean age 33.3 ± 8.9 years) who received different doses of dronabinol (2.5 mg to 15 mg/day). Based on the Massachusetts General Hospital Pulling Scale (MGH-HPS), patients were assessed for compulsive hair pulling before and after treatment. Also, the efficiency of cognitive functions was evaluated using neurological tests.
What was the result? Before unveiling the result let’s first look at the examine “trichotillomania behavioral disorder”
What is trichotillomania?
The obsessive plucking of hair from the head, pubic, eyebrows, eyelashes, face, or any other part of the body is known as trichotillomania behavioral disorder. It is estimated that this disorder affects 3-5% of the population and is often associated with other psychological disorders, including depression, anxiety, Tourette’s syndrome or obsessive-compulsive disorder.
As a result of continuous hair pulling, so much hair is lost, which is manifested by the occurrence of “bald spots”. And this, in turn, unfavorably translates into low self-esteem, social anxiety, and family estrangement.
After pulling out the hair, some trichotillomania patients eat them. Which may result in gastrointestinal disturbances.
In the 18th century, a Frenchman named Baudamant described the case of a 16-year-old boy who was diagnosed with bezoar — the accumulation of undigested substances in the stomach. It turned out that the main cause of his disease was as a result of ripped out and eaten hair.
What causes trichotillomania?
Trichotillomania is classified as a behavioral disorder in adults, although the onset of the disease is most often between 11 and 13 years old. Nevertheless, the disease may show up before the age of 6, but plucking hair in early childhood (Baby Trich) is not classified as trichotillomania.
Until today, the main factor responsible for the occurrence of the disease has not been established, although the majority believe it has something to do with genetics. Does it really?
After examining members of 44 families with at least one member suffering from trichotillomania, researchers at the Duke University Medical Center found that people suffering from this disorder have a mutation in the SLITRK1 gene. It is interesting to know that, a change in the genome was not found in families with no case of trichotillomania.
It is worth mentioning that the SLITRK1 gene plays a role in the formation of connections between nerve cells, or neurons. Mutations within this gene may, therefore, promote the formation of faulty connections between neurons, resulting in the incidence of trichotillomania. Nevertheless, scientists at Duke University stress that mutations in the SLITRK1 gene account for a small percentage of people with this disease.
Another hypothesis that attempts to explain the etiopathogenesis of this disease is that of hyperactivity of the serotonergic system. In this case, the neurotransmitter serotonin is rapidly and excessively disrupted, and therefore elevated levels of 5HIAA (5-hydroxyindoleacetic acid), i.e. a metabolite formed from serotonin, are noted. This hypothesis partly explains why the use of antidepressants from the group SSRI (serotonin reuptake inhibitors) sometimes gives good results in the therapy of trichotillomania (SSRIs increase serotonin concentration in the brain).
In the therapy of this disease, drugs modulating the action of dopaminergic and glutamatergic systems are also used, as well as the use of non-pharmacological methods such as psychotherapy and behavioral therapy (HRT, or habit- reversal therapy).
Dronabinol for trichotillomania
The drug that has shown great results is the dronabinol derivative of tetrahydrocannabinol (THC).
Twelve women out of 14 subjects (85.7%) completed a 12-week study. MGH-HPS results decreased from an average of 16.5 ± 4.4 at the start of the study to 8.7 ± 5.5 at the end of the experiment. In nine patients (64.3%) there was a significant and very significant reduction in compulsive behaviors (ie ≥ 35% reduction in MGH-HPS results), whereas the mean effective dose of dronabinol was 11.6 ± 4.1 mg/day. The drug was well tolerated, without significant deleterious effects on cognitive functions.
Based on the results obtained, the researchers found that dronabinol showed a statistically significant reduction in the symptoms of trichotillomania, with no negative effects on cognitive functions. However, the researchers used a small sample (14 women) hence the results might not suffice.
With that being said, the experience of the scientists from 2011 will not be in vain, because more advanced experiments are continuing to test the effectiveness and safety of dronabinol in 50 patients suffering from trichotillomania.
The study itself will last six weeks and will end in August 2020. We already know that dronabinol will be given in a dose of 5 mg a day for the first two weeks, then the dose will be increased to 10 mg a day for the next two weeks, and in the 5th and 6th week the patients will take 15 mg of dronabinol per day.
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