Grant Jon E, Redden Sarah A, Chamberlain Samuel R
J Clin Psychopharmacol. 2019 Mar/Apr;39(2):129-134. doi: 10.1097/JCP.0000000000001005.
Data on the pharmacological treatment of trichotillomania are limited. Milk thistle has antioxidant properties and showed promise in trichotillomania in a prior case report. The goal of the current study was to determine the efficacy and tolerability of silymarin in children and adults with trichotillomania.
Twenty individuals (19 [95.0%] women; 16 adults; mean age, 27.9 [11.5] years) with trichotillomania entered a 12-week, double-blind, placebo-controlled crossover study (6 weeks of milk thistle and 6 weeks of placebo with a 1-week wash-out in between). Dosing of milk thistle ranged from 150 mg twice a day to 300 mg twice a day. Subjects were assessed with the National Institute of Mental Health Trichotillomania Severity Scale (primary outcome), the Massachusetts General Hospital Hair Pulling Scale, Clinical Global Impression scale, and measures of depression, anxiety, and psychosocial functioning. Outcomes were examined using linear mixed models with a random intercept for subject and t tests.
There were no statistically significant treatment type-by-time interactions for the main outcome measure, but significant effects were seen for secondary measures (eg, time spent pulling per day for the past week). From baseline to week 6, there was a significant decrease in Clinical Global Impression severity for the milk thistle group but not in the placebo group.
This trial failed to show that milk thistle was more effective than placebo on the main outcome measure, but milk thistle did demonstrate significant improvements on select secondary outcome measures. These findings may shed light on important neurochemical targets worthy of future investigation.
拔毛癖药物治疗的数据有限。水飞蓟具有抗氧化特性，在之前的一份病例报告中显示对拔毛癖有治疗前景。本研究的目的是确定水飞蓟素对儿童和成人拔毛癖患者的疗效和耐受性。
20名拔毛癖患者（19名[95.0%]女性；16名成年人；平均年龄27.9[11.5]岁）进入一项为期12周的双盲、安慰剂对照交叉研究（6周服用水飞蓟，6周服用安慰剂，中间有1周的洗脱期）。水飞蓟的剂量范围为每天两次，每次150毫克至每天两次，每次300毫克。使用美国国立精神卫生研究所拔毛癖严重程度量表（主要结局指标）、麻省总医院拔毛量表、临床总体印象量表以及抑郁、焦虑和社会心理功能测量指标对受试者进行评估。使用具有受试者随机截距的线性混合模型和t检验对结局进行检验。
主要结局指标在治疗类型与时间的交互作用方面无统计学显著差异，但在次要指标方面有显著影响（例如，过去一周每天拔毛所花费的时间）。从基线到第6周，水飞蓟组的临床总体印象严重程度显著降低，而安慰剂组则未降低。
该试验未能表明水飞蓟在主要结局指标上比安慰剂更有效，但水飞蓟在某些次要结局指标上确实显示出显著改善。这些发现可能为值得未来研究的重要神经化学靶点提供线索。
