Stein D J, Bouwer C, Maud C M
Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa.
Eur Arch Psychiatry Clin Neurosci. 1997;247(4):234-6. doi: 10.1007/BF02900220.
Previous trials of selective serotonin reuptake inhibitors (SSRIs) in the treatment of trichotillomania have provided conflicting data. Furthermore, the efficacy of citalopram, the most selective of the SSRIs, in trichotillomania has not previously been documented. Citalopram was used on an open-label naturalistic basis in 14 (1 male and 13 females) patients who presented with chronic hair-pulling and met DSM-IV criteria for trichotillomania. Ratings were completed every 2 weeks for 12 weeks, during which time dosage was increased to a maximum of 60 mg daily (mean dose 36.2 +/- 13.9 mg). One patient was unable to tolerate citalopram. In completers, ratings on each of the scales employed were significantly improved after treatment. Of completers 38.5% were responders (Clinical Global Impressions score of 2 or less) at week 12. Citalopram appears to be safe in trichotillomania, and it may be effective in a subset of patients. Given the relatively low response rate, however, a controlled trial is needed before this agent can be said to be more effective than placebo. The pharmacotherapy of trichotillomania deserves further study.
以往选择性5-羟色胺再摄取抑制剂（SSRI）治疗拔毛癖的试验得出了相互矛盾的数据。此外，作为选择性最强的SSRI，西酞普兰治疗拔毛癖的疗效此前尚无文献记载。本研究对14例（1例男性，13例女性）符合DSM-IV拔毛癖诊断标准的慢性拔毛患者采用开放标记自然观察法使用西酞普兰治疗。在12周内每2周进行一次评分，在此期间剂量逐渐增加至最大每日60mg（平均剂量36.2±13.9mg）。1例患者无法耐受西酞普兰。完成治疗的患者治疗后各量表评分均显著改善。在完成治疗的患者中，12周时38.5%为有效者（临床总体印象评分为2或更低）。西酞普兰治疗拔毛癖似乎安全，对部分患者可能有效。然而，鉴于有效率相对较低，在确定该药物比安慰剂更有效之前，需要进行对照试验。拔毛癖的药物治疗值得进一步研究。
