Pediatric Trichotillomania Medication

  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Apr 16, 2012
 

Medication Summary

Few drug studies on trichotillomania in children and adults exist. However, SSRIs have demonstrated a degree of effectiveness in some patients with trichotillomania. In children, SSRIs (eg, fluoxetine, sertraline, fluvoxamine) may be more advantageous as a medication choice than tricyclic antidepressants (TCAs) because of their milder adverse effects.

Physicians are advised to be aware of the following information and use appropriate caution when considering treatment with antidepressants in the pediatric population.

In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of "depressive illness." After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.

In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients treated with antidepressant medications. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. The FDA has asked that additional studies be performed, because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.

However, a recent study of more than 65,000 children and adults treated for depression between 1992 and 2002 by the Group Health Cooperative in Seattle found that suicide risk declines, not rises, with the use of antidepressants. This is the largest study to date to address this issue.[11]

Currently, evidence does not exist to associate OCD and other anxiety disorders treated with SSRIs with an increased risk of suicide.

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Selective serotonin reuptake inhibitors (SSRIs)

Class Summary

Antidepressant agents chemically unrelated to tricyclic, tetracyclic, or other available antidepressants. Inhibits CNS neuronal uptake of serotonin (5-HT). May also have weak effect on norepinephrine and dopamine neuronal reuptake.

SSRIs are greatly preferred over the other classes of antidepressants. Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when treating a child or adolescent with mood disorder.

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Fluoxetine (Prozac)

 

Selectively inhibits presynaptic serotonin reuptake with minimal or no effect in reuptake of norepinephrine or dopamine. Approved in children aged 8-18 y for major depressive disorder and in children aged 7-17 y for obsessive compulsive disorder.

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Sertraline (Zoloft)

 

Selectively inhibits presynaptic serotonin reuptake. Approved for children aged 6-17 y with OCD.

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Fluvoxamine (Luvox)

 

Potent selective inhibitor of neuronal serotonin reuptake. Does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and, thus, has fewer adverse effects than TCAs. Approved for OCD in children aged 8 y or older.

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Tricyclic antidepressants (TCAs)

Class Summary

These antidepressants are structurally related to phenothiazine antipsychotic agents. They exhibit 3 major pharmacologic actions in varying degrees (ie, amine pump inhibition, sedation, anticholinergic action [peripheral and central]). They also inhibit reuptake of norepinephrine or serotonin (ie, 5-hydroxytryptamine, 5-HT) at the presynaptic neuron.

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Clomipramine (Anafranil)

 

Inhibits reuptake of norepinephrine or serotonin (5-HT) at presynaptic neuron. Approved for children aged 10-17 y for OCD.

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Contributor Information and Disclosures
Author

Cynthia R Ellis, MD  Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Holly Jean Roberts, PhD  Assistant Professor, Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center

Holly Jean Roberts, PhD is a member of the following medical societies: Autism Society of America, National Association of School Psychologists, and Psi Chi

Disclosure: Nothing to disclose.

Connie J Schnoes, MA, PhD  Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson, MD  Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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A close-up picture of typical trichotillomania shows a combination of newly growing young hair, broken shafts, comedolike black dots, empty orifices, and vellus or intermediate hairs.
Typical geometric shape of trichotillomania in a 7-year-old boy. Smooth baldness of the scalp surface at this age is rare.
 
 
 
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