Quetiapine for the treatment of trichotillomania.

treatment, because it overlapped with work time. She was started on fluoxetine 20 mg per day, later titrated up to 40 mg per day. Hair pulling and anxiety symptoms improved, but activation side effects occurred, mainly insomnia and weight loss. After 4 weeks of fluoxetine 40 mg per day, quetiapine was introduced, beginning with 25 mg bedtime, titrated up to 100 mg in a week. Both fluoxetine activation side effects and hair pulling remitted in two weeks. Cessation of hair-plucking maintained, at the time of reporting, for a period of 4 months. To date, studies on trichotillomania treatment using behavioral and pharmacological interventions, alone or in combination are equivocal with few showing a sustained cessation of hair-plucking. These studies suggest that the combination of pharmacological treatment and habit reversal therapy (HRT), a cognitive behavioral technique, may be more efficacious for the treatment of trichotillomania than either approach alone.3 Our report supports the need of further investigation of quetiapine, other atypical antipsychotic drugs, and their association with selective serotonin reuptake inhibitors in the treatment of trichotillomania,4 particularly if therapeutic gains would maintain after medication discontinuation, or if additional structured psychosocial intervention is required to yield long-term remission.5