I was recently asked by a client if N-acetyl cysteine (NAC) can increase hair pulling in those with trichotillomania. Apparently, this woman had been doing some research on ways to help her daughter overcoming her hair pulling and found several mixed reports about the use of NAC with people with trichotillomania.
As we’ve reported in the past (N-acetylcysteine and Treatment of Trichotillomania and Beyond NAC – Addressing the Cause) NAC has been used in an attempt to decrease hair pulling in those with trich. The limited research on this subject is promising, with one study showing reduced hair pulling in 56% of people taking 1200-2400 mg/day of NAC. However, we have heard mixed results from clients that had previously tried using NAC for trichotillomania; some had decreased hair pulling with NAC, a few had a complete elimination of the urge to pull as long as they were on the NAC, several had increased hair pulling with NAC and most did not see any change in hair pulling while taking NAC.
The results are not surprising if we look at the underlying brain chemistry. N-acetylcysteine appears to work by reducing the release of glutamate (an excitatory neurotransmitter) into the synapse of neurons in a part of the brain called the nucleus accumbens. The nucleus accumbens plays a key role in our feelings of reward, pleasure, addiction, aggression and fear. By inhibiting the release of glutamate, NAC causes an increase in glutamate concentration in the nucleus accumbens which reduces compulsive behaviors, including hair pulling.
However, as discussed previously, there is a priority in neurotransmitter systems within the body and the glutamate-GABA system is thought to be regulated by the serotonin-catecholamine system in the brain. Therefore, if we move upstream (i.e.., closer to the root cause) and address the serotonin-catecholamine system first, the glutamate-GABA system should (and usually does) correct itself. This is exactly what we find in practice.
Clinically, if we optimize the serotonin-catecholamine system with amino acid therapy, we can eliminate the urges to pull and subsequently decrease/eliminate hair pulling in the vast majority of people with trichotillomania. On rare occasion, a person must then also use other amino acids, like NAC, to completely eliminate the urges to pull.
Everyone with trichotillomania wants to decrease and/or eliminate their urges to pull. In our experience, properly administered amino acid therapy holds the best promise to do so.