Amino Acid Therapy and Trichotillomania

Amino acid therapy can be very effective at restoring proper neurotransmitter function and alleviating the insatiable urge to pull that some many people with trichotillomania experience. There are really two ways in which amino acids are used for people with trichotillomania. The first is to use n-acetyl cysteine, or NAC, which has been shown in clinical trials to reduce the urge to pull in about 56% of people that use NAC (see our post entitled N-acetylcysteine and Treatment of Trichotillomania for more information). NAC is thought to work by increasing the concentration of glutamate (an excitatory neurotransmitter) in a part of the brain that reduces compulsive behavior and hair pulling. Glutamate works in conjunction with GABA (an inhibitory neurotransmitter) to control many functions in the body. Thus, NAC provides a safe and moderately effective strategy to use amino acid therapy to decrease the urge to pull associated with trichotillomania.

However, we have found that a more effective way to implement amino acid therapy in regards to trichotillomania is to address the serotonin/dopamine system.  By providing the brain the proper proportion of the necessary amino acid precursors and cofactors necessary to achieve optimal serotonin and dopamine function we have had an 86% success rate with eliminating the urge to pull, as opposed to just reducing the urge to pull.

This increased success rate is attributed to the fact that dopamine exhibits control over the release of glutamate and GABA in certain parts of the brain. Therefore, the imbalance between glutamate and GABA that leads to trichotillomania in most people is likely to be caused by an imbalance with dopamine and serotonin (as they are farther upstream). By optimizing serotonin and dopamine function, all the systems downstream, including glutamate and GABA normalize as well. When this happens, the urge to pull disappears.

Another key distinction between using NAC or this balanced amino acid approach is the ability to remain symptom free once the amino acid(s) have been discontinued. With NAC, the urge to pull often returns once the supplement is discontinued (this provides further evidence that NAC may not be addressing the root cause of the imbalance). However, with balanced amino acid therapy we have found that once optimized neurotransmitter function is established and maintained for a period of time, most people can reduce or eliminate the amino acids and remain symptom free utilizing dietary and lifestyle factors to maintain optimal neurotransmitter status.  This means that it is very likely you won’t have to take these supplements forever and you can remain trichotillomania-free. This occurs because we are addressing the underlying root imbalance that seems to lead to the urge to pull for most people with trichotillomania. By correctly the underlying neurotransmitter imbalance with balanced amino acid therapy you effectively eliminate the problem, which allows you to stop pulling your hair out.

A Touching Story

Lacey was at wit’s end with trichotillomania. She had pulled for 28 years, with no end in sight. She had constant, uncontrollable urges and could not stop pulling hair out. She thought she was mentally ill, and worse, she feared that she’d pass along trich to her 4 year-old son.

Then she met Dr. Chad Oler, and everything changed. Listen to her story, and find out how she learned to stop pulling hair out.

Lacy’s Podcast

When Lacey found Dr. Chad, she discovered a way to stop pulling hair out that’s surprisingly easy, has produced dramatic results, and is ready for you to start IMMEDIATELY.

Treatments for Trichotillomania – What Works and What Doesn’t

A search of the internet for ‘treatments of trichotillomania’ brings back over 335,000 results. This can make the search for a viable treatment option very difficult, if not downright impossible.  However, upon closer investigation, you will find that there are really only a few treatments for trichotillomania that have any scientific evidence behind them, although even within this select group of therapies, results are highly individualized.

Treatments for Trichotillomania

Cognitive Behavioral Therapy (CBT): Cognitive behavior therapy attempts to alter behavior by identifying environmental factors that trigger hair pulling and then helping a person learn skills to interrupt and redirect their responses to those triggers. Used over time, the new behavior replaces the old (i.e., pulling). CBT should be performed by a therapist trained in this method, ideally with experience in the treatment of trichotillomania. Certain methods of CBT such as Habit-Reversal Training and the Comprehensive Model for Behavioral Treatment of Trichotillomania have shown to be the most successful CBT treatments for trichotillomania, so be sure to ask your provider if they use or have been trained in these therapies.

Medications: many medications have been tried as a treatment for trichotillomania. Unfortunately, the results have been disappointing (see other posts on this site for more information on drug treatments for trichotillomania). That said, some people do benefit from drug therapies, either alone or in conjunction with cognitive-behavior therapy or amino acid therapy. The effect, however, is almost always temporary because drug therapies cannot address the underlying cause of trichotillomania in most people. In addition, the use of medications for the treatment of trichotillomania in children or adolescents brings additional concerns. Very few drug trials involve children and to date there have been no studies of the use of medication for the treatment of trichotillomania in children.  Due to the limited evidence supporting these medications effectiveness, as well as concerns about the long-term effects of medications on the developing brain, several groups, including the Trichotillomania Learning Center’s Scientific Advisory Board have advised that “for most children and adolescents with trichotillomania, medications should not be used as a treatment of first choice.”

Amino acid therapy: Amino acid therapy involves providing the body the nutrients it needs to optimize neurotransmitter balance in the body. One of the main underlying causes of trichotillomania for many people is an imbalance in one or more neurotransmitters. The ONLY way to correct this for the long term is to supply the body the amino acids and co-factors it needs to restore proper neurotransmitter balance, which will eliminate the urge to pull, allowing you to stop pulling.  Once the urge to pull is gone, other therapies, like Cognitive Behavior Therapy are much more effective as a treatment for trichotillomania in order to address any remaining behavioral and/or habitual triggers to pull.

It can be a confusing and frustrating experience for people searching for treatments for trichotillomania. However, after looking at the scientific and clinical evidence, only two have shown reproducible results – cognitive behavioral therapy and amino acid therapy – for people with trichotillomania.

Trichotillomania Cures

I am often asked if our approach ‘cures’ trichotillomania. The simple answer is ‘it depends’.

The word ‘cure’ or ‘curing’ are used and strictly protected as medical terms, only to be used by medical doctors and other health care professionals that are licensed to practice medicine. Judging by the number of law suits against integrative, complementary and alternative practitioners who have mistakenly used this term in regards to what they do, I’d say that it is strictly enforced. As I am a naturopathic doctor and do not practice medicine, I am not entitled to use the terms ‘cure’, ‘cures’ or ‘curing’ in relation to what I do or to describe the effects that what I recommend may have on or for a person.

Interestingly, the general public often use these terms without recourse. I even had one client look up the word ‘cure’ and forward me the definition: ‘A cure or remission is the end of a medical condition’, so they stated that because we helped them eliminate the urge to pull their hair out, we helped them ‘cure’ their trichotillomania and should therefore be listed in any list of ‘trichotillomania cures’.

While I am glad this person feels better, this discussion brought up a couple additional points that are important to keep in mind (not only for a person considering amino acid therapy, but also for me as a complementary health care practitioner). In addition to the above discussion about the use of the words ‘cure’, ‘cures’ and ‘curing’, we are not specifically addressing any medical condition(s), including trichotillomania using amino acid therapy. What we are doing is looking for and addressing fundamental root imbalances in body or brain chemistry and addressing them using natural methods if at all possible. These imbalances can manifest themselves in conditions that are diagnosed by medical professionals as trichotillomania. However, they can also manifest themselves in other ways that prompt people to seek medical help; these diagnoses can include depression, anxiety, OCD, ADD, ADHD, insomnia, migraines, fibromyalgia and numerous other sets of symptoms labeled as ‘diseases’ by the medical profession.

We don’t concern ourselves nearly as much with what a group of symptoms is called by the medical profession as we do with figuring out what imbalances created these symptoms and addressing those underlying imbalances. By addressing the underlying imbalances, our clients often see a reversal of many previously diagnosed medical conditions, not just the one(s) they are seeking us out for. That is why when you read the many testimonials and background information about amino acid therapy throughout this site, you see that many, many conditions can be corrected through the proper use of amino acid therapy. We cannot say amino acid therapy ‘cures’ trichotillomania or any other diagnosed medical condition as I am not a medical doctor; I am a naturopath.

But what really matters is that by finding and addressing the underlying neurotransmitter imbalances that a person with trichotillomania has, they can eliminate the urge to pull. If they want to find out if they are ‘cured’ or if this ‘cures’ trichotillomania, they just need to ask their medical doctor if no longer having the urge to pull means that they are ‘cured’.

Stephanie’s Story

We just did a post on Stephanie’s story with trich and how amino acid therapy helped her ‘beat trich’ in her words. I wanted to follow up with a couple points regarding Stephanie’s story to point out a few things that we see often when working with people with trich.

First, many people see results in just a month or two, just as Stephanie did. In fact, about 80% of people can completely eliminate the urge to pull in that time frame. For those 20% that don’t, additional testing is used to help them eliminate the urge to pull.

Second, once we find the right dose of amino acids that a person needs, they need to take them about 6-9 months before we can start tapering the dose without the recurrence of symptoms. If a person misses a dose or multiple doses, the urge to pull will often return within a few days and will persist until a person gets back on the recommended supplements for about 3-5 days. This means that the person continues to need the amino acids to eliminate the urge to pull.

Third, eliminating the urge to pull does not mean that a person automatically stops pulling. We’ve talked in other posts about the difference between the urge to pull (the compulsion) and the behavior of pulling. Once the urge is gone, a person can still find themselves pulling when they get triggered by certain events (the most common one is stress). When this happens, they may find their hands playing with or pulling their hair before they even realize what is happening. The difference is that once they become conscious of it, a person on the proper dose of amino acids and stop pulling and not think about it anymore. This is where other therapies, such as stress reduction, exercise and Cognitive Behavioral therapies can be a big help.

Fourth, exercise, lifestyle and dietary recommendations can often decrease the need for amino acids. If a person addresses the day-to-day reasons for neurotransmitter imbalance, they can often substantially reduce the amount of amino acids they need over time to eliminate the urge to pull.

And finally, just like Stephanie, many people can reduce and eliminate the need for the amino acids and still have no urge to pull. Most of the time, these people have taken the amino acids as recommended for at least 6-9 months and have incorporated other strategies to help deal with the behavioral and environmental component of pulling (we help guide them through this process as well). This provides them the life skills that they need to function as they want to without the need for the amino acids. This doesn’t always happen, but it happens a great deal of the time, and it’s so wonderful to see the confidence, the pride and the relief in the people that ‘beat trich’ as Stephanie did.

Image: scottchan / FreeDigitalPhotos.net

Trichotillomania in Children

Trichotillomania, or ‘trich’, often shows its first signs in childhood. In fact, we see trichotillomania in children as much as in adults, and the majority of the adults we work with had their first symptoms of trich as children.

It is not uncommon for trichotillomania in children to start right around puberty. I haven’t seen any data to give concrete rationale why this is, however, it would not be a stretch to say that there are obviously a lot of hormonal changes going on during this period as well as elevated stress due to social pressures, body changes and self-awareness. These coupled together could cause or exacerbate the neurotransmitter changes that often lead to trichotillomania in children and the urge to pull.

However, it is interesting that we see many children, mostly girls, that exhibit trichotillomania symptoms well before puberty. We have a large number of girls that are between 7-11 years old that have been diagnosed with trichotillomania or have been referred to us by their parents after they have done their own searching on the internet to try and determine what is happening with their kids.

The great news is that children often respond very quickly with amino acid therapy. In fact, we’ve only had a couple cases where amino acid therapy hasn’t completely eliminated the urge to pull in these kids.

For parents, seeing their kids pulling, or the effects of their pulling – such as missing eyebrows or eyelashes, bald spots on their head or other part of their bodies or bald spots on pets – can be a traumatic experience. However, it is often not until the parent sees the shame or despair in their child’s eyes when they talk about pulling or not being able to stop or help themselves that the true tragedy of this condition hits home.

Trichotillomania in children is reversible with amino acid therapy. Once your child experiences this relief, you will be able to look into your child’s eyes and see not shame, fear or despair, but the joy of being a kid free from the burden of trich.

Drugs That Are Useful for Trich

‘Trichy’ Drugs

The Clinician’s Guide to the Treatment of Trichotillomania available through the Trichotillomania Learning Center website (www.trich.org) lists several potential medications that have been found useful for some people with trich.

These include clomipramine (trade name Anafranil) which has the capacity to block the reuptake of serotonin and norepinephrine, which are two key neurotransmitters in the brain and venlafaxine (Effexor), which shares similar chemical properties as clomipramine and also has documented benefits in trichotillomania. In addition, several studies using antidepressant medications that block the reuptake of serotonin alone, called selective serotonin reuptake inhibitors (SSRI’s), including fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft), have shown mixed results.

The problem is, as the TLC site points out, that even though individuals often have a reduction in hair pulling in response to the above medications,” improvement is often modest and rarely complete. Some individuals experience initial improvement but find that the effect wears off with time.” In addition, these drugs also often create many unwanted side effects that cause people to discontinue using them.

The reason for the lackluster success of these medications is that although they are targeting one of the key reasons people experience trich – namely, neurotransmitter imbalance – they do nothing to actually restore proper neurotransmitter function in the body. They are simply shuffling the neurotransmitters around in an attempt to trick the body into thinking there is more of a given neurotransmitter than there actually is. They do nothing to actually increase the amount of the neurotransmitters present in the brain and do not help improve neurotransmitter imbalance(s) or function. However, they do cause further depletion of neurotransmitters over time, which is why the effects may ‘wear off with time’ and why many people find that their symptoms are worse when they stop taking a drug than before they started.

It is also interesting to note that even though people suffering from trich may not see a decrease in hair pulling, they may experience improvements in other areas of their lives using the drugs above. The TLC Guide states that “many individuals who do not experience much improvement in their hair pulling report improvement in other areas such as reduction of anxiety and improvement of mood.” This is because areas such as depression and anxiety are also under direct influence of neurotransmitters. However, because the drugs are not actually helping address the underlying imbalance(s), these effects will also wear off with time.

So what’s the answer? Give the body the nutrients it needs to restore proper neurotransmitter balance and function. Doing so addresses the underlying cause that creates the urge to pull for most people. It will also improve any other disorders associated with improper neurotransmitter balance, including improvements in depression, anxiety, mood, sleep, migraines and a host of other ailments. The best part is, there are no side effects, as all you are doing is restoring proper neurotransmitter balance. No tricking the body, no artificial chemicals and no urge to pull – that is a great combination for success!

Neurotransmitter Systems Priority

This post has to do with the optimal sequence we follow to help people get to their goals. In regards to neurotransmitter related disorders, there is a definite sequence that works best.

The serotonin and/or catecholamine system has a role, either directly or indirectly, in controlling most of the other systems and functions in the body. For example, cortisol synthesis is controlled in part by norepinephrine. Hormone synthesis is dependent on norepinephrine. The sympathetic nervous system is controlled by norepinephrine.

We have noted previously that neurotransmitters are chemical messengers in the body that control bodily functions. There are many other chemical messages as well, including hormones. With hormones in particular, we have found that if we balance the primary neurotransmitters as a first course of action (i.e., serotonin and dopamine), many symptoms associated with hormone imbalance (e.g., hot flashes, mood swings, irregular menses, etc.) often resolve. Therefore, it is our assertion that in most cases, the primary neurotransmitters need to be balanced first (or at the very least in concert with hormones) in order to properly manage symptoms of hormone imbalance.

In addition, other neurotransmitter systems are partially controlled by the serotonin and/or catecholamine systems. For example, the GABA neurotransmitter system is associated with control of anxiety and panic attacks. Yet when the serotonin and/or catecholamine neurotransmitter levels are brought to proper levels, as confirmed by lab testing, these diseases may be fully under control. This would indicate control of GABA by the serotonin / catecholamine system even though at this time we have been unable to identify a chemical pathway for such in the literature. Therefore, it is also are assertion that we need to rebalance the primary neurotransmitters first (i.e, serotonin and/or dopamine) before moving onto to secondary neurotransmitters (i.e., GABA, glutamate, etc.).

We have shared a lot of information in various posts on the science of amino acid therapy and we hope that it provides you a more thorough understanding about how and why amino acid therapy is a very viable and effective therapy to use with trichotillomania and why we have had such great success eliminating the urge to pull.

Trichotillomania and Stress

Here is a story that sounds so familiar that I wanted to share it:
Trichotillomania Story

In it, Michelle explains that her pulling started after a severe amount of stress and that she often pulls more when she is stressed out. This is very, very common as stress is one of the key reasons neurotransmitter imbalances develop (see our latest post on 2 Major Causes of Neurotransmitter Imbalance).

Even though you can rebalance your neurotransmitter levels through proper amino acid therapy, properly addressing chronic stress involves a lot more than taking pills. As Michelle points out, she feels she could deal with this much better with a strong support network; this is, in fact, exactly what we have found in our clinic as well. Luckily, that support network can be made up of not only people you can see day-to-day, but also those who you can interact with via social networks and online forums. The key is to feel and be connected – to others and often to whatever higher power you believe in.

Outside of staying connected and feeling supported, many people need to implement specific daily strategies to help them management stress. This may include psychotherapy, EMDR, meditation, yoga, deep breathing, exercise and any number of other daily or regular therapies to help them lessen the impact stress has on their lives.

It may not seem easy, but getting the pieces in place certainly raises the potential for eliminating the urge to pull. Once more, it also sets the stage for long term health and healing on many levels.

Amino Acid Therapy: The What’s, How’s and Who Cares: Part 2

Once your neurotransmitter levels are rebalanced, your symptoms will disappear. This is like a ‘light-switch’; you either have enough or you don’t. When you do, you will wake up one day and your symptoms will be gone. It often seems miraculous, but it is actually just a sign of balanced brain chemistry. You will be back in control and able to function optimally.

Once this happens, you will stay on that dose of amino acids for 6-9 months while your body replenishes its stores of neurotransmitters. After that time, we will work with you to steadily decrease the amino acids to the minimum dose necessary to keep your symptoms under control. Many people can eliminate the need for the amino acids altogether with the proper dietary and lifestyle adjustments.

There are four reasons why someone would need to take amino acid products ongoing in order to control their symptoms:

1. Head trauma – this can cause permanent nerve damage and the need for continual amino acid therapy
2. Neurotoxicity – this is caused by environmental and/or other toxic exposure that permanently damages neurons
3. Genetics – a person can have impaired ability to create or maintain proper neurotransmitter imbalance from birth
4. Continuation of dietary or lifestyle habits that cause neurotransmitter imbalances

The first three are permanent states and people with these impairments will need some amount of amino acid therapy to remain symptom free. However, the amount needed long-term is often much less than the amount needed to establish proper neurotransmitter balance. The fourth cause is completely correctable and we will work with you to establish the dietary and lifestyle habits to help you maintain neurotransmitter balance.

Note: you cannot substantially increase your neurotransmitter levels through diet or lifestyle alone, but you can maintain your neurotransmitter levels using diet and lifestyle. This is because in order to achieve proper neurotransmitter balance, you need specific doses of specific nutrients at specific times to maximize absorption and conversion of the raw materials into neurotransmitters. Even though the raw materials used are normal components of food, they are administered in much higher amounts and in different combination than those found in food.

Also note: many medications can cause depletion of neurotransmitters, including all anti-depression, anti-anxiety, migraine and sleep medications. If you have taken or are currently taking medications that deplete neurotransmitter levels (including all selective serotonin reuptake inhibitor (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) medications), you may want to consider taking the following to restore proper nutritional status:

CoQ10 (100 mg) – 1 gelcap daily with food

Glycogenics – 1 tablet twice daily with food

In addition, taking a low level of amino acid therapy along with these medications will help stop further depletion of neurotransmitters and will help improve the effectiveness of anti-depression, anti-anxiety, migraine and sleep medications (including all SSRI and SNRI) medications.

For more information, please visit our websites (www.naturalpathhealthcenter.com, www.optimalbodybalance.com or www.stoppullinghairout.com ) or www.neuroassist.com.