A quick look at the literature shows exactly that; an example:  there is a strong association between sleep disturbances and mood disorders, including depression. (1, 2) In fact, insomnia is reported by more than 90% of depressed patients. (3) This is all well and good, but how do we know that this correlation is due to neurotransmitter levels?

Research shows that in people suffering from insomnia, balancing the brain’s neurotransmitter levels can improve sleep. (4) This has led many researchers to believe that complete relief of insomnia may improve the symptoms of depression. (3) But what does this have to do with trich and the urge to pull?

Well, as we have talked about in previous articles, the urge to pull is often due to or intensified by imbalances in neurotransmitters, including serotonin and dopamine. Decreased sleep can cause, as well as be caused by, imbalances in these same neurotransmitters. This means that if a person has insomnia or purposefully does not get enough sleep over time (i.e., goes to bed late, has odd sleep habits, etc.), neurotransmitter imbalances can result. These imbalances will then lead to increased urges to pull. Incidentally, they also usually lead to increased cravings for carbohydrate or sugar-laden foods, particularly in the afternoon or evening, along with the need for stimulants of one kind or another to keep focused and alert (think coffee, soda, ‘energy’ drinks and chocolate). Unfortunately, in addition to keeping you a little more alert in the short term, these stimulants can also cause further neurotransmitter imbalances that keep you awake – and pulling.

Here are some simple things that you can do to begin lessening the effect of too little sleep on your urge to pull:

1. Get as much sleep before midnight as possible; set a time and go to bed, say at 9-10 PM. Even if you can’t go to sleep right away, do some deep breathing and/or meditation and don’t worry about it. Your body is resting and eventually sleep will come.
2. Set an alarm and get up at the same time daily, even if you don’t fall asleep well the night before. You may be in for a few rough days, but eventually, most people will begin to get into a more normal sleep cycle.
3. Make your bedroom peaceful – turn off the lights, TV, radio and anything else that may distract you or keep you engaged. Sometimes, peaceful music or sounds can help, as can ‘white-noise’ such as a fan. Earplugs often help.
4. Stop drinking liquids 2-3 hours before bed to limit the number of times you need to get up to use the bathroom
5. Keep a notebook by your bed and write down everything that is churning through your mind and make a ‘to-do’ list for the next day. If new things come to you during the night, write them down and forget about them – they’ll be waiting for you in the morning.
6. In the morning, so some exercise or yoga to help you wake up and minimize the need for stimulants. If you still need something, try green tea (Earl Grey Green Tea is a bit heavier for those die-hard coffee drinkers.)

If you have insomnia or long-standing sleep issues, these simple steps are unlikely to be of much help. In this case, a more thorough workup is often necessary and additional therapies may be needed. Luckily, we have found (as have numerous other researchers) that re-establishing optimal neurotransmitter balance can safely and effectively improve sleep over time. This, combined with giving yourself the opportunity to get enough sleep will not only have you sleeping better, it will help you eliminate your urge to pull. Small things really can make a big difference over time and sleep is KING when it comes to maintaining neurotransmitter balance.

References

1. Ohayon MM, roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003 Jan-Feb;37:9-15.
2. Germain A, Kupfer DJ. Circadian rhythm disturbances in depression. Hum Psychopharmacol. 2008 Oc;23(7):571-85.

1. Thase ME. Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry. 1999;60 (Suppl. 17):28-31.
2. Irwin MR, Wang M, Ribeiro D. et al. Sleep loss activates cellular inflammatory signaling. Biol Psychiatry. 2008 Sep15;64(6):538-40.

In particular, we have been seeing a lot of people suffering from trichotillomania that also have insatiable cravings for sweets and/or simple carbohydrates, including breads, cookies, candy, chips, pastries and similar foods. Most people that have this combination of sugar cravings and trichotillomania don’t realize they are connected, and they often feel helpless on both accounts. However, I am here to tell you that not only are they related, they can both be resolved using the same techniques.

Balanced Amino Acid Therapy

Both the urge to pull and cravings for sugar and sweets are regulated by your brain chemistry. The chemical messengers responsible for this regulation are called neurotransmitters, which include serotonin and dopamine. Imbalances in your neurotransmitter function will cause miscommunication, which often leads to symptoms including the urge to pull, cravings and any number of the conditions listed above. However, restoring proper neurotransmitter balance will improve communication and alleviate these conditions.

One of the keys to establishing proper neurotransmitter function is the employment of balanced amino acid therapy. This means that a health care professional trained in the proper use of amino acids will help you determine exactly the right mix of amino acids and cofactors you need in order to establish optimal neurotransmitter function. Once this occurs, not only will your urge to pull disappear, your cravings will also be substantially reduced or eliminated altogether. This occurs because you are addressing the root cause of your problems, and by digging down to the root, you can manage a whole host of symptoms due to neurotransmitter imbalance.

Jenna came to us after her mom had been searching the internet for three years trying to find a solution for her daughter. Jenna had started pulling the hair out of her sheep-skin blanket before progressing to pulling out her eyebrows and then from her head. By the time we spoke with Jenna’s mom, the right side of her head was bald and she didn’t have any eyelashes or eyebrows.

In addition, Jenna had been diagnosed with obsessive compulsive disorder (OCD), with the onset of symptoms occurring when she was just six years old. Her mother stated that she had a period of several years when she did exhibit any OCD symptoms, but that about three years ago, she started constantly washing her hands (to the point that her hands cracked and bled), “straightening things”, developing extensive bedtime rituals and became very worried about contamination and germs. Jenna had been on Prozac for about a year when we first spoke. Both she and her mom were desperate.

We began by attempting to balance out Jenna’s neurotransmitter levels as we always do. However, it became obvious quite quickly that this was not working, so we ran some testing to help guide her care. Jenna’s body was requiring incredibly high levels of amino acids to show any kind of change and the testing was extremely valuable to help make sure we were on the right track.

It took 12 tests and 10 months until she got the result she was looking for. The dedication and support exhibited by Jenna and her parents was incredible over this time period, especially considering that Jenna did not experience any relief of symptoms for the first 10 months we worked together. However, her diligence, and her parents dedication paid off. Like flipping a switch, everything changed.

I spoke with Jenna recently and she told me it was suddenly “easy to control my trich and OCD” and that she “didn’t need reassurance as much”. She was sleeping well, eating normally and doing well in school. Her mom was ecstatic. She said both she and Jenna were realizing most of the repetitive actions were now only habits versus being due to OCD or anxiety and that Ana was now able to differentiate between them and stop when she wanted to. This was a HUGE improvement according to her mom; “We have a life again, and we have our daughter back!” said mom. Now, Jenna’s work is awareness; becoming aware of when she is doing something mindlessly and asking herself if she wants to continue. Now she has control.

Everybody wants instant gratification – and why wouldn’t we? Getting something for less or little effort is always preferable, especially when we are talking about ending what could be a debilitating condition such as trich or OCD. However, when things don’t happen right away and our resolve is tested, then we find out how badly we want a solution. In this instance, desperation was the key to sticking with the program until we achieved the desired result. This means preparing for the long-haul knowing that a resolution will come when we determine exactly what your body needs to achieve balance. We will help you reach your goals, but it is your resolve and dedication that will matter most if and when the going gets tough or the journey grows long.

“I don’t even think about hair pulling.”

We started Denise on amino acid therapy, but she didn’t feel great right off the bat; in fact, she said, “I felt ‘foggy’ at first, but that cleared up. I always felt a little off after taking the amino acids, so I spread them out more throughout the day.” Her hair pulling had improved at this point, but was not eliminated so we adjusted her dosing.

Denise said she “instantly felt so much better – like somebody flipped a switch. I’m more motivated and have a lot more energy. I haven’t felt this good in decades!” She wanted to try and eliminate the Zoloft at this time, so we consulted with her prescribing physician and they came up with a tapering plan.

As Denise continued to taper off the Zoloft, she experienced waves of nausea and occasional depression. We checked her vitamin D levels and found them to be extremely low; once we added in the appropriate amount of vitamin D, the depression disappeared. She also noted that she would occasionally pull her hair out of habit, but that the urges were gone. Denise said, “I don’t pull if I don’t want to.” We recommended she seek out behavior therapy assistance to help her establish new habits instead of pulling.

Once she completed the taper off the Zoloft, the nausea subsided and she said, “I feel darn good – I have forgotten about pulling my hair! I don’t even think about hair pulling!” She continued to have a lot of energy and felt very focused. She also noticed that her appetite had decreased and that her sleep was improving. Most important to Denise, her hair was now growing back and she had absolutely no desire to pull it out, even when she was under stress.

Denise’s story exhibits many facets associated with amino acid therapy. It often takes some individualized tweaking to help restore proper neurotransmitter status; this could mean adjusting the dosing schedule or the amounts of certain amino acids. It usually means adapting the dosing schedule to accommodate each person’s needs.

In addition, as we continued to work with Denise, we also uncovered some other imbalances that we then needed to correct; this too is common. It is a rare occurrence that a single deficiency or imbalance is responsible for the totality of a person’s symptoms. However, by addressing each imbalance as it surfaces, we can continue to peel away the proverbial onion until we’ve gotten to and addressed the appropriate issues. At that time, just like with Denise, many aspects of one’s health will improve; and they will stop pulling their hair.

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.

We started Tina on a very low level of amino acids, as she was a very small girl. However, as the weeks went by we continually ratcheted up her dosing, as the urge to pull was not changing. After about two months, Tina said, “I’m still pulling the hair on my legs and occasionally my eyebrows, but my eyelashes have almost completely grown back in. However, a whole lot of other things have changed. My anxiety is much better and I am not ‘tensing’ as much anymore.”

A couple weeks later, Tina’s parents were ecstatic. Tina’s mom said, “Tina is doing really well! Her eyebrows and eyelashes are mostly grown in and she’s (Tina’s) really proud they are. She will still occasionally pull when she gets really angry, but later she’ll tell us that she just did it because she was mad, not because she felt the urge to pull. In addition, she is not pulling from the dog anymore and all the dog’s bald spots are filling back in. Her anxiety is much better.”

Her dad continued, “A lot of other things have markedly improved. In softball, Tina used to be so scared of the pitch that she would continually jump away from the plate with every pitch. Now, she’s not afraid to stand in there and swing the bat. She even got hit by a pitch last week, and she got right up and got a hit the very next pitch! She also complains a lot less than she used to and is hanging out with her friends a lot more. She also seems to have a better relationship with her friends.”

“I’m 100 times better!”

I just spoke with Tina and her parents and she is continuing to do well as we work with her physician to decrease and eliminate the Zoloft. She’s already cut the dose in half with no negative changes. Tina told me, “I feel 100 times better than I did before. My eyebrows and eyelashes have completely grown back in and I’m not afraid anymore. I have gone swimming a few times with my friends and it feels great.”

Tina came to us when she was still young and hadn’t been pulling for very long. Luckily, her parents took a very active role in her care and didn’t shame or blame Tina for pulling her hair out. Tina’s case was somewhat unique in that she required much higher doses of amino acids than was originally expected. However, with patience, persistence and testing, we were able to determine the correct dosing to get Tina symptom free so she can enjoy being a kid.

Many people find relief in some form of counseling. As we’ve mentioned in several other posts, cognitive behavioral therapy (CBT) works especially well for some people with trich. For many people, simply telling their story and how trich has affected their lives allows them to release a HUGE burden – for this, support groups are wonderful.

If you live in a large city, you may be able to find a local support group where you can go in person. Here is a great resource to see if there is a support group in your area: http://www.trich.org/treatment/support-groups.html.

Going to an actual group can be a big stretch for many people and/or they don’t have the luxury of having a local support group, so online support groups can play a vital role. There are many support groups out there, so find one that works for you. Here are a couple to get you started:

http://trichotillomania.supportgroups.com/

http://www.dailystrength.org/c/Trichotillomania-Hair-Pulling/support-group

http://www.mdjunction.com/trichotillomania-ttm

http://health.groups.yahoo.com/group/TLCTrichSupport/

Check some of these out, read some of the posts and get involved to your comfort level. There are a LOT of people out there that know exactly what you are going through and just connecting with them may help ease some of your pain. It certainly won’t hurt.

There is a great quote that I have posted in my office – “True understanding is found through compassion.” Nowhere is this more true than with trich. Reach out and let yourself be supported.

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

“I was diagnosed with trich in 1^st grade and I’ve pulled every 1-3 days since then. By the time I found Dr. Oler I was 17 years old and had pulled out all my eyebrows, eyelashes and about 50% of the hair on my head. My dad’s a doctor, so I’ve tried pretty much every possible medical treatment and drug for trich out there. They didn’t help me get rid of the urge and I usually felt awful when I took them.

Within a month of starting the amino acid therapy my urge to pull was completely gone! It was great! And unbelievable! Dr. Oler told me to continue my current dosing for 2 months and follow up. Over those 2 months, I pulled a couple times, but it wasn’t an urge; it felt more like the hairs weren’t growing right and I just pulled those and left everything else alone. My eyelashes, eyebrows and hair on my head all started growing back. During this time, I stopped taking the amino acids a couple times, but noticed the urge to pull increased, so I went back to Dr. Oler’s recommendations.

After 2 more months, all my hair was grown back and I wasn’t having any urges anymore. However, I forgot to take my supplements with me when I went away from Christmas and New Years and the urges came back BIG TIME and I pulled everything out again in about 5 days. As soon as I got home, I started the supplements again and didn’t have any urge to pull after about 5 days.

I continued at this dose for 6 months. I wasn’t pulling, my energy levels were great, I slept well, my cravings were gone and I started playing rugby again. I also noticed that my focus, concentration and memory had improved and I was doing better in my classes. I was very content.

After a couple more months, Dr. Oler recommended that we start to decrease the amino acids, as by this time, my neurotransmitter stores should be back to where they belong. I was apprehensive, but reassured that I could always go back to taking what I was currently taking and get the same results within a few days even if the urge to pull returned. I had a little bit of an increased urge to pull after changing the dose, but it only lasted a few days and it wasn’t too bad, but no urges after that.

We continued to decrease the amino acid dosing over time, adjusting as needed if I had an increased urge to pull or stress triggered me to pull. I also started learning some other ways to manage stress, like deep breathing, taking a quick walk around the block and aerobic exercise which helped.

It’s now been two years since I started working with Dr. Oler and I (1) don’t have any urges to pull, (2) am no longer taking medications for trich, and (3) haven’t taken any of the amino acid supplements for over 3 months. All my hair is grown back and I have absolutely no urge to pull anymore unless there is a lot of stress in my life. Even then, I can get through it without pulling very much. I am very content where I am at. Thank you for helping me beat trich!”

-Stephanie, 08/02/11

Image: Graeme Weatherston / FreeDigitalPhotos.net

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.