Memantine for Hair Pulling?Four Trial Checks

The trial combined two diagnoses

A 2023 double-blind trial randomized 100 adults: 53 with trichotillomania, 43 with skin-picking disorder and four with both. Research treatment was memantine 10 mg daily for two weeks, then 20 mg for six weeks, versus placebo, allocated 55 versus 45.¹

Symptom scores and response used different measures

The primary modified 0–20 symptom scale fell 6.98 points versus 1.19 among completers. Separately, 26/43 memantine completers versus 3/36 placebo completers were rated much or very much improved. Twenty-one participants did not finish. Modified scales lacked previous validation; hair regrowth was not the endpoint.¹

Missing results deserve attention

The protocol planned carrying previous observations forward; publication compared completers and analyzed repeated scores without filling missing visits.¹²

Eight weeks cannot establish lasting benefit or long-term safety. Two memantine participants stopped because of dizziness. Grant disclosed Biohaven/Janssen grants; Chamberlain reported Wellcome funding and Elsevier payments.¹

Off-label prescribing needs a separate review

The current US tablet label covers moderate-to-severe Alzheimer’s dementia, making use for pulling or picking off-label. Common adverse effects include dizziness, headache, confusion and constipation. Severe kidney impairment requires a lower dose; tell the prescriber about kidney or liver problems, seizures, pregnancy and breastfeeding. Human pregnancy and milk data are inadequate.³

Bring a complete medicine list, including cough medicines containing dextromethorphan, ketamine, amantadine and sodium bicarbonate. The label cautions about other NMDA antagonists and medicines that make urine alkaline. The study schedule above is not a personal dosing plan.³

NHS⁴ guidance describes habit reversal training, a form of CBT, for trichotillomania: recording pulling, identifying triggers and practising a replacement action. Ask about access to that treatment when discussing medication.⁴

In “What to Say When It Feels Vain,” Hair, Everywhere encourages describing the actual change and its effect on you. For this appointment, include where you pull, how often, any skin damage and treatments already tried. Bring those details even when the visit feels embarrassing.