Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania

Background: There is some overlap in the phenomenology and treatment response of trichotillomania, Gilles de la Tourette's syndrome (TS), and obsessive compulsive disorder (OCD). Neuroleptics may play a role in the treatment of TS as well as refractory OCD, and the question arises whether this also holds for trichotillomania. Method: Patients with trichotillomania were treated in open clinical practice with serotonin reuptake blockers. When symptom resolution was incomplete or symptom relapse occurred, low-dose pimozide was added. Results: In six out of seven patients, the addition of pimozide to a serotonin reuptake blocker led to an improvement in hair pulling. In patients who were able to tolerate their medication, this response was sustained. Conclusion: Augmentation of serotonergic agents with dopamine blockers may play a role in the treatment of trichotillomania. Further controlled trials of pimozide augmentation in trichotillomania are needed.