Stimulants, aripiprazole, and two SSRIs top the FDA’s reports of drug-linked trichotillomania
STUDY: Huang RS et al, Journal of Cutaneous Medicine and Surgery 2026
STUDY TYPE: Pharmacovigilance study
FUNDING: Independent
Background
Trichotillomania, compulsive hair-pulling, has a well known link to dopaminergic medications like amphetamines. This study searched the FDA’s adverse event database to broaden our view of medications might also trigger the behavior.
The Study
- 397 trichotillomania reports submitted to the FDA from 2003 to 2025.
- Median age 15; 65% female.
- Each drug’s reporting rate was compared with all other drugs in the database.
Results
Six drugs were reported with hair pulling far more often than expected:
- Lisdexamfetamine: 85 times the expected rate
- Aripiprazole: 77 times (96 reports, the most of any drug)
- Atomoxetine: 61 times
- Methylphenidate: 52 times
- Fluoxetine: 21 times
- Paroxetine: 17 times
Half of these drugs treat ADHD, which itself raises the risk of hair pulling. Depression, anxiety, and obsessive-compulsive disorder carry the same risk, muddying the aripiprazole and SSRI signals. On the other hand, lisdexamfetamine and methylphenidate raise dopamine, as does aripiprazole (at D3), a possible mechanism.
Case reports add weight. In one, hair pulling started after aripiprazole, worsened with a dose increase, and resolved within two days of stopping. Similar cases exist for lisdexamfetamine and atomoxetine.
Practice Implications
- These reports can’t prove cause, and 397 cases over 22 years make this a rare event.
- Watch for trichotillomania and other compulsive behaviors on dopaminergics, including the D3 partial/agonists like aripiprazole which can cause compulsive gambling as well.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
