Probable emergence of symptoms of trichotillomania by atomoxetine: a case report

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Atomoxetine is the first nonpsychostimulant agent approved by the Food and Drug Administration for the treatment of ADHD. Trichotillomania (TTM) is an obsessivecompulsive and related disorder characterized by a long-term urge that results in the pulling out of one’s hair from any part of his/her body. Studies have implicated dopaminergic and serotonergic dysfunction in the aetiology of TTM. We report a male patient with ADHD developing of symptoms of TTM following atomoxetine use. Atomoxetine indirectly affects dopamine levels in the mesolimbic dopamine system, similarly to methylphenidate/ amphetamine, and can thus lead to hair pulling behaviour. Further studies concerning the potential adverse effects of atomoxetine, such as the development of TTM, are now needed.