When do you consider the use of N-acetylcysteine (NAC) in patients with trichotillomania?  

Generally speaking, there is no FDA-approved medication available to date for the treatment of trichotillomania. Various case reports have shown variable benefits with SSRIs, SNRIs, TCAs, and antipsychotics. However, Habit reversal therapy (HRT) is the gold standard for the treatment. N-Acetylcystei...

Consider using memantine, well well-tolerated and has evidence. I've used it successfully.Grant et al., PMID 36856701NAC is usually the go-to, but it doesn't always work and apparently, it doesn't taste good. I've had memantine work as monotherapy for skin excoriation disorder or trichotillomania in...

I completely agree with Dr. @Jafferany above. If patients have not benefited from targeted psychotherapy or have logistical hurdles to engaging in the therapy (cost, time, availability, motivation), then a trial of an SSRI or SNRI is worthwhile. I frequently will add N-acetylcysteine to the medicati...