Trial reportJournal of the American Academy of Child and Adolescent Psychiatry2013
N-Acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-on trial.
Trial report in Journal of the American Academy of Child and Adolescent Psychiatry, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 8 syntheses or guidelines pooled it, 166 citations in OpenAlex.
- Placebo and nocebo effects of pharmacotherapy for obsessive-compulsive related disorders: a systematic review and meta-analysis.Acta neuropsychiatrica · 2026Pooled it
- Glutamatergic Medications for Obsessive-Compulsive and Related Disorders: A Systematic Review and Meta-Analysis.JAMA network open · 2025Pooled it
- The genetics of trichotillomania and excoriation disorder: A systematic review.Comprehensive psychiatry · 2024Pooled it
- Mitochondrial modulators for obsessive-compulsive and related disorders: a systematic review and meta-analysis.Translational psychiatry · 2022Pooled it
- Pharmacotherapy for trichotillomania.The Cochrane database of systematic reviews · 2021Pooled it
- Measuring Treatment Response in Pediatric Trichotillomania: A Meta-Analysis of Clinical Trials.Journal of child and adolescent psychopharmacology · 2020Pooled it
- Drug Treatment of Trichotillomania (Hair-Pulling Disorder), Excoriation (Skin-picking) Disorder, and Nail-biting (Onychophagia).Current neuropharmacology · 2019Pooled it
- Treating trichotillomania: a meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors.Journal of psychiatric research · 2014Pooled it
- N-Acetylcysteine in the Treatment of Pediatric Tourette Syndrome: Randomized, Double-Blind, Placebo-Controlled Add-On Trial.Journal of child and adolescent psychopharmacology · 2016Trial
- LONG-TERM OUTCOME IN PEDIATRIC TRICHOTILLOMANIA.Depression and anxiety · 2015Trial
- A genomic study of trichotillomania and excoriation disorder in families.Translational psychiatry · 2026Article
- Bridging the Gap between Dermatology and Psychiatry: A Review on Quality of Life in Trichotillomania and Special Considerations in Management.Skin appendage disorders · 2024Review
- Pediatric Treatment-Resistant Obsessive Compulsive Disorder: Treatment Options and Challenges.Paediatric drugs · 2024Review
- Dissecting hair breakage in alopecia areata: the central role of dysregulated cysteine homeostasis.Amino acids · 2024Review
- State of the Evidence for Use of Psychotropic Medications in School-Age Youth.Children (Basel, Switzerland) · 2023Review
- The Potential ofInternational journal of environmental research and public health · 2022Review
- The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders.CNS drugs · 2022Review
- Dramatic Improvement of Trichotillomania with 6 Months of Treatment With N-Acetylcysteine.Global pediatric health · 2022Article
- Trichotillomania and Skin-Picking Disorder: An Update.Focus (American Psychiatric Publishing) · 2021Article
- N-Acetylcysteine for Pediatric Obsessive-Compulsive Disorder: A Small Pilot Study.Journal of child and adolescent psychopharmacology · 2020Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo examine the efficacy of N-acetylcysteine (NAC) for the treatment of pediatric trichotillomania (TTM) in a double-blind, placebo-controlled, add-on study.
methodA total of 39 children and adolescents aged 8 to 17 years with pediatric trichotillomania were randomly assigned to receive NAC or matching placebo for 12 weeks. Our primary outcome was change in severity of hairpulling as measured by the Massachusetts General Hospital-Hairpulling Scale (MGH-HPS). Secondary measures assessed hairpulling severity, automatic versus focused pulling, clinician-rated improvement, and comorbid anxiety and depression. Outcomes were examined using linear mixed models to test the treatment×time interaction in an intention-to-treat population.
resultsNo significant difference between N-acetylcysteine and placebo was found on any of the primary or secondary outcome measures. On several measures of hairpulling, subjects significantly improved with time regardless of treatment assignment. In the NAC group, 25% of subjects were judged as treatment responders, compared to 21% in the placebo group.
conclusionsWe observed no benefit of NAC for the treatment of children with trichotillomania. Our findings stand in contrast to a previous, similarly designed trial in adults with TTM, which demonstrated a very large, statistically significant benefit of NAC. Based on the differing results of NAC in pediatric and adult TTM populations, the assumption that pharmacological interventions demonstrated to be effective in adults with TTM will be as effective in children, may be inaccurate. This trial highlights the importance of referring children with TTM to appropriate behavioral therapy before initiating pharmacological interventions, as behavioral therapy has demonstrated efficacy in both children and adults with trichotillomania.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.