Trichotillomania under a Therapy with Lisdexamfetamine

Background/Purpose: We report a 9-year-old boy with ADHD, motor tic disorder, and developmental disorder of coordination, who developed a severe and stigmatizing trichotillomania under a therapy with Lisdexamfetamine. After withdrawal of Lisdexamfetamine, the symptoms disappeared.

Methods: A long-lasting therapy with methylphenidate had a good effect on concentration and hyperactivity, but no sufficient effect on the loss of impulse control, which happened mostly in the early morning and late afternoon—when methylphenidate had no effect. Aiming at an effect over the whole day Lisdexamfetamine was started with an outstanding improvement of concentration, hyperactivity and impulse control. After some weeks the boy started to tear his hair on both temporal sides. He suffered of this behavior, but could not stop it. Social problems followed.

Results: After discussions about other possible causes, regarding the comorbidity tic disorder, we stopped Lisdexamfetamine, a few days later the tearing of hair disappeared.

Conclusion: Lisdexamfetamine can trigger a trichotillomania. There were no reports about the side effect so far, only skin picking is mentioned in the prescribing information. The complex neuropsychological clinical picture should be considered.

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