Role of transcranial magnetic stimulation in the management of trichotillomania: A systematic review

Table 2 Characteristics of participants

Ref.	Sample size	Psychiatric morbidities	Concurrent treatment		Past treatment		Outcome scale	Results	Side effects	Conclusion
			Psychotropics (mg/d)	Psychotherapy	Psychotropics (mg/d)	Psychotherapy
Chaudhary et al[18], 2024	1	Not mentioned	Fluoxetine 80 mg, Aripiprazole 2 mg	Not mentioned	Yes (details not mentioned)	Not mentioned	YBOCS, MGH-HPS, and CGI-I	56% and 80% reduction in YBOCS and MGH-HPS scores, respectively. CGI-I scores improved from moderately worse to moderately efficacious. After 6 sessions of maintenance acTBS over 6 weeks, improvement was sustained	NR	First case report for acute and maintenance acTBS which was well tolerated and effects sustained
Di Ponzio et al[19], 2023	14	7 major depressive disorder, 2 ADHD, 4 GAD, 1 bipolar disorder	Selective serotonin reuptake inhibitors: Fluoxetine equivalent of 30 mg	None	Yes (details not mentioned)	Cortical bone trajectory	MGH-HPS and SDQ	Mean percentage of improvement was 58.2% in MGH-HPS and 17.1% in SDQ. No significant reduction after 1 month follow-up. Linear regression analysis indicated no age effect between pre- and post-intervention. Worsening of MGH-HPS scores was at follow-up in older age group	NR	Positive outcomes suggest implications for reward circuits, which are usually used for addictions. This is consistent with the emerging view that obsessive-compulsive and related disorders are behavioral addictions. Worsening of MGH-HPS scores at follow-up in the older age group indicates reduced plasticity in elderly
Aydin et al[17], 2020	5	Case 1 ADHD; Case 2 none; Case 3 none; Case 4 GAD; Case 5 bipolar type II, obsessive-compulsive disorder, alcohol abuse, specific phobia	Case 1 Methylphenidate 36 mg; Case 2 no psychotropics; Case 3 Fluoxetine 80 mg; Case 4 Fluoxetine 20 mg; Case 5 Sertraline 100 mg, Aripiprazole 5 mg, Quetiapine 150 mg	None in all cases	Case 1 Fluoxetine 20 mg; Case 2 Escitalopram 20 mg; Case 3 Fluoxetine 80 mg, N-acetyl cystine 1200 mg; Case 4 no; Case 5 no	Yes in case 1 and case 3	MGH-HPS, Beck’s anxiety inventory, Beck’s depression inventory	Three patients had substantial benefit (100%, 75%, and 70% improvement in MGH-HSP), one patient had 33% improvement. The last patient experienced a mild increase in the severity	Transient flashes in eye for 2-3 session in one case	Repetitive transcranial magnetic stimulation was effective in 3 of 5 patients. One was a partial responder, and the other nonresponder might have been due to multiple comorbidities that acted as confounding factors
Kar et al[21], 2020	2	Not mentioned	Case 1 Escitalopram 30 mg; Case 2 Sertraline 200 mg	Habit reversal therapy	Not mentioned	Not mentioned	MGH-HPS	Reduction of 66.6% and 73.6% in both cases, respectively. Case 1 sustained benefits for 6 weeks, while case 2 was maintained well for 2 months then experienced worsening which improved with psychotherapy for 6 months	NR	Reduction in symptom severity and therapy was well tolerated

ADHD: Attention deficit hyperactivity disorder; acTBS: Accelerated continuous theta burst stimulation; CGI-I: Clinical global impression improvement; GAD: Generalized anxiety disorder; MGH-HPS: Massachusetts General Hospital Hair Pulling Scale; NR: None reported; SDQ: Symptoms of depression questionnaire; YBOCS: Yale-Brown Obsessive-Compulsive Scale.