{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:46Z","timestamp":1790983126490,"version":"4.1.0"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"\n Background<\/jats:title>\n Trichotillomania is predominantly managed via serotonergic pharmacotherapy and behavioral interventions. However, options become scarce when patients exhibit extreme intolerance to first-line agents. Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), has been reported in a limited number of cases as a potential treatment option for hair-pulling disorders but remains infrequently used in clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n A 25-year-old female medical student with a 13-year history of severe, stress-triggered Trichotillomania developed debilitating hypersomnia (16\u201318 hours of sleep\/day) during separate trials of fluoxetine and escitalopram. This adverse effect, also historically reported by her mother, forced abrupt drug cessation and caused severe academic decline during medical school. Following intolerance to two selective serotonin reuptake inhibitors (SSRIs), the patient was treated with a combination of bupropion and therapist-guided mindfulness-based behavioral therapy. Over the subsequent two months, she experienced marked improvement in hair-pulling behaviors without recurrence of hypersomnia. Clinical improvement was sustained throughout a 24-month follow-up period after discontinuation of bupropion while continuing intermittent self-directed mindfulness practice.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This case suggests that a combined treatment approach incorporating bupropion and mindfulness-based behavioral therapy may be associated with sustained improvement in trichotillomania when SSRIs are poorly tolerated. Although the individual contribution of each intervention cannot be determined from a single case, this report adds to the limited literature supporting further investigation of non-serotonergic pharmacological strategies in selected patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1938337","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:26:09Z","timestamp":1787203569000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful management of trichotillomania in a patient with SSRI-induced hypersomnia: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Deemah Ateeq","family":"Alateeq","sequence":"first","affiliation":[{"name":"Internal Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.jpsychires.2014.07.015","article-title":"Treating trichotillomania: A meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors","volume":"58","author":"McGuire","year":"2014","journal-title":"J Psychiatr Res"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad177","article-title":"Adverse effects of 21 antidepressants on sleep during acute-phase treatment in major depressive disorder: a systemic review and dose-effect network meta-analysis","volume":"46","author":"Zhou","year":"2023","journal-title":"Sleep"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3814\/2010\/715414","article-title":"Sustain released bupropion in the treatment of tricotillomania: Outpatient follow up survey","volume":"2010","author":"Dannon","year":"2010","journal-title":"SRX Pharmacol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-5-557","article-title":"Bupropion for the treatment of fluoxetine non-responsive trichotillomania: a case report","volume":"5","author":"Bipeta","year":"2011","journal-title":"J Med Case Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e31824858f7","article-title":"Bupropion XL for the sustained treatment of trichotillomania","volume":"32","author":"Berman","year":"2012","journal-title":"J Clin Psychopharmacol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2026.1773677","article-title":"Pharmacogenetics of antidepressant response: a focused review on CYP2C19, CYP2D6, SLC6A4, and HTR2A polymorphisms","author":"Blambila","year":"2026","journal-title":"Front Pharmacol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1938337\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:26:10Z","timestamp":1787203570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1938337\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":6,"alternative-id":["10.3389\/fpsyt.2026.1938337"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1938337","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"1938337"}}