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These gaps suggest that a higher level of evidence is needed to address this issue [14]

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[46] Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have limited usefulness in treating trichotillomania, and can often have significant side effects

Flora SD, Grassi C, Carati L

Since there are known APOE -dependent differences in the gut microbiota in both humans and APOE-TR mice (Tran et al., 2019), L-carnitine metabolism could be impacted and, in turn, affect cerebrovascular function by disturbing normal L-carnitine shuttle function, particularly if other vulnerabilities are present

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