Atomoxetine-Induced Spontaneous Seminal Discharge in Adult ADHD With Trichotillomania: Case Report and Literature...

Trichotillomania disorder is a psychiatric condition characterized by recurrent hair-pulling behaviors that result in substantial distress or impairment. Comorbidity between trichotillomania and adult attention-deficit/hyperactivity disorder (ADHD) is challenging, and an increasing body of evidence suggests a neurobiological overlap between the two conditions, particularly in the areas of executive functioning and inhibitory control. Atomoxetine is a selective norepinephrine reuptake inhibitor approved for ADHD by the Food and Drug Administration (FDA). It has been recommended for ADHD patients comorbid with anxiety disorders. Although most people can tolerate atomoxetine, there have been reports of uncommon side effects, such as sexual problems. This case report describes a 37-year-old man diagnosed initially with trichotillomania and generalized anxiety disorder and started on fluoxetine 20 mg for six weeks with substantial symptoms improvement of both disorders. Unfortunately, the patient exhibited increased impulsivity and irritability, which hindered his daily life functioning. Given this paradoxical response, fluoxetine was terminated. A multisession reassessment revealed lifelong ADHD with inattention, disorganization, emotional dysregulation, and impulsiveness. Consequently, Atomoxetine initiation/titration (25→75 mg) was attempted; however, he experienced spontaneous seminal discharge 6 weeks later. The assessment and workup included a normal urologic exam. We systematically evaluated potential infectious, inflammatory, and endocrine causes, checking testosterone, prolactin, LH/FSH, TSH, and urinalysis, all of which fell within the reference ranges. Subsequently, Atomoxetine was gradually withdrawn, and this rare side effect, seminal discharge, resolved within five days post-cessation of the medicine. After three months of monitoring, we re-evaluated ADHD and trichotillomania, adjusted the therapy, and observed that there was no recurrence of symptoms. This instance shows the importance of careful monitoring for rare side effects in people with complex psychiatric comorbidities.