In this article, we discuss the use of venlafaxine, an antidepressant with predominant effects at both noradrenergic and serotonergic reuptake sites, in the treatment of trichotillomania (TTM), a complex psychiatric condition manifested by chronic, severe hair pulling. We review case examples of 10 consecutive patients exhibiting moderately severe TTM symptoms, as judged by self-report, extent of hair loss, and duration of remission, and discuss our observations regarding the effects of venlafaxine therapy (mean dose, 274 mg/day) on these patients over the course of several months (mean, 15.1 weeks). The Massachusetts General Hospital Hair Pulling Scale, Massachusetts General Hospital Trichotillomania Impact Scale (MGH TIS), Psychiatric Institute Trichotillomania Scale (PITS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Clinical Global Improvement (CGI) scale were used to appraise the patients' condition during routine clinical visits. A retrospective chart review of clinical data demonstrated significant improvement in TTM symptoms from baseline to last clinical visit in both behavioral (MGH HPS, P=.02; PITS, P=.02) and psychosocial (MGH TIS, P=.009) terms. Mean improvement on the CGI scale was 2.38±1.51, between “much improved” (2) and “slightly improved” (3). There were no significant differences from baseline to endpoint scores on the BDI or BAI. This retrospective treatment review indicates that short-term treatment with venlafaxine improved TTM symptoms; however, longer controlled trials with extended baseline periods are needed for optimal assessment of pharmacologic treatment of TTM. We look to future studies to confirm and supplement our initial positive findings.