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or naltrexone may potentially reduce the problematic pulling and picking behaviours when used in combination with HRT. Treatment outcomes are disappointing and inconsistent, with only partial responses. Therefore, alternative, and more effective treatments are being explored, especially for areas where HRT or NAC is not available or affordable. Local researchers have become particularly interested in the therapeutic potential of Sceletium tortuosum (see, for example, Manganyi et al., 2021). WAYS IN WHICH SCELETIUM TORTUOSUM MAY BE OF USE IN BFRBDS As evident from Sceletium tortuosum ’s nickname – “kougoed/ things to chew on”, this plant is typically consumed orally. When ingested, the isolated key compound present in Sceletium tortuosum – an alkaloid known as mesembrine – interacts with the serotonin neurotransmitter which works similarly to the mechanism of action of SSRIs by inhibiting the reuptake of serotonin, allowing more serotonin availability in the brain, and thus enhancing mood, and lowering anxiety. As mentioned, people with BFRBDs often struggle with high levels of anxiety, which can trigger hair-pulling or skin-picking episodes. The anti-anxiety and mood- enhancing effects of Sceletium tortuosum could potentially help with emotional regulation in breaking the repetitive and compulsive nature of BFRBDs by decreasing urges to engage in hair-pulling or skin- picking. Due to these benefits and their herbal nature, many individuals may consider this natural agent an attractive alternative as fewer adverse effects are expected in comparison to synthetic pharmaceuticals. Sceletium tortuosum use in BFRBDs in humans has not yet been studied. However, an animal study found that a low dose of Sceletium tortuosum reduced psychological stress in rats, which resulted in a 30% decrease in the time spent on self-soothing behaviour such as grooming. Further research on its potential to decrease self- soothing behaviours (arguably a component of body-focused repetitive behaviours) in humans was recommended and could provide insight into these behaviours in TTM and SPD. Another animal study done on rats found that Sceletium tortuosum had therapeutic potential in treating depression, a condition often comorbid in BFRBDs. Even though it has antidepressant properties, studies suggest low response rates to Sceletium tortuosum monotherapy, with recommendations for use in conjunction with evidence- based pharmaceutical treatment. Furthermore, Sceletium tortuosum decreases amygdala activity and increases serotonin availability and may thus reduce anxiety. Moreover, cognitive enhancement effects and positive impacts on emotional processing have also been associated with Sceletium tortuosum usage. Researching these properties in TTM and SPD would therefore add value. CONCLUSION Some research evidence and historical use support the potential psychiatric benefits of Sceletium tortuosum . However, research on the use of this plant in psychiatry is in its infancy and is non-existent in specific disorders such as these BFRBDs. Further research on the safety, feasibility, acceptability, tolerability, and efficacy of Sceletium tortuosum in adults with TTM and SPD is warranted. References available on request. Disclaimer: It is essential to acknowledge that research pertaining to the utilisation and safety of Sceletium Tortuosum in human subjects is currently at an early stage of development. Consequently, this article does not advocate for its current use. Issue 6 | 2023 | MENTAL HEALTH MATTERS | 29 MHM