Abstract
N-acetylcysteine, a sulphur-containing amino acid for the treatment of paracetamol overdose and chronic obstructive pulmonary disease, is a widely available off-the-shelf oral antioxidant supplement in many countries. With the potential to modulate several neurological pathways, including glutamate dysregulation, oxidative stress, and inflammation that can be beneficial to the brain functions, N-acetylcysteine is being explored as an adjunctive therapy for many psychiatric conditions. This narrative review synthesises and presents the current evidence from systematic reviews, meta-analyses, and latest clinical trials on N-acetylcysteine for addiction and substance abuse, schizophrenia, obsessive-compulsive and related disorders, and mood disorders. Good evidence exists to support the use of N-acetylcysteine as an adjunct treatment to reduce the total and negative symptoms of schizophrenia. N-acetylcysteine also appears to be effective in reducing craving in substance use disorders, especially for the treatment of cocaine and cannabis use among young people, in addition to preventing relapse in already abstinent individuals. Effects of N-acetylcysteine on obsessive-compulsive and related disorders, as well as on mood disorders, remain unclear with mixed reviews, even though promising evidence does exist. Larger and better-designed studies are required to further investigate the clinical effectiveness of N-acetylcysteine in these areas. Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects. Current evidence supports its use as an adjunctive therapy clinically for psychiatric conditions, administered concomitantly with existing medications, with a recommended dosage between 2000 and 2400 mg/day.
Highlights
IntroductionN-acetylcysteine (molecular formula: C5H9NO3S) is an acetylated derivative of cysteine, a sulphur-containing amino acid (see Figure 1)
N-acetylcysteine is an acetylated derivative of cysteine, a sulphur-containing amino acid
It is being explored as an adjunctive therapy for many psychiatric conditions. [1, 2] With early life stress found to be associated with the onset and the severity of many psychiatric conditions in adulthood, N-acetylcysteine is a potential preventive therapy for young at-risk subjects. [3,4,5]
Summary
N-acetylcysteine (molecular formula: C5H9NO3S) is an acetylated derivative of cysteine, a sulphur-containing amino acid (see Figure 1). As an antioxidant precursor to glutathione, N-acetylcysteine has been used as a prodrug in the clinical treatment of paracetamol overdose for over 30 years.[1] More recently, it has been applied as a mucolytic in the treatment of chronic obstructive pulmonary disease, cystic fibrosis, and contrast-induced nephropathy.[1] Nacetylcysteine is widely available in many countries, including USA, Canada, and Australia, as an inexpensive offthe-shelf nutritional supplement commonly marketed as a potent antioxidant for brain functions It is being explored as an adjunctive therapy for many psychiatric conditions. Based on the latest inclusion dates of the selected systematic reviews and meta-analyses, we searched for newer randomisedcontrolled trials to augment the evidence base
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