N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action

N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action

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J Psychiatry Neurosci 2011;36(2):78-86

Olivia Dean, BSc, PhD; Frank Giorlando, MBBS, BMedSc; Michael Berk, MBBCh, MMed(Psych), PhD

Dean, Berk — Mental Health Research Institute, Parkville; Dean, Giorlando, Berk — Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong; Berk — Youth Health Orygen Research Centre, Parkville, and the School of Medicine, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Geelong, Victoria, Australia

Abstract

There is an expanding field of research investigating the benefits of alternatives to current pharmacological therapies in psychiatry. N-acetylcysteine (NAC) is emerging as a useful agent in the treatment of psychiatric disorders. Like many therapies, the clinical origins of NAC are far removed from its current use in psychiatry. Whereas the mechanisms of NAC are only beginning to be understood, it is likely that NAC is exerting benefits beyond being a precursor to the antioxidant, glutathione, modulating glutamatergic, neurotropic and inflammatory pathways. This review outlines the current literature regarding the use of NAC in disorders including addiction, compulsive and grooming disorders, schizophrenia and bipolar disorder. N-acetylcysteine has shown promising results in populations with these disorders, including those in whom treatment efficacy has previously been limited. The therapeutic potential of this acetylated amino acid is beginning to emerge in the field of psychiatric research.


Submitted Mar. 30, 2010; Revised June 2, 22, 2010; Accepted June 24, 2010.

Competing interests: This work was supported in part by a grant from the Australian National Health and Medical Research Council (O.D. and M.B., NHMRC No. 509109) and a Melbourne Research Scholarship (F.G.) to the University of Melbourne. Dr. Berk declares having been a consultant for AstraZeneca, Eli Lilly, GlaxoSmithKline, Janssen Cilag and Servier; his institution has received grants from the Stanley Medical Research Institute, MBF, the National Health and Medical Research Council, Beyond Blue, the Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, GlaxoSmithKline, Organon, Novartis, Mayne Pharma and Servier; he has received honoraria from Astra Zeneca, Eli Lilly, Janssen Cilag, Lundbeck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth; and he has travel funding from Janssen Cilag, Astra Zeneca, Wyeth and Pfizer.

Contributors: Drs. Dean and Berk designed the study. Dr. Dean acquired the data and analyzed it with Drs. Giorlando and Berk. All authors wrote and reviewed the article and approved its publication.

DOI: 10.1503/jpn.100057

Correspondence to: Dr. O. Dean, Mental Health Research Institute, 155 Oak St., Parkville, Victoria, Australia; oliviad@barwonhealth.org.au