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Review
. 2022 May;36(5):451-482.
doi: 10.1007/s40263-022-00907-3. Epub 2022 Mar 22.

The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders

Richard C J Bradlow  1 , Michael Berk  2   3   4   5 , Peter W Kalivas  6   7 , Sudie E Back  7   8 , Richard A Kanaan  9   10
Affiliations
Review

The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders

Richard C J Bradlow et al. CNS Drugs. 2022 May.

Erratum in

Abstract

N-acetyl-L-cysteine (NAC) is a compound of increasing interest in the treatment of psychiatric disorders. Primarily through its antioxidant, anti-inflammatory, and glutamate modulation activity, NAC has been investigated in the treatment of neurodevelopmental disorders, schizophrenia spectrum disorders, bipolar-related disorders, depressive disorders, anxiety disorders, obsessive compulsive-related disorders, substance-use disorders, neurocognitive disorders, and chronic pain. Whilst there is ample preclinical evidence and theoretical justification for the use of NAC in the treatment of multiple psychiatric disorders, clinical trials in most disorders have yielded mixed results. However, most studies have been underpowered and perhaps too brief, with some evidence of benefit only after months of treatment with NAC. Currently NAC has the most evidence of having a beneficial effect as an adjuvant agent in the negative symptoms of schizophrenia, severe autism, depression, and obsessive compulsive and related disorders. Future research with well-powered studies that are of sufficient length will be critical to better understand the utility of NAC in the treatment of psychiatric disorders.

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Conflict of interest statement

Bradlow, R., Kalivas, S., and Back, S., declare that they have no conflicts of interest. Professor Michael Berk received Grant/Research Support: NHMRC Senior Principal Research Fellowship (1156072), Cooperative Research Centre Speaker remuneration: Astra Zeneca Bristol Myers Squibb Eli Lilly Glaxo SmithKline Lundbeck Pfizer Sanofi Synthelabo Servier Solvay Wyeth. Consultant payments: Servier, Lundbeck, Otsuka, Milken Institute, Sandoz/SASOP, Allori for Eisai, Janssen, 28th Symposium Controversias Psych, Mental Health Commission Govt Aust, ASCP, Medplan Canada, European Psych Assoc, Abbot, AstraZeneca, Merck, Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Janssen, Thieme Pharmacopsychiatry Journal – Advisory Board Member, BeyondBlue – Research Advisory Committee Member, Australian Early Psychosis Collaborative Consortium (AEPCC) Advisory Council Member. Patents: Michael Berk is a co-inventor of two patents regarding the use of NAC and related compounds for psychiatric indications, which, while assigned to the Mental Health Research Institute, could lead to personal remuneration upon a commercialisation event. Professor Kanaan has received grants from The Defense Health Foundation and the Sir Edward Dunlop Medical Research Fund for a clinical trial of NAC in PTSD. He has also received the donation of NAC from Bioadvantex Pharma for the trial.

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