NAC for Mental Health
November 4, 2009 Written by JP
[Download PDF]
[Font too small?]
A common theme found in naturopathic medicine is that a substance used for one purpose often ends up benefiting other seemingly unrelated conditions. When this occurs, scientists generally scramble to determine how in the world such a turn of events is even possible. There’s certainly a great deal of value in identifying the underlying mechanisms by which a “medicine” works. But if the body is viewed as a whole, rather than in isolated parts, then the concept of broad spectrum healing tends to make more sense. One example is a rather obscure supplement that reduces the ill effects of oxidants in the body while also promoting a healthier environment in the brain.
N-acetyl cysteine (NAC) is an amino acid (a component of protein) often used to support pulmonary health and protect against medication induced kidney and liver damage. It is a precursor and regenerator of a potent antioxidant in the body known as glutathione. However, several years ago a new role emerged for this natural supplement – as an adjunct in the treatment of psychiatric disorders. (1)
A few recent studies have discovered an application for NAC in the management of some very common compulsive behaviors. The first example is based on three case studies observed at the University of Melbourne, Australia. At the time, a larger study was taking place to evaluate the effects of NAC in patients with bipolar disorder. During the course of the bipolar research, it was noted that 3 patients with anxiety-based nail biting were “cured” after the administration of NAC. Another study from the University of Minnesota investigated whether NAC could help patients with a disorder known as trichotillomania, “repetitive (self) hair pulling that causes noticeable hair loss”. (2,3)
- 50 adults with trichotillomania were randomly given a placebo or NAC (1,200 – 2,400 mg daily) for 12 weeks.
- Standardized tests that assessed levels of anxiety, depression, hair pulling and psychological functioning were conducted pre and post trial.
The patients receiving NAC showed a significant reduction in hair pulling. 59% of the NAC users were “much or very much improved” as compared to 16% in the placebo group. Benefits began to appear after 9 weeks of treatment and produced no detectable adverse reactions.
A case study from 2006 in the journal Psychopharmacology also supports a connection between NAC supplementation and a decline in obsessive-compulsive disorder (OCD). In that instance, the addition of NAC to conventional antidepressant treatment improved OCD symptoms. It’s important to note that treatment with the antidepressant alone was ineffective. Only the combination of the two “medications” produced satisfactory results. The authors of the case study concluded that “further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD”. (4)
Mental health specialists who focus on addictions are also expressing an interest in N-acetyl cysteine. Several different addictive habits appear to respond to the administration of this humble amino acid. A September 2007 study in the journal of Biological Psychiatry tested the effects of NAC in 27 “pathological gamblers”. 83% of the NAC study volunteers responded well to the treatment as compared to 29% in the placebo group. The “mean effective dose of NAC was 1,477 mg” per day. The authors of the experiment explained that NAC “might target core symptoms of reward-seeking addictive behaviors such as gambling”. They also urge for additional “larger, longer, placebo-controlled double-blind studies”. (5)
The greatest amount of research on NAC and addiction has focused on cocaine. Two trials from 2007 provide glimpses of hope for those struggling with this addition. In the first study, 23 “treatment-seeking cocaine-dependent patients” were given varying dosages of NAC (1,200, 2,400 or 3,600 mg daily) over a 4 week period. All dosage levels were well tolerated, but the higher dosages (2,400 – 3,600 mg) produced the best results. The authors noted that “The majority of the subjects who completed the study (16 of the 23) either terminated use of cocaine completely or significantly reduced their use of cocaine”. A separate study was conducted on cocaine-addicted patients in a hospital setting. 15 men and women received either a placebo or NAC during different stages of the experiment. While undergoing NAC treatment, the patients “reported less desire to use and less interest” in cocaine. (6,7)
Scientific reviews from 2008 and 2009 specifically point to NAC as a promising and safe adjunct therapy for cocaine addiction. Researchers believe that NAC may inhibit glutamate (an excitatory brain chemical) activity that prompts drug-seeking feelings. Recent laboratory trials in animal models of nicotine addiction appear to support this theory. (8,9,10)
Two of the most challenging psychiatric conditions to treat are bipolar disorder and schizophrenia. But both conditions may be responsive to NAC therapy. Thus far, it is schizophrenia that has taken the lead in NAC-based research.
A September 2008 study noted that “brain glutathione levels are decreased in schizophrenia”. The authors go on to point of that: a) NAC is known to increase brain glutathione in animal models; b) schizophrenia is often a chronic condition that is unresponsive to conventional treatment and; c) the efficacy and safety of NAC has yet to be established in humans with this condition. To help address the final point, 84 patients with chronic schizophrenia were enrolled in a double-blind, placebo-controlled study. The trial lasted a total of 24 weeks and provided either a placebo + medication or 1,000 mg of NAC + medication twice daily. The patients receiving NAC + medication demonstrated improvements in two standardized diagnostic indices: the Positive and Negative Symptoms Scale and the Clinical Global Impression Severity Scale. Those receiving NAC also exhibited reductions in a common drug-induced side effect known as akathisia, in which patients feel the need to move around in a restless manner (fidgeting, foot tapping, pacing, rocking, etc.). These results are supported by a study from August of 2008 which determined that increased glutathione levels in the brain (via NAC) may improve “auditory sensory processing” in those with schizophrenia. (11,12,13,14,15)
A recent publication in the journal of Biological Psychiatry suggests that N-acetyl cysteine may also be helpful in controlling the depressive symptoms of those with bipolar disorder (sometimes referred to as “manic depression”). Much like schizophrenia, many patients with bipolar disorder exhibit signs of “glutathione depletion” and inadequate response to conventional treatment. A trial involving 75 bipolar patients in “the maintenance phase” were treated with NAC or a placebo, in addition to their standard medicine. The study lasted 24 weeks and involved an NAC dosage of 1,000 mg twice daily. After 8 weeks of treatment, patients using the NAC showed statistically relevant improvements in daily “functioning” and quality of life scores. By week 20, the researchers also noted positive changes in depressive symptoms. The authors of the trial remarked that “NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder”. (16)
While researching today’s column, I browsed through a listing of ongoing and upcoming clinical trials. I noticed that researchers from around the world are continuing to look into NACs potential with regard to alcoholism, autism spectrum disorder, combined addictions (gambling and nicotine), drug addiction and obsessive compulsive disorder. I’m very happy to see this. My sincere hope is that NAC will soon play a bigger role in the safe and sane treatment of these and other mental disorders. If you know someone who’s struggling with with a psychiatric condition, please share this information and encourage them to pass it along to their physicians as well. This is far too important information to remain hidden deep in the well of scientific literature. (17,18,19,20,21)
Be well!
JP
Related Posts:
Tags: Addiction, Autism, Depression
Posted in Mental Health
November 5th, 2009 at 5:31 pm
Isn’t it amazing how a single substance can be applied to so many different uses! NAC is also a powerful antioxidant and can be very beneficial for individuals recovering from chronic disease. Look for a sustained release formula to extend the life of NAC in the bloodstream.
November 5th, 2009 at 5:39 pm
It truly is amazing. Tomorrow I plan to post a column that, in part, discusses NAC in relation to influenza. It’s fascinating substance.
Thanks for adding the sustained release recommendation, Bill. It’s much appreciated!
Be well!
JP
November 6th, 2009 at 6:31 am
Thricotillomania – great word JP!
Lots of Drug Rehab facilities use NAC as part of the daily regime.
November 7th, 2009 at 12:13 am
Anne,
Yeah. But trying saying it fast ten times!
I’m happy to hear that NAC is making inroads in rehab treatment centers. Good news indeed!
Be well!
JP
November 7th, 2009 at 2:34 pm
Wow! Great post with great information! Thanks!
November 7th, 2009 at 7:17 pm
Thanks, Marisela!
Be well!
JP
November 8th, 2009 at 12:34 pm
You’re welcome JP!
Your post caught my attention because I have a friend who has schizophrenia. I am sharing your post with him.
He has been taking a supplement with N-acetyl cysteine(NAC) as one of its primary ingredients, that helps raise one’s GSH (glutathione) levels.
It has made an incredible difference!
November 9th, 2009 at 12:01 am
Marisela,
That’s wonderful news! Thanks for sharing that with us.
Be well!
JP
November 12th, 2009 at 5:35 pm
My doctor just prescribed this to me today as something that might work for chronic moderate anxiety/depression. She was unsure about dosage as each person is so different. She also prescribed Deplin which has been very effective for me. Both are brain ready forms of amino acids that are in metabolic pathways that were not previously thought to be important to anxiety. These pathways are now thought to be more relevant to chronic anxiety that is not responsive to other meds. Any additional info and/or dosage would be appreciated.
mary
November 12th, 2009 at 6:44 pm
Mary,
I’m encouraged to hear that some doctors are beginning to include NAC along with more conventional medications.
My best suggestion would be to share this column with your physician. I’ve added links (the numbers at the end of the paragraphs) to all the scientific studies that I used to put this information together. Perhaps seeing the actual data will assist your doctor in selecting an appropriate dosage.
As a general comment, I can say that some people are starting with the low end of the dosage spectrum (1,200 mg) and increasing that level if necessary. That might be a good starting point to discuss with your doctor.
Be well!
JP
December 1st, 2009 at 6:08 pm
Has anyone been prescribed NAC to help with OCD related issues? I think my doctor wants to try it out on me, but he said I would be his first patient to have taken this. Just wondering if anyone has experience with it??
December 1st, 2009 at 8:06 pm
Alyssa,
I don’t have OCD but I hope someone with direct experience will reply to your inquiry.
If I find any additional information about NAC and OCD, I’ll be sure to post it.
Be well!
JP
January 1st, 2010 at 7:18 pm
After reading reports of Yale’s Medical Center conducting clinical trials for use of NAC for OCD, I ordered some. I will let you know how it is working as soon as I see some results.
January 2nd, 2010 at 6:54 pm
Thank you, Perri! I’ll look forward to your report!
I hope your experiment yields promising results!
Be well!
JP
January 9th, 2010 at 10:16 pm
My 11 year old daughter has been suffering from trichotillomania for almost 4 years. She had been taking NAC for about 2 months and I am seeing more hair grow back in. We also got her acrylic nails and her eyebrows and eyelashes came back right away. We had previously tried behavioral therapy, and spent 1 year with a psychiatrist trying various SSRIs, which did not help at all. I am taking her to a naturopath to assist with NAC and other supplements, this dr. ordered blood and urine tests (something the psychiatrist did not do) and we are currently waiting on the test results to start naturopathic treatment.
January 9th, 2010 at 10:29 pm
That’s wonderful news, MC! Thank you for sharing it with us.
I hope and suspect that the naturopathic support will provide continued success and beyond for your daughter. I salute you for exploring such a complementary option.
Be well!
JP
PS – I’d love to know how it works out for you all. If you wouldn’t mind, please keep us posted.
January 16th, 2010 at 10:41 pm
My Wife is Bipolar I. She has started taking about 3 months ago. Last two months have been the best ever. In all honesty, it is hard to pinpoint if NAC is the answer, we also made other changes as well.
January 16th, 2010 at 11:26 pm
Thank you for sharing your experience, RGH!
If you happen to visit again, can you please let us know about some of the other changes your wife made? It would be interesting for me and others to know.
I hope your wife continues to find success in overcoming this challenge.
Be well!
JP
March 3rd, 2010 at 1:54 am
Hi JP,
To answer your question, my wife has made a huge turn-around in her bipolar illness. In addition to adding NAC, my wife made a several big changes: Regular exercise, sleeping less (from 11+ hours to 8-9), stopped drinking coffee, is reducing klonapin, we have lost a ton of stress, and is back under the care of a psychiatrist (as opposed to solely a very good family Dr.). Most importantly though, I think she came to understand that she was depressed and was affecting everybody around her.
It has been about 10 years since her last full blown mania and hospitalization. But, for the last many years, she had what I would describe as a moderate depression mixed with something like a low grade mania. Of course, all along she has been taking quite a cocktail of medicine. While we can’t pinpoint adding NAC as the cause of her turnaround, it has now been about 4 wonderful and normal months.
March 3rd, 2010 at 8:43 pm
RGH,
Thank you very much for coming back and updating your findings. I really appreciate it and I’m sure anyone who reads your comments will feel the same.
I’m thrilled to know that your wife is making such strides which are undoubtedly improving her quality of life and that of your family as well.
I wish you and your wife continued success and much happiness in the days to come.
Be well!
JP
April 7th, 2010 at 12:22 pm
I started taking 1200mg/day five days ago for debilitating OCD and trichotillomania after researching it on the internet, having found SSRIs and other treatments ineffective. I know not to expect any results, if at all, until about 9 weeks in, and so far the only effects have been nausea and fatigue! I would love to know how some of the people who posted before are getting on with it, and will post again in a couple of months (or sooner) if it has had any effect. It’s really helpful to read other people’s experiences of it on pages like this. One thing I am confused about is how much magnesium/zinc/vitamin c I’m meant to be taking alongside it, as different sites seem to emphasise different minerals and there is no definitive advice about it.
Lucy
April 7th, 2010 at 5:41 pm
Lucy,
Hopefully some NAC users will chime in and share their experiences soon. In the meantime, I thought I’d mention a possible way around the nausea issue. A few manufacturers make sustained-release NAC. An extended delivery system may suit your digestive system better than conventional capsules.
Here’s an example of such a supplement:
http://www.jarrow.com/product/323/N_A_C_SUSTAIN
Be well!
JP
April 12th, 2010 at 4:46 pm
What dosage of NAC and Vit C should I give my 9 year old daughter who is suffering from trichotillomania ?
Any help much appreciated.
April 12th, 2010 at 10:08 pm
Liz,
A study currently enrolling at Yale University is evaluating a dosage of 1,200 mg twice-daily (2,400 mg/day). They’re accepting patients between the ages of 8-17.
http://clinicaltrialsfeeds.org/clinical-trials/show/NCT00993265
I don’t know if this dosage would be appropriate for your daughter. But it may be useful for her pediatrician to know about.
Be well!
JP
June 1st, 2010 at 10:18 am
I have been taking 2400mg of NAC (not sustained release…which I am currently looking for one which is affordable) for depression/anxiety along with Wellbutrin. I honestly do notice a difference. Especially around PMDD time. It has been about 4 months now.
June 1st, 2010 at 4:41 pm
Thank you very much for sharing your experience with us, Heather. It’s much appreciated!
Be well!
JP
June 8th, 2010 at 11:06 am
I started NAC in late Dec 2009. My psychiatrist recommended it and said it was important to start with 1200mg (600mg 2x/day) for the first few weeks and then increase to 2400mg (1200mg 2/xday). It took about 3 months to notice a distinct improvement in my mood. For the first time in years, I started to feel ‘over-medicated’. As a result, I have now completely stopped taking Lamictal (one of a myriad of drugs I have tried over the years for my Bipolar II diagnosis), and am in the process of stopping AdderallXR (5 mg decrease each month – now at 10mg) as well as Klonopin (now at .25mg). I have noticed a marked improvement in my social anxiety, which had crippled me since I was very young. I wasn’t expecting this but am thrilled. I believe in a holistic approach to treating my illness: I changed my diet 2 years ago (low-fat vegan), no alcohol, no caffeine, no processed foods, along with doing my best to maintain a ‘normal’ routine of adequate sleep and exercise and am an avid organic gardener (this activity is my best stress-reliever). I also take Flaxseed Oil and multi-vitamin along with Vitamin C daily. I have not encountered any digestive issues, but I take it with morning and evening meal. Since I became vegan, all digestive issues I previously experienced (heartburn, especially) disappeared. I found out that if I had a script, I could submit receipts for NAC and Flaxseed Oil to my Health Care Spending Account (HCSA) for reimbursement, so my doctor wrote prescriptions for the NAC and Flaxseed Oil. (Yes, it’s my money in the HCSA, but at least it’s tax deductible.) I want to find out more about appropriate amounts of Vitamin C and other supplements when I next visit my psychiatrist. Bottom line: I can tell when an episode is approaching and do have my moments, but they are not debilitating anymore. I have not missed a day of work due to my Bipolar since February. The only change I have made is adding the NAC. Just taking it one day at a time and am hoping I continue to stay well. While it is sometimes hard to notice one’s own improvement, my husband tells me all the time now what a difference he has seen in me. For the better
June 8th, 2010 at 12:22 pm
Julie,
Thank you so much for sharing all that great information! Very encouraging!
I hope you find continued success in balancing your program in the best possible way.
Be well!
JP
June 21st, 2010 at 6:22 am
I started taking NAC back in April (post 21 on this page) for OCD and Trichotillomania. I started on 1200mg a day and gradually went up to 2400mg a day.
Since then I have had my final university exams and a huge amount of stress, which exacerbated my OCD and Trichotillomania symptoms, and which probably had some effect on the efficacy of the NAC; I noticed no real difference while I was still doing my exams. In fact, it was probably worse because of the pressure. After my final exam (two weeks ago), to my astonishment I had about a week when I hardly pulled my hair out at all (for the first time in 3 years). I attributed this to finishing my degree rather than the NAC, and sort of intentionally forgot to reorder more. A couple of days later, I had a really debillitaing episode which has continued until this point, and despite my former scepticism I’m beginning to think this is because I stopped taking NAC, and that it just took a long time to take effect. I’ve just re-ordered some more.
I don’t know how helpful this will be to anyone who is thinking of trying it out, but I would just say: don’t expect a result too soon. I don’t know if my Trich-free week was because of the NAC or because I was no longer a student, but my sudden ‘relapse’ makes me think the NAC was affecting me more than I thought.
Lucy
June 21st, 2010 at 10:22 pm
Lucy,
I’m certain that your account will be helpful. Every piece of evidence, anecdotal and scientific, is helpful at this point. Research into NAC and mental health is still in it’s infancy. That’s precisely why your experience is so valuable. It adds something new that *may* help others who are considering NAC and physicians who prescribe it. Many thanks!
PS – I hope that you’re able to reclaim your Trich-free status very soon and that this change will remain with your in the long term.
Be well!
JP