NAC for Mental Health
November 4, 2009 Written by JP [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)
Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!
Be well!
JP
Tags: Addiction, Autism, Depression
Posted in Alternative Therapies, Mental Health, Nutritional Supplements
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! ๐
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. ๐
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! ๐
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 ๐
June 8th, 2010 at 12:22 pm
Julie,
Thank you so much for sharing all that great information! Very encouraging! ๐
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
October 12th, 2010 at 10:37 am
I have been suffering from moderate to sever anxiety for years now.. resulting in panic attacks and such. Constant worrying … fear of death… consumed my life…. and just an over all feeling of stress everyday. My Dr recommended NAC I have startes out with just 600 mg a day along with 1200 mg of fishoil and I truly believe it is helping me! My mood is overall improving! I feel good and have way more positive thoughts and feelings then I can remember having in a long time! Not to mention its only been 5 days!! Not sure if its the NAC or fishoil or the combination of them … but I am looking forward seeing what the future weeks bring me!
October 12th, 2010 at 1:29 pm
That’s such wonderful news, Melissa! Continued success! ๐
Be well!
JP
October 12th, 2010 at 1:41 pm
That IS great news!! I too have been taking it for depression/anxiety. I take it as an add on to wellbutrin. I have to be honest, I am not sure it is in fact helping. I even went up to what I now take – 3000mg per day. I also take 2400 of fish oil. Maybe I am taking too much?? Its been a good 6-9 months now I would say.
October 12th, 2010 at 11:38 pm
Heather,
The NAC dosage seems adequate, IMO. What fish oil product are you using? The concentration of EPA in fish oil supplements can vary considerably. This may be a factor.
Be well!
JP
October 13th, 2010 at 7:27 am
First let me say thank you JP for taking the time to research recent NAC usage for “off-label” treatment and to put together an extremely informative article. I spoke with my psychiatrist about NAC and he didn’t know much about it which really surprised me. I’ve been very pleased with this doctor; he’s willing to try new things and a strong patient advocate.
I was diagnosed with ocd about 16 years ago and have been taking medication and getting treatment since. The medication and therapy have helped but not as much as I had hoped. At this point I’m not looking for a magic bullet, rather something that will decrease the frequency and/or intensity of the ocd obsessions that I have.
I’ve been very encouraged to try NAC after doing some of my own research and reading the thread of responses to this article. I just started taking it. For those of you that have tried or or on NAC, have you found that your general anxiety level increased when you first began taking NAC? If so did it begin to drop after being on NAC for awhile?
Thanks everyone for your time, research and feedback!
Josh
October 28th, 2010 at 3:16 pm
for inexpensive and potent NAC try http://www.swansonvitamins.com/Search?keyword=NAC+%28N-Acetyl+Cysteine%29&doSearch=true&ntt=&n=0&ntk=Level1
it is a remarkable supplement for so many issues
peace to all
November 27th, 2010 at 2:37 pm
No flush niacin from inositol hexanicotinate helped me so much for the treatment of schizophrenia. Niacin is required for the body to make glutathione. It made all the difference to me, I could decrease my medication and live normally even after 3 psychotic episodes. I’m gonna try NAC. I know that mercury depletes glutathione in the brain, so it could be a cause for mental illnesses. There is mercury in vaccin and in “silver” amalgams which are made 40% of mercury. Watch this video that shows how mercury vapor can go out of a tooth with amalgam. http://www.youtube.com/watch?v=9ylnQ-T7oiA
March 1st, 2011 at 2:33 pm
So happy to find this post, I’m encouraged to read everyone’s comments/experience. I’ve suffered from both trich and derm for over 20 years and have only recently been able to talk about it and seek help. My psych recommended NAC and I’m excited to try it – my question is, will it interfere with my other meds (effexor, synthroid and iron supplement)? Will certain foods block its effects?
Steven – thanks for that link; I paid three times that at Whole Foods yesterday!
March 1st, 2011 at 6:54 pm
Rain,
Your pharmacist and/or psychiatrist would likely be aware of any known interactions. Here’s a recent update I’ve posted which includes more information about studies that have combined NAC with conventional medications:
https://www.healthyfellow.com/786/best-of-nac-for-mental-health/
Be well!
JP
April 25th, 2011 at 12:36 am
Rain:
I have just finished participating in an NAC trial for uni-polar depression. I felt that it made a really big difference to my depression. I say this because the washout period turned out to be a real bummer: the slide back into a depressive state including the return of the unrelenting negative self-talk. All I can say is that I am glad that the washout is over and I can start to take NAC as a supplement. Fingers crossed that I will soon return to a more quiet state.
April 28th, 2011 at 1:32 pm
Thank you for sharing your experience with NAC, May. I hope Rain and others view your comment and benefit from it. Continued success!
Be well!
JP
August 2nd, 2011 at 9:56 pm
Just found out about the NAC and am excited to try it! Does anyone know if you can take too much?
Also wanted to let everyone know about a different supplement that I have been using for the last year called Inositol. I take 18 g/day and the only side effect has been a little gas–not a lot! It has helped me completely get rid of the OCD unwanted obsessions that popped into my head, although I still have worries! If I don’t take it for even one day, the obsessions come back so it definitely works. I take it in powder form and just mix it with water, it’s a little sweet. There is a lot of research out there on the internet, but it’s been so long since I’ve researched it, I don’t remember what sites that I could quote. Hope this helps someone!
August 4th, 2011 at 12:37 pm
Lisa,
I think it’s probably best to stick with the dosages utilized in the published clinical studies – preferably alongside guidance provided by a health care professional. At the mentioned dosages, NAC seems to be quite safe.
I’ve updated this column with some additional information (found at the bottom of the linked column) that you might find interesting:
https://www.healthyfellow.com/786/best-of-nac-for-mental-health/
re: inositol and OCD
There are several studies that support your experience. Not everyone responds to inositol, but it appears that some do. A few highlights from the medical literature:
http://www.springerlink.com/content/u27115101k3677p4/
http://www.sciencedirect.com/science/article/pii/S0278584601002445
http://www.ncbi.nlm.nih.gov/pubmed/10565802
Thank you for sharing your success with us.
Be well!
JP
March 21st, 2012 at 5:46 am
Hi. This is an interesting article and comment section. I supposedly have OCD in addition to low energy which may be chronic fatigue syndrome. I am desperate to get my energy back but the compulsions and the anxieties wear me out and waste my time. I always seem to feel short changed on time and energy. I just recently heard about the possibility of NAC helping OCD.
This is the first research article I have found on the subject. I already have been using NAC, not for OCD so far but as a part of my total Fukushima radiation protection protocol of vitamins and supplements. Since NAC boosts glutathione it helps the body detox and keeps the immune system strong. Cysteine is a sulfur containing compound and supposedly sulfur detoxifies mercury. I used to have amalgam fillings so that’s another reason I use it.
So far I have only followed the direction on the bottle of one to two pills a day. I did not know if more was safe or helpful to take more. I wondered though. SO I have been taking up to 1200mg a day but apparently you can use 3X that much, safely? I am going to try doubling my dosages tomorrow and see if anything happens. I’ll try and report back on my results.
March 22nd, 2012 at 12:27 pm
Hi
This is Divya . i have post partum ocd after birth of my twin boys 2010 . i took zoloft 3 months and stopped it due to weight gain . i tried homeopathy in india but it didn’t work well . currently i am on st johns wort , 5 htp and inositol ,gaba , b complex and fish oil . after reading this article i add Nac to my list . now i am felling better i dont know its bec of nac or inositol . nac made me terrible headache . is Nac have side effect lke headache .
March 22nd, 2012 at 4:52 pm
Hi Nick and Divya,
Nick: I would personally stick to the dosages used (safely) in the clinical studies I’ve outlined in this column and this follow up:
https://www.healthyfellow.com/786/best-of-nac-for-mental-health/
More isn’t necessarily better. And, working with the guidance of a sympathetic health professional is also advisable.
Divya: NAC has been linked to occasional headaches in clinical trials, but usually when it’s been used in conjunction with other medications. With all of the supplements you’re taking, it may take some detective work to determine *if* NAC is the culprit of your headaches. It’s possible, but not certain, IMO.
Be well!
JP
June 2nd, 2012 at 10:52 am
Thanks for all your research and information!
I first tried NAC when the diagnosis of bipolar II was thrown at me. Started at 1,000 mgs per day and worked up to as much as 3,000 mgs daily in divided doses (though spent most of the time @ 2,000 mgs daily). Sadly, no sustained improvement was noted even after long-term use and I eventually dropped it. Over a year & a half ago I started the slow reduction process from a benzodiazepine. The withdrawal side effects have been devastating and my life is consumed by a myriad of symptoms like crippling anxiety & panic, chronic insomnia with tortured nightmares if I nod off, depression, agoraphobia, akathisia, etc (none of which I had prior to the slow tapering process, aside from some depression & related sleeplessness). Finally remembering the possible glutathione connection in reducing the glutamatergic hyperactivity that may be part of the withdrawal syndrome, I introduced a very small dose of NAC, roughly 100 mgs. Within an hour or two I felt calmer. I took 3 doses of approx 100 mgs the first day and actually even managed a little peaceful sleep that night. I’m still in the early stages of using NAC for this application and have yet to do another benzodiazepine reduction to judge its benefits in the acute withdrawal stage. It does seem the right glutamatergic-correcting dosage of NAC might vary from person to person and at least in my current condition, less is better. Perhaps the high doses I was taking previously were just too much for me, throwing off the crucial GABA/glutamate balance. I also suffer from occasional blepharitis (an inflammatory eye condition), which NAC can help with. The use of NAC for many health issues is very promising. I would simply recommend erring on the side of too little to start out, evaluate your response and build slowly for tolerance. Further reading has indicated that supplementation with extra vitamin C and trace minerals, especially copper and zinc, may be prudent. Best wises to all!
June 2nd, 2012 at 3:21 pm
Thanks a lot for sharing your experience with us, Cara! It’s a truly valuable addition to this thread.
I wish you continued success with NAC. And, I hope you’ll come back to share any additional observations you discover along the way. I’m sure they’d be useful for other patients and physicians too.
Be well!
JP
June 10th, 2012 at 1:00 pm
Update: 7 days ago I did a reduction in my benzodiazepine dose, which typically by now would have ramped up my side effects to the point of being pretty much unbearable. Rather than getting worse I am amazed to find myself slowly improving, feeling calmer & clearer with a lessening of most of my withdrawal symptoms (decrease in anxiety being most notable) . In additional to NAC, I added Gotu Kola (taken at separate times) which is thought to be another glutathione booster. Currently I am taking 200 mgs NAC with breakfast and 500 mg NAC with supper (always with a protein containing meal). The Gotu Kola is used 2 – 3 times per day, in-between the meals and prior to bedtime, since the half life of NAC is fairly short. Still working out the optimal doses of both supplements for myself. I am currently quite optimistic and will post another update as more time passes and/or once I’ve done another reduction in a few weeks.
May good health be yours.
July 22nd, 2012 at 12:12 pm
My 9 year old soon has been taking NAC for several months. He is currently taking 600mg twice daily. We started him out on a smaller dose and worked up to this dose. He was exposed to crack before birth. He has been diagnosed with episodic dyscontrol and sensory issues to name a few. We have tried many medicines of which he would have very bad reactions. He is a smart and sweet little boy. I can tell you that with the NAC we have been able to take him off of some of his medicine and now he is a very manageable little boy with mild Adhd. He takes the tricyclic Pamelor small dose and trileptal. We were able to take him off of the depakote with hardly any withdrawal effects. The change in him since the NAC is remarkable. He has almost no sensory issues except when things get real loud and a lot of activity going on. But even then we can talk to him and he can get past it. I would strongly encourage NAC for children that have been exposed to crack before birth. Before NAC when 6:00 at night came his behavior would remind us it was time for his medicine. Now his behavior does not deteriorate at 6:00 and sometimes I have forgotten about the medicine until 8:00 at night. I also watch to make sure he isn’t constipated. I think NAC might can cause so I give him miralax if we need to. Before we started on the NAC I talked to his psychiatrist and pediatrician. They both said that it was safe. The pediatrician said to supplement with copper and zinc. If it was not almost time for school to start I would see if he could go off of the Pamelor and Trileptal. I will wait for next summer for this.
July 22nd, 2012 at 1:56 pm
Hi Dianne,
Thanks so much for sharing your experience with us.
A brief item to consider: Magnesium can reduce constipation and may also be useful for ADHD symptoms. It *may* be a better option than Miralax. Please discuss this possibility with your son’s physicians.
http://www.lipidworld.com/content/9/1/105
http://www.aafp.org/afp/2009/0715/p157.html
Be well!
JP
July 22nd, 2012 at 9:15 pm
I am sorry I put the wrong amount of NAC that my son is taking. He is now on 300 mg twice a day. The total of the day being 600 mg. It seems that lower doses than most people work better for him. We started out with 150 twice a day and then worked up. On the Magnesium does it raise Dopamine. He seems to have a dopamine problem that is the oposite of your standard ADHD. It seems that his problem is that his dopamine gets too high sometime.
Thank you for the recommendation.
Dianne
July 23rd, 2012 at 1:47 am
Hi Dianne. Thank you for the correction.
I’m unaware of any human evidence showing that oral magnesium affects dopamine concentrations in the brain. Some animal research suggests that it might, though the data is mixed and far from conclusive. It’s also possible that a deficiency in magnesium may alter dopamine concentrations in the brains of test animals.
http://www.ncbi.nlm.nih.gov/pubmed/3275203
http://www.ncbi.nlm.nih.gov/pubmed/7545412
http://www.ncbi.nlm.nih.gov/pubmed/10817660
Maintaining insufficient levels of magnesium in order to control dopamine may or may not be advisable. Please inquire with your son’s doctor(s) to determine if magnesium is appropriate in his case.
Be well!
JP
October 29th, 2012 at 2:47 pm
I want to relate my anecdotal experience with NAC. First of all, I want to mention that it’s the only supplement that has ever appeared in my night-time dreams. A bottle of NAC appeared in a dream about three years ago. I barely knew the stuff existed. Well, needless to say, I immediately looked into it, checked it out thoroughly, and began taking it. (I also take other supplements including coQ10 and magnesium lotion.) Over these three years, I really haven’t noticed, or been able to pinpoint, positive effects from any one supplement; my overall health has improved significantly but I can’t attribute this to any one product. Well, let me tell you what happened today. I have been feeling somewhat depressed lately about my work life and love life. I’m going through a bad patch. I’m a little bit prone to depressoin anyway. This latest period of depression has been low-grade and manageable, but unpleasant; its presence has not helped me work out of this bad patch. (I will say, what I’m experiencing is barely worth mentioning compared to the challenges faced by many people.) Today I felt really quite depressed – more so than usual. Just now I took some NAC (Jarrow time release on an empty stomach) along with a couple of other supplements (a good multivitamin, some acetyl l carnitine). Boom. My depression completely lifted. I feel absolutely myself. I am aware of the possible placebo effect here, I’m aware it might not be the NAC, but somehow I felt it IS the NAC, so I began poking around, and found this site. I offer this anecdote for whatever it might be worth. Thank you JP for a useful Web page. And, to quote Charles Dickens, “God bless us everyone.”
November 1st, 2012 at 8:04 am
Could you pls let me know how much mg of vitamin C should be taken while consuming 2400mg NAC per day?
Thank you very much…
November 1st, 2012 at 8:05 am
Hello;
Could you pls let me know how much mg of vitamin C should be taken while consuming 2400mg NAC per day?
Thank you very much…
November 1st, 2012 at 10:19 pm
Hello. Some nutritionists and organizations (ex. Life Extension Foundation) recommend taking two-to-three times as much Vitamin C as NAC. The theory behind the combination is that Vitamin C will supposedly reduce the likelihood of NAC: a) contributing to a rare type of kidney stones; b) acting as a pro-oxident in the body. However, I haven’t come across any specific data supporting this assertion.
Be well!
JP
November 1st, 2012 at 10:26 pm
Thank you for sharing your NAC experience with us, Bob. I wish you continued success and wellness!
Be well!
JP
December 16th, 2012 at 11:46 am
Hi there, I am wondering if anyone would mind sharing with us how the NAC has been working for anxiety. If anyone else has used this to help treat GAD and Social anxiety i’d love to hear their results. I just started the NAC today so it may be some time before i get results, if any, but I am looking for other success stories to give me a little bit of hope ๐ …………..(I suffer from lifelong anxiety and depression. It seems that while I have some success treating the depression with various drugs and/or mood lifting supplements, the anxiety is much more stubborn. It is so upsetting to me that I can’t control it that it makes me get depressed thinking about it. it’s a vicious cycle that i am desperate to break. Sometimes i’m ok but other times I get afraid to talk to people in public, even checking out at the register at a store can be awkward for me. I enrolled in college to get a new degree & I now want to participate in class and present oral presentations without feeling so scared all the time. I really hope the NAC helps me get by!)
January 16th, 2013 at 11:10 am
Hi…Michael from the UK here
I recently stopped taking setraline for a general anxiety disorder…Really quite a bad one. The anxiety remained but to be honest the setraline didn’t really do much for me anyway except make me very nausious every morning. Note I took setraline for 4 years.
I read a book called the chemistry of calm and NAC was mentioned as one of approx 5 supplements that could help…I went out and bought all 5!
I also drink quite heavily as it does soothe the anxiety…until you wake up that is! Then you are in a world of pain with anxiety levels through the roof! As a result also experienced abdomen discomfort/pain…could be the liver crying out for help.
To cut a long story short I took 2 X 600 NAC in the morning and after about an hour or so the abdomen discomfort lifted completely and so did my anxiety!
BRAIN FOG GONE
WORRYING GONE
EYESIGHT BLURRY GONE
ANXIETY GONE
MOOD IMPROVED ….ELEVATED!
BREATHING IMPROVED
I have been taking two in the morning and two at night for approx a week now and it feels like a miracle! I have never felt better than I do now than in the last ten years.
As a bonus i also get the physical protective properties of this amino acid.
Hope people out there suffering with anxiety read this and I hope that NAC works as well for you as it is doing for me.
PS….What about the 4 supplements…..Theanine seems to do something but nothing as instant or as marked as NAC.
Good luck everyone and keep posting….I,ll post again iin a month and let you know how I’m getting on
Best Regards
Michael
January 16th, 2013 at 12:45 pm
Many thanks for sharing your positive experience with us, Michael. I wish you continued success!
Be well!
JP
April 2nd, 2013 at 10:15 am
Hi, everyone. ๐ I hope this blog is still open for commenting. It is wonderful to share with others who understand and are o be able to give both our compassion and observations that may help others.
We are trying NAC as well. My teenage son is on the autistic spectum and also has OCD. He has a good doctor, who specializes in both ASD and OCD.
Along with two other medications our son takes, we wanted to try the NAC, if his doctor said it was okay. The doc is up on all the latest research and said it was perfectly fine to add in this supplement. Per the doctor’s orders, we started our son on 600 milligrams of NAC, twice a day. After three days of no noticeable side effects, we then increased it to 1,200 milligrams twice a day. He is on his third day of that dosage. The doc wants us to try to get him up to 2,400 milligrams, twice a day.
So far, so good. I will let you know what our experience is. As I am sure many on this site can understand, I gird myself for medications/supplements NOT helping more than I anticipate they will…because it is a tough journey, and I find I do better not over-expecting. I am also a Chistian, so this has all been a real faith-building time for me. Sometimes I am really disappointed at how fearful I am for my son, instead of relying more upon the Lord’s promises. I don’t think I need to explain to any of you how difficult these kinds of problems are for the person affected and the entire family.I have cried buckets of tears but prayed just about as much! I am a work in progress as well.
So all that said…when I say that I see some positives already from the NAC, you will know I am not looking for it or expecting it! I do not know how this could be (seeing some benefit yet). From what I have read, it takes more time to see a benefit — but perhaps by that, it means a bigger benefit. But I do notice subtle but positive changes that only happened after we started this. Again, could be a coincidence or other factors, as I am leery of attributing anything to the NAC yet, but time will tell.
Hugs to all on here. I understand, believe me.
Anybody still around?:)
April 2nd, 2013 at 4:12 pm
Michael,
Since my last post was so long (and sorry for the typos, folks), I wanted to say how happy I am that you found something so helpful for your anxiety. ๐
April 8th, 2013 at 6:17 pm
I was told that nac could change blood tests results on the liver. I have sclerosing cholangitus (sp) my Alk. PHos. is l000. Has been for years. I was born with this and told I would not live to be 20. I am 68. Don’t want a liver transplant. I am a nutritionist and have managed by myself for the most part. Should I be careful taking nac?? I would be grateful for any advice you have.. Also forgot to ask if the tests would go higher or lower???
April 8th, 2013 at 11:12 pm
Hi Suzanne,
I’m by no means an expert in sclerosing cholangitis. However, it preliminary evidence suggests that NAC *may* be a promising therapy. In terms of NAC’s effect on ALP, it appears to vary based on the liver condition being treated. The 2nd – 4th links below illustrate my point:
http://www.ncbi.nlm.nih.gov/pubmed/20019586
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270363/
http://onlinelibrary.wiley.com/doi/10.1111/j.1872-034X.2007.00215.x/abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270338/
Be well!
JP
April 8th, 2013 at 11:14 pm
Thank you for your contribution, Joy! I’m sure others will come back around and benefit from it. Please keep us posted on your continued observations!
Stay strong and be well!
JP
April 9th, 2013 at 7:59 am
JP,
Thanks so much. I will post how it goes.
Good to know that this blog is still active. Whenever I find a blog that talks about NAC, it’s an old thread…and everyone has moved off the topic. Darn it!
Appreciate your support!:)
April 9th, 2013 at 8:10 am
Suzanne,
It looks like JP gave you some excellent links. I know you have a very specific situation, so I’m sure you will look into this carefully before deciding…but one of the things my husband and I liked about NAC is what we read on its liver and heart-protecting qualities. Our son takes another medicine for OCD, and he needs to have an EKG and blood levels checked, regarding the liver. Those results have always been just fine, but adding this supplement makes us feel it’s a good complement to his overall health.
I’m hoping NAC is something that would benefit you…medicine is often so much more an art than science, isn’t it? Sounds like you’ve been a really great advocate for yourself! ๐
April 9th, 2013 at 10:56 am
If anyone wants to know what brand of NAC we are using — and what I recently found out in regard to the purest form of this product — just say the word. Because our son is autistic, I do plenty of research on products with less fillers and also what would possibly work most effectively for him.
I am staying with the same brand, but after consulting the brand’s customer service rep, I have just ordered what is the purest form…and it is very affordable from the brand’s website.
I will explain more, if anyone is interested.
JP: If it’s a no-no on this site to get into brands, please just let me know!
April 10th, 2013 at 1:54 pm
Hi Joy,
Feel free to share the name of the product. The only thing I do not permit, which is clearly not the case here, is mentioning products by those who have a financial interest in said products.
Be well!
JP
April 10th, 2013 at 3:05 pm
Hi, JP~
You’re so nice. Rest assured, I don’t sell products. Despite typos (that I blame on my iPad), I’m actually a freelance writer. ๐
Well, now I have even more info on some products.
Our son is currently taking Swanson’s NAC. But when I went to order some more on Amazon, I noticed that there was another Swanson brand of NAC (same dosage) that claimed to be the “ultra” brand — a little more expensive and manufactured in Japan. I found this a little confusing, so I located the Swanson website and called them to ask about the difference. The Swanson rep was really helpful, and she summed up the difference between the two choices well: “It’s like peanut butter…there’s the generic store brand — and then there’s Jif. With some people, it does make a difference.”
I did order the “Jif” Ultra NAC, just to compare. That said, I’d recommend everyone check not only with your doctor but also thoroughly inspect the labels on any of these supplements — to make sure you’re not allergic or sensitive to any extra ingredients that may be in them.
In the meantime, I’ve heard back from a medical professional (who specializes in OCD) that he feels the GNC brand of NAC is a good product; he also said that there’s been some buzz lately (from his colleagues) about a dissolving tablet formulation of NAC working even better for their patients. He gave me a link to that particular company, if anyone wants to read about it.
That’s about it. And yes, after all I read about the dissolving tabs, I ordered them, too. And no, I’m not doing all this comparing at once. ๐ We’ll take our time with it.
I hope this is of help to someone else.
April 17th, 2013 at 12:58 pm
The “ultra” Swanson brand had a nauseating effect on our son. That could subside in time, but we saw no reason to continue with it, since the other Swanson NAC does not have any side effects for him, and it appears it already shows promise. Unless a complete coincidence, we are seeing positive changes with the NAC. It’s early on, so time will tell.
April 17th, 2013 at 5:23 pm
Thank you for the update, Joy!
Be well!
JP
May 9th, 2013 at 10:29 pm
I have found NAC very intriguing as a means of combating anxiety disorders. In my case I have pretty severe OCD. I am a vastly obsessive type OCD person and have been on SSRIs for years. I weaned off my zoloft over the period of a year or so. A year later that appears to have been a big mistake. I guess I am one of those people that needs his SSRI. I am now working my way back up on it. But since my increase in anxiety started I have been doing a bit more research and well here I am on this NAC site. It’s good to see that this could potentially benefit people with OCD a lot. NAC is well known as the antidote for acetamenophan overdose as it will lead to an acute spike in liver Glutathione levels. Here is more information regarding the brain chemistry behind N Acetyl Cysteine and psychiatric disorders for those who are interested (a pubmed link)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/
I will share my experiences if I ever do a trial with NAC ๐
May 10th, 2013 at 11:06 pm
Thank you, Pete. I wish you success no matter which approach you decide to try. If you happen to experiment with NAC, please let us know your impression.
Be well!
JP
September 17th, 2013 at 1:53 pm
My daughter has suffered from OCD, anxiety and mild autism for the past four years. It was an abrupt onset of all of the disorders. Mentioned to all doctors of Pandas but not enough info to suggest going on something for it. Recently she stopped eating and was diagnosed with severe OCD and anxiety. Was always on Celexa 10 mg but now increased to 20 mg. doctor ordered folic acid and NAC. On all for about 8 days now. She likes to each again but no liquid intake. Hopeful that it can work but always have doubt in the back of my mind. Taking one day at a time.
February 23rd, 2015 at 6:24 pm
Update: NAC, a nutritional supplement, acts as a valuable adjunct to conventional care for autistic children …
http://journals.lww.com/clinicalneuropharm/pages/articleviewer.aspx?year=2015&issue=01000&article=00003&type=abstract
Clin Neuropharmacol. 2015 Jan-Feb;38(1):11-7.
N-acetylcysteine as an adjunctive therapy to risperidone for treatment of irritability in autism: a randomized, double-blind, placebo-controlled clinical trial of efficacy and safety.
OBJECTIVES: According to the proposed interference of N-acetylcysteine (NAC) with pathophysiologic processes of autistic disorders (ADs), we aimed to assess the effectiveness and safety of NAC as an adjunct to risperidone in the treatment of ADs in a randomized, double-blind, clinical trial.
METHODS: The participants were referred outpatients between 4 and 12 years of age with the diagnosis of ADs and a score of more than 12 on Aberrant Behavior Checklist-Community (ABC-C) Irritability subscale score. The participants were randomized into 2 groups. One group received risperidone plus NAC, and the other group received risperidone plus placebo. The dose of risperidone was titrated between 1 and 2.0 mg/d, and the dose of NAC was 600 to 900 mg/d. The main outcome was mean decrease in the ABC-C irritability subscale score from baseline at 5 and 10 weeks. Changes in other subscales were considered as secondary outcome measures.
RESULTS: Forty patients completed the 10-week trial. Baseline characteristics including age, sex and body weight, as well as baseline scores in 5 subscales did not demonstrate statistically significant difference between the 2 groups. Repeated-measures analysis showed significant effect for time ร treatment interaction in irritability (P = 0.01) and hyperactivity/noncompliance (P = 0.02) subscales. By week 10, the NAC group showed significantly more reduction in irritability (P = 0.02) and hyperactivity/noncompliance (P = 0.01) subscales scores.
CONCLUSIONS: N-acetylcysteine can be considered as an adjuvant therapy for ADs with beneficial therapeutic outcomes.
Be well!
JP
June 13th, 2015 at 4:50 pm
Update 06/13/15:
http://www.ncbi.nlm.nih.gov/pubmed/26066780
J Affect Disord. 2015 Apr 11;184:13-17.
Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial.
BACKGROUND: Previous studies have highlighted the potential therapeutic benefits of music therapy as an adjunct to standard care, in a variety of psychiatric ailments including mood and anxiety disorders. However, the role of music in the treatment of obsessive-compulsive disorder (OCD) have not been investigated to date.
METHODS: In a single-center, parallel-group, randomized clinical trial (NCT02314195) 30 patients with OCD were randomly assigned to standard treatment (pharmacotherapy and cognitive-behavior therapy) plus 12 sessions of individual music therapy (n=15) or standard treatment only (n=15) for one month. Maudsley Obsessive-Compulsive Inventory, Beck Anxiety Inventory, and Beck Depression Inventory-Short Form were administered baseline and after one month.
RESULTS: Thirty patients completed the study. Music therapy resulted in a greater decrease in total obsessive score (post-intervention score: music therapy+standard treatment: 12.4ยฑ1.9 vs standard treatment only: 15.1ยฑ1.7, p<0.001, effect size=56.7%). For subtypes, significant between-group differences were identified for checking (p=0.004), and slowness (p=0.019), but not for washing or responsibility. Music therapy was significantly more effective in reducing anxiety (post-intervention score: music therapy+standard treatment: 16.9ยฑ7.4 vs standard treatment only: 22.9ยฑ4.6, p<0.001, effect size=47.0%), and depressive symptoms (post-intervention score: music therapy+standard treatment: 10.8ยฑ3.8 vs standard treatment: 17.1ยฑ3.7, p<0.001, effect size=47.0%).
LIMITATIONS: Inclusion of a small sample size, lack of blinding due to the nature of the intervention, short duration of follow-up.
CONCLUSION: In patients with OCD, music therapy, as an adjunct to standard care, seems to be effective in reducing obsessions, as well as co-morbid anxiety and depressive symptoms.
Be well!
JP
August 30th, 2016 at 9:19 pm
Hi JP!
Thank you for the interesting info! I knew about NAC in relation to glutathione booster, lung fortifier, etc…I like the sustained release formula.
I have a 13 months old son who suffers from a very severe form of genetic epilepsy. He is on 4 AEDs and we started a slow benzo wean. We deal with a great amount of agitation, restlessness,lack of sleep, etc too. I am wondering if NAC could not be a good supplement to try and in what dosage? Could you, please give us some advice? Thanks a lot
August 30th, 2016 at 11:22 pm
Hi GP!
A recent review doesn’t provide strong evidence for the use of NAC for epilepsy. Here’s an excerpt from the review:
—
Source: http://www.sciencedirect.com/science/article/pii/S0149763415001190
“3.1.9. Epilepsy
All the studies have been in progressive myoclonus epilepsy, UnverrichtโLundborg Disease (ULD) (Table 12). ULD is an autosomal recessive neurodegenerative disorder (21q22.3) that typically begins between 6 and 15 years of age characterized by myoclonus and tonicโclonic seizures, followed by the development of dysarthria, cognitive dysfunction and ataxia. Most patients have marked impairment in daily life functioning and marked disability (Lehesjoki and Koskiniemi, 1998). In first case series (N = 4; LOE 4) of use of adjunctive treatment with NAC in ULD, four siblings were treated with 4โ6 g/day of NAC over 26โ30 months for ULD and showed remarkable improvement in symptoms and basic daily functioning (Hurd et al., 1996). Similar responses to 6 g/day NAC were seen in a 40-year-old male with ULD with marked improvement in walking, myoclonus, generalized seizures, talking and daily living skills (N = 1; LOE 4). Symptoms clearly worsened when he refused his medications for 1 week when parents were on vacation. Improvement was seen back within 2 days as soon as he restarted his medicines and was sustained for 10 month of follow-up (Selwa, 1999). Another case series (N = 5; LOE 4) also showed positive response to 4โ6 g/day NAC in the majority of the five cases of progressive myoclonic epilepsies (four with ULD and one with Lafora Body disease) (Ben-Menachem et al., 2000). Mixed response ranging from dramatic improvement in some individuals, partial or failed improvement in some and significant side effects including possible neutropenia and sensorineural hearing loss in some were reported in a subsequent case series (N = 4; LOE-4) (Edwards et al., 2002). With four case studies/series (LOE 4), the GOR is C. The results of the case series are mixed and some serious adverse events are mentioned in these studies therefore the recommendation for use of NAC in progressive myoclonus epilepsy is mixed and further controlled studies are needed.”
—
Has your health care team considered the utility of medium chain triglycerides and/or a ketogenic diet? Here’s why I ask:
http://www.ncbi.nlm.nih.gov/pubmed/27249895
J Med Assoc Thai. 2016 Feb;99(2):159-65.
Effectiveness of Medium Chain Triglyceride Ketogenic Diet in Thai Children with Intractable Epilepsy.
OBJECTIVE: To determine the efficacy, side effects and feasibility of Medium chain triglyceride (MCT) ketogenic diet (KD) in Thai children with intractable epilepsy.
MATERIAL AND METHOD: Children with intractable epilepsy were recruited. Baseline seizure frequency was recorded over 4 weeks before starting MCT KD. Average seizure frequency was assessed at 1 month and 3 months, compared to the baseline using Wilcoxon Signed Rank Test. Side effects and feasibility were also assessed by blood tests and an interview.
RESULTS: Sixteen subjects were recruited with mean seizure frequency of 0.35-52.5 per day. After treatment, there was a significant reduction in seizure frequency, ranging from 12% to 100% (p = 0.002 at 1 month, and 0.001 at 3 months). 64.3% of the subjects achieved more than 50% seizure reduction at 3 months and 28.6% of the patients were seizure-free. Common adverse effects were initial weight loss (37.5%) and nausea (25%). 87.5% of subjects and parents were satisfied with the MCT KD with 2 cases dropping-out due to diarrhea and non-compliance.
CONCLUSION: MCT ketogenic diet is effective and feasible in Thai children with intractable epilepsy. Despite modification against Asian culinary culture, the tolerability and maintenance rate was still satisfactory. A larger study is required.
—
http://onlinelibrary.wiley.com/doi/10.1111/epi.13256/full
Epilepsia. 2016 Jan;57(1):51-8.
Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy.
OBJECTIVE: We aimed to compare the efficacy, safety, and tolerability of a modified Atkins diet (MAD) with the classic ketogenic diet (KD) for the treatment of intractable childhood epilepsy.
METHODS: From March 2011 to March 2014, 104 patients aged 1-18 years who had refractory epilepsy were randomly assigned to each diet group (ClinicalTrials.gov, number NCT2100501). A seizure diary record was used to compare seizure frequencies with the baseline prediet seizure frequency at the third and sixth months after diet therapy initiation.
RESULTS: Fifty-one patients were assigned to the KD and 53 patients to the MAD. The KD group had a lower mean percentage of baseline seizures compared with the MAD group at 3 months (38.6% for KD, 47.9% for MAD) and 6 months (33.8% for KD, 44.6% for MAD), but the differences were not statistically significant (95% confidence interval [CI] 24.1-50.8, p = 0.291 for 3 months; 95% CI 17.8-46.1, p = 0.255 for 6 months). Instead, for patients aged 1-2 years, seizure outcomes were consistently much more favorable in patients consuming the KD compared with those consuming the MAD. The rate of seizure freedom at 3 months after diet therapy initiation was significantly higher (53% for KD, 20% for MAD, p = 0.047) in these patients. The MAD had advantages with respect to better tolerability and fewer serious side effects.
SIGNIFICANCE: The MAD might be considered as the primary choice for the treatment of intractable epilepsy in children, but the classic KD is more suitable as the first line of diet therapy in patients <2 years of age.
---
I hope this is helpful. Be well!
JP
September 3rd, 2016 at 3:14 pm
My psychiatrist suggested NAC for depression. What was most surprising was the effect it had on the OCD. Specifically, a time obsession that I had for more than four decades. For example, if I didn’t leave home before noon then the day was ‘ruined’ and I had to wait until the next morning. Also, other activities could only be started exactly on the hour, but if the second hand moved even a mm beyond the 12, then the hour was ‘ruined’ and I’d have to wait for the next hour. I’ve lost entire days to trying to get the exact hour before the second hand moved beyond the 12. It’s difficult to describe. Anyway, it completely disappears when I’m taking NAC.
September 5th, 2016 at 6:05 pm
Thanks a lot, SM! I hope your positive experience will inspire others to explore NAC as part of their OCD treatment program.
Be well!
JP
November 2nd, 2016 at 1:13 pm
Updated 11/02/16:
http://www.psychiatrist.com/JCP/article/Pages/2016/aheadofprint/15m10239.aspx
J Clin Psychiatry. 2016 Oct 11.
A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans With Posttraumatic Stress Disorder and Substance Use Disorders.
OBJECTIVE: The antioxidant N-acetylcysteine is being increasingly investigated as a therapeutic agent in the treatment of substance use disorders (SUDs). This study explored the efficacy of N-acetylcysteine in the treatment of posttraumatic stress disorder (PTSD), which frequently co-occurs with SUD and shares impaired prefrontal cortex regulation of basal ganglia circuitry, in particular at glutamate synapses in the nucleus accumbens.
METHODS: Veterans with PTSD and SUD per DSM-IV criteria (N = 35) were randomly assigned to receive a double-blind, 8-week course of N-acetylcysteine (2,400 mg/d) or placebo plus cognitive-behavioral therapy for SUD (between March 2013 and April 2014). Primary outcome measures included PTSD symptoms (Clinician-Administered PTSD Scale, PTSD Checklist-Military) and craving (Visual Analog Scale). Substance use and depression were also assessed.
RESULTS: Participants treated with N-acetylcysteine compared to placebo evidenced significant improvements in PTSD symptoms, craving, and depression (ฮฒ values < -0.33; P values < .05). Substance use was low for both groups, and no significant between-group differences were observed. N-acetylcysteine was well tolerated, and retention was high. CONCLUSIONS: This is the first randomized controlled trial to investigate N-acetylcysteine as a pharmacologic treatment for PTSD and SUD. Although preliminary, the findings provide initial support for the use of N-acetylcysteine in combination with psychotherapy among individuals with co-occurring PTSD and SUD. Be well! JP
April 13th, 2017 at 4:24 pm
Updated 04/13/17:
https://www.ncbi.nlm.nih.gov/pubmed/28318471
Acta Neuropsychiatr. 2017 Mar 20:1-10.
Adjunctive N-acetylcysteine in depression: exploration of interleukin-6, C-reactive protein and brain-derived neurotrophic factor.
OBJECTIVE: This study aimed to explore effects of adjunctive N-acetylcysteine (NAC) treatment on inflammatory and neurogenesis markers in unipolar depression.
METHODS: We embarked on a 12-week clinical trial of NAC (2000 mg/day compared with placebo) as an adjunctive treatment for unipolar depression. A follow-up visit was conducted 4 weeks following the completion of treatment. We collected serum samples at baseline and the end of the treatment phase (week 12) to determine changes in interleukin-6 (IL6), C-reactive protein (CRP) and brain-derived neurotrophic factor (BDNF) following NAC treatment.
RESULTS: NAC treatment significantly improved depressive symptoms on the Montgomery-Asberg Depression Rating Scale (MADRS) over 16 weeks of the trial. Serum levels of IL6 were associated with reductions of MADRS scores independent of treatment response. However, we found no significant changes in IL6, CRP and BDNF levels following NAC treatment.
CONCLUSION: Overall, this suggests that our results failed to support the hypothesis that IL6, CRP and BDNF are directly involved in the therapeutic mechanism of NAC in depression. IL6 may be a useful marker for future exploration of treatment response.
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JP