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N-Acetyl Cysteine (NAC) in the treatment of obsessive-compulsive disorder: a 16-week, double-blind, randomised, placebo-controlled study

Sarris, Jerome, Oliver, Georgina, Camfield, David A., Dean, Olivia M., Dowling, Nathan, Smith, Deidre J., Murphy, Jenifer, Menon, Ranjit, Berk, Michael, Blair-West, Scott and Ng, Chee H. 2015, N-Acetyl Cysteine (NAC) in the treatment of obsessive-compulsive disorder: a 16-week, double-blind, randomised, placebo-controlled study, CNS Drugs, vol. 29, no. 9, pp. 801-809.

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Title N-Acetyl Cysteine (NAC) in the treatment of obsessive-compulsive disorder: a 16-week, double-blind, randomised, placebo-controlled study
Author(s) Sarris, Jerome
Oliver, Georgina
Camfield, David A.
Dean, Olivia M.ORCID iD for Dean, Olivia M. orcid.org/0000-0002-2776-3935
Dowling, Nathan
Smith, Deidre J.
Murphy, Jenifer
Menon, Ranjit
Berk, MichaelORCID iD for Berk, Michael orcid.org/0000-0002-5554-6946
Blair-West, Scott
Ng, Chee H.
Journal name CNS Drugs
Volume number 29
Issue number 9
Start page 801
End page 809
Total pages 9
Publisher Springer
Place of publication Berlin, Germany
Publication date 2015-09
ISSN 1172-7047
Summary BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling mental illness for which pharmacological and psychosocial interventions are all too often inadequate. Recent preclinical and clinical studies have implicated dysfunction of glutamatergic neurotransmission in the pathophysiology of OCD. The amino acid-based nutraceutical N-acetyl cysteine (NAC) is a safe and readily available agent that has been found to modify the synaptic release of glutamate in subcortical brain regions via modulation of the cysteine-glutamate antiporter. OBJECTIVE: The aim of this study was to assess the efficacy and safety of NAC in treating OCD. METHODS: A 16-week, double-blind, placebo-controlled, randomised trial using 3 g/day of NAC (1.5 g twice daily) in 44 participants (aged 18-70 years) with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)-diagnosed OCD, during 2013-2015. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS), conducted every 4 weeks. RESULTS: Analysis of the full sample (intention-to-treat) with repeated measures mixed linear modelling revealed a nonsignificant time × treatment interaction for the YBOCS scale total score (p = 0.39). A per-protocol analysis removing protocol violators also failed to show a significant time × treatment interaction for YBOCS total score (p = 0.15). However, a significant time × treatment interaction was observed for the YBOCS 'Compulsions' subscale in favour of NAC (p = 0.013), with a significant reduction observed at week 12 (dissipating at week 16). At 16 weeks, only four (20 %) participants were considered 'responders' (YBOCS ≥35 % reduction at endpoint) versus four (27 %) in the placebo group. The NAC was well-tolerated, aside from more cases of heartburn occurring compared with placebo (p = 0.045). CONCLUSION: Further research involving NAC for OCD may require larger samples to detect moderate or small effect sizes, involve dosage or formulation differences, use in concert with exposure therapy, or an additional post-study observational period to mitigate study withdrawal. TRIAL REGISTRATION: ACTRN12613000310763.
Language eng
Field of Research 110999 Neurosciences not elsewhere classified
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, Springer
Persistent URL http://hdl.handle.net/10536/DRO/DU:30078516

Document type: Journal Article
Collection: School of Medicine
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Created: Thu, 29 Oct 2015, 09:50:52 EST

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