Efficacy and safety of N-acetylcysteine as add-on therapy in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis

Gadallah, Al-Hussein; Ebada, Mahmoud Ahmed; Gadallah, Ahmed M.; Ahmed, Hussien; Rashad, Wegdan; Eid, Khalid Adel; Bahbah, Eshak I.; Alkanj, Souad

doi:10.1016/j.jocrd.2020.100529

Cited by 10 publications

(7 citation statements)

References 49 publications

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“…There have been six RCTs investigating NAC treating OCD, four with NAC as adjuvant therapy to selective serotonin reuptake inhibitors (SSRIs) and two as single therapy, with doses ranging from 2000 to 3000 mg/day [ 102 – 107 ]. Five of those RCTs were included in a meta-analysis published in 2020 that found that NAC significantly reduced Yale-Brown Obsessive Compulsive Scale (YBOCS) scores compared to placebo [ 108 ]. However, the effect of NAC was not substantial, and only two papers demonstrated a greater than 35% reduction in the YBOCS score, which is indicative of clinical improvement of OCD patients [ 108 ].…”

Section: Obsessive-compulsive and Related Disorders (Ocrd)mentioning

confidence: 99%

“…Five of those RCTs were included in a meta-analysis published in 2020 that found that NAC significantly reduced Yale-Brown Obsessive Compulsive Scale (YBOCS) scores compared to placebo [ 108 ]. However, the effect of NAC was not substantial, and only two papers demonstrated a greater than 35% reduction in the YBOCS score, which is indicative of clinical improvement of OCD patients [ 108 ]. The RCT not included in the meta-analysis investigated adjuvant NAC (2,700 mg/day) treatment of 11 patients with OCD aged 8–17 years and found a significant reduction in YBOCS compared to placebo [ 107 ].…”

Section: Obsessive-compulsive and Related Disorders (Ocrd)mentioning

confidence: 99%

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

et al. 2022

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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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Section: Obsessive-compulsive and Related Disorders (Ocrd)mentioning

confidence: 99%

Section: Obsessive-compulsive and Related Disorders (Ocrd)mentioning

confidence: 99%

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

et al. 2022

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“…The Cochrane ROB assessment tool is designed to detect five types of bias, including selection bias (sequence generation and allocation concealment), performance bias (blinding of participants and investigators), detection bias (blinding of outcome assessors), attrition bias (incomplete outcome data), and reporting bias (selective outcome reporting). [ 6 - 8 , 10 ] Each study is classified in each domain as low, high, or unclear ROB.…”

Section: Material’s and Methodsmentioning

confidence: 99%

Efficacy and safety of polyethylene glycol dural sealant system in cranial and spinal neurosurgical procedures: Meta-analysis

Diab¹,

Al-Shami

Negida

et al. 2021

Surgical Neurology International

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Background: We aimed to assess the efficacy of polyethylene glycol (PEG) dura sealant to achieve watertight closure, prevention of cerebrospinal fluid (CSF) leak and to investigate its possible side effects. Methods: We searched Medline (through PubMed), Scopus, and the Cochrane Library through December 2019. We included articles demonstrating cranial or spinal procedures with the use of PEG material as a dural sealant. Data on intraoperative watertight closure, CSF leak, and surgical complications were extracted and pooled in a meta-analysis model using RevMan version 5.3 and OpenMeta (Analyst). Results: Pooling the controlled trials showed that PEG resulted in significantly more intraoperative watertight closures than standard care (risk ratio [RR] = 1.44, 95% confidence interval [CI] [1.24, 1.66]). However, the combined effect estimate did not reveal any significant difference between both groups in terms of CSF leaks, the incidence of surgical site infections, and neurological deficits (P = 0.7, 0.45, and 0.92, respectively). On the other hand, pooling both controlled and noncontrolled trials showed significance in terms of leak and neurological complications (RR = 0.0238, 95% CI [0.0102, 0.0373] and RR = 0.035, 95% CI [0.018, 0.052]). Regarding intraoperative watertight closure, the overall effect estimate showed no significant results (RR=0.994, 95% CI [0.986, 1.002]). Conclusion: Dura seal material is an acceptable adjuvant for dural closure when the integrity of the dura is questionable. However, marketing it as a factor for the prevention of surgical site infection is not scientifically proved. We suggest that, for neurosurgeons, using the dural sealants are highly recommended for duraplasty, skull base approaches, and in keyhole approaches.

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“…Our prior systematic review exploring the principal nutraceutical in this formulation (NAC) for OCD and related disorders (OCRD) 67 found that the balance of evidence supported the use of NAC in presentations of moderate-severity OCD and OCRD, and a more recent meta-analysis supported a small but significant improvement in OCD symptoms from add-on NAC. 68 Doses of 2.4 to 3 g/day for a minimum of 8 weeks were considered adequate for providing an initial therapeutic effect. However, even within these patient groups, response rates are variable, and some reports have not confirmed efficacy (particularly in treatment-resistant populations).…”

Section: Cns Spectrumsmentioning

confidence: 99%

Treatment of refractory obsessive–compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study

et al. 2021

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Background Obsessive–compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach. Objective To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5′ phosphate, and selenium. Methods A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive–Compulsive Scale (YBOCS), administered every 4 weeks. Results An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of −7.13 (95% confidence interval = −9.24, −5.01), with a mean reduction of −1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered “responders” (YBOCS ≥35% reduction and “very much” or “much improved” on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD. Conclusions While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.

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Efficacy and safety of N-acetylcysteine as add-on therapy in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis

Cited by 10 publications

References 49 publications

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

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

Efficacy and safety of polyethylene glycol dural sealant system in cranial and spinal neurosurgical procedures: Meta-analysis

Treatment of refractory obsessive–compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study

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