N-acetylcysteine augmentation therapy for moderate-to-severe obsessive-compulsive disorder: randomized, double-blind, placebo-controlled trial.
Reviewed by: Alan Gaby, MD
Author: Paydary K, et al
Reference: N-acetylcysteine augmentation therapy for moderate-to-severe obsessive-compulsive disorder: randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther 2016;41:214-219.
Design: Randomized, double-blind, placebo-controlled trial.
Participants: Forty-four patients (mean age, 33 years) with moderate-to-severe obsessive-compulsive disorder (OCD).
Study Medication and Dosage: N-acetylcysteine (NAC; 2,000 mg per day) or placebo for 10 weeks. All patients received 200 mg per day of fluvoxamine (a selective serotonin-reuptake inhibitor).
Primary Outcome Measure: Scores on scales that measure the severity of OCD.
Key Findings: Compared with placebo, NAC significantly improved the mean total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (p = 0.01) and the mean score on the Y-BOCS obsession subscale (p = 0.01).
Practice Implications: Hyperactivity of glutamatergic neurotransmission has been implicated in the pathogenesis of OCD. NAC is believed to reduce glutamatergic activity. In previous case reports and double-blind trials, NAC was beneficial in the treatment of OCD, including patients with trichotillomania (hair-pulling disorder) and compulsive skin picking. The results of the present study demonstrate that NAC is beneficial as an adjunct to fluvoxamine in the treatment of moderate-to-severe OCD.