N‐acetylcysteine for major mental disorders: a systematic review and meta‐analysis of randomized controlled trials

Objective This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N‐acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. Methods The PubMed, Cochrane Library...

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Bibliographic Details
Published in:Acta psychiatrica Scandinavica 2018-05, Vol.137 (5), p.391-400
Main Authors: Zheng, W., Zhang, Q.‐E., Cai, D.‐B., Yang, X.‐H., Qiu, Y., Ungvari, G. S., Ng, C. H., Berk, M., Ning, Y.‐P., Xiang, Y.‐T.
Format: Article
Language:English
Subjects:
Acetylcysteine
Affective disorders
Antioxidants
Bipolar disorder
Clinical trials
major depressive disorder
Mental depression
Mental disorders
Meta-analysis
N‐acetylcysteine
Oxidative stress
Psychopathology
Schizophrenia
Systematic review
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Summary:Objective This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N‐acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. Methods The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. Results Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = −0.74, 95% CI: −1.43, −0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. Conclusions Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.
ISSN:0001-690X
1600-0447
DOI:10.1111/acps.12862