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N-Acetylcysteine for bipolar disorder.

Seventy-five patients (mean age, 46 years) with bipolar disorder in the maintenance phase were randomly assigned to receive, in double-blind fashion, N-acetylcysteine (NAC; 1 g twice a day) or placebo, in addition to their usual medication, for 24 weeks. Compared with placebo, NAC treatment resulted in significant improvements on the Montgomery Asberg Depression Rating Scale (MADRS; p = 0.002), the Bipolar Depression Rating Scale (p = 0.012), and several other ratings of clinical status, quality of life, and functioning. Benefit was evident by eight weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Effect sizes at the end of the study were medium to high for improvements on the MADRS and for nine of the 12 secondary endpoints. Four weeks after NAC was discontinued, the improvements were lost. No significant adverse effects were seen.


Comment: Bipolar disorder is a chronic, difficult-to-treat psychiatric condition. The results of the present study indicate that NAC is useful as adjunctive treatment for patients with bipolar disorder. While the mechanism of action is not known, NAC is a precursor to glutathione, the levels of which are low in patients with bipolar disorder.

Berk M, et al. N-Acetyl cysteine for depressive symptoms in bipolar disorder-a double-blind randomized placebo-controlled trial. Biol Psychiatry. 2008;64:468-475.

by Alan R. Gaby, MD
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Title Annotation:Literature Review & Commentary
Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Clinical report
Geographic Code:1USA
Date:Dec 1, 2008
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