N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial

Jerome Sarris, Gerard Byrne, David Castle, Chad Bousman, Georgina Oliver, Lachlan Cribb, Scott Blair-West, Vlasios Brakoulias, David Camfield, Carolyn Ee, Suneel Chamoli, Mark Boschen, Olivia M. Dean, Nathan Dowling, Ranjit Menon, Jenifer Murphy, Najwa Joelle Metri, Thomas P. Nguyen, Andrew Wong, Rebecca JordanDiana Karamacoska, Susan L. Rossell, Michael Berk, Chee H. Ng

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Objective: Preliminary evidence has suggested that adjunctive N-acetylcysteine (NAC), an antioxidant precursor to glutathione, may reduce symptoms of obsessive-compulsive disorder (OCD). We conducted a 20-week, multi-site, randomized controlled trial to investigate the safety and efficacy of the adjunctive use of NAC in OCD. Methods: The study was a phase III, 20-week, double-blind, randomized controlled trial across multiple sites in Australia investigating 2 g to 4 g per day of NAC (titrated according to response) in 98 participants with DSM-5 diagnosed OCD. Data were analysed using linear mixed effects models for the 89 participants who attended at least one follow-up visit. Results: A modified intention-to-treat analysis of the primary outcome found no evidence that NAC reduced symptoms of OCD measured on the Yale-Brown Obsessive-Compulsive Scale, relative to placebo (mean difference at week 20 = 0.53, 95% compatibility interval = −2.18, 3.23; p = 0.70; favouring placebo). There was also no evidence that NAC, compared to placebo, improved outcomes on the secondary measures including anxiety, depression, quality of life, functioning, or clinician/participant impression. NAC was well-tolerated with only mild gastrointestinal adverse events associated with the treatment. Conclusion: We found no evidence supporting the efficacy of the adjunctive use of NAC in OCD.

Original languageEnglish
Article number110550
Number of pages9
JournalProgress in Neuro-Psychopharmacology and Biological Psychiatry
Volume117
DOIs
Publication statusPublished - 13 Jul 2022
Externally publishedYes

Keywords

  • Anxiety
  • Clinical trial
  • Nutraceutical
  • Obsessive compulsive disorder
  • Oxidative stress

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