N-acetylcysteine for obsessive-compulsive disorder

Townsend Letter for Doctors and Patients, Nov, 2006 by Alan R. Gaby

A 58-year-old woman with a history of obsessive-compulsive disorder since childhood had a stable but partial response to fluvoxamine (Luvox; a selective serotonin-reuptake inhibitor), which she had been taking for 12 years. N-acetylcysteine (NAC) was added at a dose of 600 mg/day, which was increased progressively over six weeks to 3 g/day for an additional seven weeks. A clear improvement in compulsive hand-washing was seen, and this improvement persisted for a further two months with continued NAC treatment.

Comment: Hyperactivity of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder. NAC was tried in this case, because it is believed to reduce synaptic glutamatergic activity. Obsessive-compulsive disorder frequently fails to respond adequately to medications and psychotherapy, so additional studies of NAC are warranted. While NAC is generally well tolerated, long-term use has the potential to deplete zinc and copper, so supplementation with these minerals is probably a good idea for people taking NAC.

Lafleur DL, et al. N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Psychopharmacology. 2006;184:254-256.