N-Acetylcysteine for the Treatment of Psychiatric Disorders: A Review of Current Evidence

Table 4

Summary of included reviews: N-acetylcysteine for mood disorders.

Authors (Year)	Type	Inclusion	No. Studies (Study Size)	Conclusion
Fernandes et al. (2016) [29]	SR + MA	Double-blind RCTs of NAC versus placebo in adult subjects with presence of depressive symptoms.	Total = 5 (n = 574): Bipolar = 2 (n = 224); MDD = 3 (n = 350)	Treatment with NAC improved depressive symptoms as assessed by MADRS and HDRS compared to placebo (SMD = 0.37; 95% CI = 0.19 to 0.55; P < .001).
Deepmala et al. (2015) [15]	SR	Clinical trials of psychiatric and neurological disorders which reported a direct clinical effect of NAC as an outcome.	Total = 10 (n = 793): Bipolar = 8 (n = 539); MDD = 2 (n = 254)	NAC may lessen symptoms of bipolar disorder but may not affect the frequency of cycling between mood states. Results of NAC treatment for MDD is still mixed with further evidence required.
Minarini et al. (2017) [16]	SR	Clinical trials that assessed NAC use as the independent variable and clinical outcomes related to a psychiatric disorder.	Total = 12 (n = 868): Bipolar = 10 (n = 614); MDD = 2 (n = 254)	Results remain inconclusive with potential clinical application of NAC for depressive symptoms in bipolar disorder.
Zheng et al. (2018) [27]	SR+MA	All published randomised RCTs of NAC for major mental disorders with meta-analysable data.	Total = 3 (n = 394): Bipolar = 2 (n = 125); MDD = 1 (n = 269)	NAC had no significant effect on depressive and manic symptoms as assessed by the YMRS in bipolar disorder and only a small effect on major depressive symptoms.

Abbreviation. Confidence interval (CI); standard mean difference (SMD); Hamilton Depression Rating Scale (HDRS); major depressive disorder (MDD); meta-analysis (MA); Montgomery-Asberg Depression Rating Scale (MADRS); N-acetylcysteine (NAC); randomised control trial (RCT); systematic review (SR); Young Mania Rating Scale (YMRS).