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Update: N-acetylcysteine (NAC)

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A previous blog post talked about the potential benefits of N-acetylcysteine (NAC) for trichotillomania, citing a Minnesota study that showed over half of the participants showed reduced hair pulling when using it. A more recent review of the research discussed NAC and its effectiveness for various mental health disorders.

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More details about how it works

NAC is an amino acid historically used as a mucolytic and for treatment of acetaminophen overdose. A mucolytic dissolves thick mucus in the respiratory system. It essentially dissolves the chemical bonds that holds the thick secretions together. A common version of a mucolytic is Mucinex which is made with guaifenesin. However, NAC’s mucolytic properties are not the focus of this blog post, but it does provide an indication of how long NAC has been used in medicine.

Sold as a nutritional supplement over the counter, NAC is often marketed as an antioxidant that can improve brain functioning. Without going in-depth about neuroscience, NAC

NAC increases a brain antioxidant called glutathione. Low levels of glutathione cause oxidative stress and reduced antioxidant levels in the brain. People with several types of psychiatric disorders including depression and OCD tend to have low levels of these brain chemicals. Therefore, researchers hypothesize that NAC boosts those levels which may help those disorders in some way.

Second, NAC seems to have positive effects on the neurotransmitters dopamine and glutamate. Again, people with psychiatric disorders tend to have neurotransmitters that do not behave correctly, and many psych drugs try to stabilize them. Research indicates that NAC improves the status of dopamine and glutamate indicating promise for disorders like OCS and addiction.

The third way NAC acts on the brain is by reducing systemic inflammation. The evidence is not clear, but some people with mental health disorders such as depression, have inflammation and oxidative stress which may contribute to the disorder. There is some evidence that NAC impacts inflammation.

Does it work for trich?

The question we all want an answer to is whether NAC works for trich. Thus far the answer is maybe.

The research evidence of NAC suggests:

  • In addiction studies, NAC contributed to fewer cravings and lower desire to use drugs.

  • Schizophrenia research shows reduced symptoms when NAC was added to regular treatment.
  • OCD and related disorder research show people with OCD-type disorders have high levels of glutamate and when treated with NAC show symptoms improvement.
  • People with mood disorders and depression respond well to NAC with reduced symptoms. 

In short, NAC seems to help most of the time, but what does this mean for people with trich? It depends on the behavioral manifestations of trich symptoms. Someone who has a trich profile that includes compulsions and pulling in response to depression may benefit from using NAC. However, many of the studies cited in the research review indicated NAC use as an add-on to existing pharmacological therapy.

NAC side effects included gastrointestinal issues such as nausea, cramps, bloating, with few people reporting headaches, dry mouth, and fatigue. However, these side effects were minimal and most people in the studies tolerated it very well without any side effects. Although NAC was used with other medications, the research did not state whether NAC interacts with other medications.

Recommendation

NAC shows promise as well as research-based evidence that it can help people with certain mental health disorders. It doesn’t hurt to try it but do so in consultation with a physician who can assess your individual symptom and medication profile.


References

Ooi, S. L., Green, R. & Pak, S. C. (2018). N-acetylcysteine for the treatment of psychiatric disorders: A review of current evidence. BioMed Research International. https://doi.org/10.1155/2018/2469486

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