N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials

W. Zheng, Q. E. Zhang, D. B. Cai, X. H. Yang, Y. Qiu, G. S. Ungvari, C. H. Ng, M. Berk, Y. P. Ning, Y. T. Xiang

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Abstract

Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. Methods: The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. Results: Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = −0.74, 95% CI: −1.43, −0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. Conclusions: Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.

Original languageEnglish
Pages (from-to)391-400
Number of pages10
JournalActa Psychiatrica Scandinavica
Volume137
Issue number5
DOIs
Publication statusPublished - 1 May 2018

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Acetylcysteine
Mental Disorders
Meta-Analysis
Randomized Controlled Trials
Bipolar Disorder
Schizophrenia
Major Depressive Disorder
Confidence Intervals
Depression
Drug-Related Side Effects and Adverse Reactions
Psychopathology
PubMed
Libraries
Psychiatry
Antioxidants
Odds Ratio
Research Personnel
Databases
Safety
Control Groups

Cite this

Zheng, W. ; Zhang, Q. E. ; Cai, D. B. ; Yang, X. H. ; Qiu, Y. ; Ungvari, G. S. ; Ng, C. H. ; Berk, M. ; Ning, Y. P. ; Xiang, Y. T. / N-acetylcysteine for major mental disorders : a systematic review and meta-analysis of randomized controlled trials. In: Acta Psychiatrica Scandinavica. 2018 ; Vol. 137, No. 5. pp. 391-400.
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N-acetylcysteine for major mental disorders : a systematic review and meta-analysis of randomized controlled trials. / Zheng, W.; Zhang, Q. E.; Cai, D. B.; Yang, X. H.; Qiu, Y.; Ungvari, G. S.; Ng, C. H.; Berk, M.; Ning, Y. P.; Xiang, Y. T.

In: Acta Psychiatrica Scandinavica, Vol. 137, No. 5, 01.05.2018, p. 391-400.

Research output: Contribution to journalArticle

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T2 - a systematic review and meta-analysis of randomized controlled trials

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AU - Yang, X. H.

AU - Qiu, Y.

AU - Ungvari, G. S.

AU - Ng, C. H.

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AU - Ning, Y. P.

AU - Xiang, Y. T.

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N2 - Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. Methods: The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. Results: Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = −0.74, 95% CI: −1.43, −0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. Conclusions: Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.

AB - Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. Methods: The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. Results: Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = −0.74, 95% CI: −1.43, −0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. Conclusions: Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.

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KW - major depressive disorder

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