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SYSTEMATIC REVIEW article

Front. Psychiatry
Sec. Psychopharmacology
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1421150
This article is part of the Research Topic Biological and Non-Pharmacological Treatments of Obsessive-Compulsive Disorder and Related Disorders View all 7 articles

The safety and efficacy of N-acetylcysteine as an augmentation in the treatment of obsessive-compulsive disorder in adults: A systematic review and meta-analysis of randomized clinical trials

Provisionally accepted
Shayan Eghdami Shayan Eghdami 1Negin Eissazade Negin Eissazade 2Mohsen Heidari Mokarar Mohsen Heidari Mokarar 3Mahsa Boroon Mahsa Boroon 3Laura Orsolini Laura Orsolini 4Mohammadreza Shalbafan Mohammadreza Shalbafan 1*
  • 1 Iran University of Medical Sciences, Tehran, Iran
  • 2 Institute for Cognitive Science Studies (ICSS), Tehran, Tehran, Iran
  • 3 Alborz University of Medical Sciences, Karaj, Alborz, Iran
  • 4 Marche Polytechnic University, Ancona, Marche, Italy

The final, formatted version of the article will be published soon.

    Background: Obsessive-compulsive disorder (OCD) ranks as the fourth most prevalent psychiatric disorder, with selective serotonin reuptake inhibitors (SSRIs) as its mainstay pharmacological treatment. However, approximately 40 to 60% of patients do not adequately respond to initial treatment, highlighting the need for alternative options. N-acetylcysteine (NAC) is one of the several medications that have been used in augmentation with SSRIs to enhance their efficacy. Objectives: We aimed to investigate the safety and efficacy of NAC, a glutamate-modulating agent, as an augmentation in the treatment of moderate to severe OCD.We conducted a thorough search across PubMed, Scopus, Web of science, and ProQuest to identify relevant trials published until December 2023. The primary outcome of interest was the mean difference between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores before and after administrating augmented NAC among patients with moderate to severe OCD. Furthermore, we compared the occurrence of adverse drug events between the experimental and control groups. Results: We included six randomized controlled trials with 195 patients. The results of our study indicated a positive outcome for the experimental group in terms of the total Y-BOCS score when using the medication for a period of five to eight weeks (p-Value = 0.05). However, no significant difference was observed for durations shorter than five weeks or longer than 12 weeks. Additionally, no significant difference was found between the two groups in terms of the obsession and compulsion Y-BOCS scores. Furthermore, no significant differences were observed in terms of adverse events. Conclusion: Augmentation of NAC with SSRIs may benefit patients with moderate to severe OCD. However, it is necessary to conduct additional multi-center trials over extended periods to develop a comprehensive strategy for action.

    Keywords: Acetylcysteine, Obsessive-Compulsive Disorder, Glutamate, Systematic review, Meta-analysis

    Received: 21 Apr 2024; Accepted: 26 Aug 2024.

    Copyright: © 2024 Eghdami, Eissazade, Heidari Mokarar, Boroon, Orsolini and Shalbafan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Mohammadreza Shalbafan, Iran University of Medical Sciences, Tehran, Iran

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.