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Treating Bipolar Depression with N-Acetyl Cysteine

Posted on September 9, 2008 by Dr. Fink

Treating the depression side of bipolar disorder is always a challenge. All too often, antidepressants don’t work or they have undesirable side effects. Many of the most popular and effective antidepressants also carry the risk of unmasking the manic side of bipolar disorder, particularly in patients with Bipolar I.

Because of this, researchers are looking for other treatment options. Results from a recent study entitled “N-Acetyl Cysteine for Depressive Symptoms in Bipolar Disorder—A Double-Blind Randomized Placebo-Controlled Trial,” look hopeful.

According to researchers who performed the study, individuals with both depression and bipolar disorder experience a glutathione deficiency. Glutathione is an antioxidant that protects cells from toxins. In the study scheduled for publication in the September 15th issue of Biological Psychiatry, Dr. Michael Berk and colleagues sought to evaluate whether N-acetyl cysteine (NAC), “a safe, orally bioavailable precursor of glutathione,” could help alleviate depressive symptoms.

In a randomized, double-blind, placebo-controlled trial, they evaluated the mood symptoms of individuals with bipolar disorder, half of whom received placebo and half of whom received NAC (1 g twice daily), as an add-on therapy to their usual treatment. Over the 24 weeks of the study, NAC was well tolerated, and induced a marked and significant improvement in depressive symptoms.

Additionally there were no significant side effects reported in the group taking NAC compared to the group taking a sugar pill. The study only looked at results for up to 20 weeks of treatment with NAC. The remaining 4 weeks of the study followed participants through a “wash out period.” The benefits were lost when the NAC was stopped.

From the study, the researches concluded: “NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.”

“Brain glutathione metabolism appears to be a valuable new treatment target for psychiatric disorders, and we hope the impressive results of this study open up a new treatment option.”

- Dr. Michael Berk

Ashley Bush, M.D., Ph.D., the article’s corresponding author, further explains: “Glutathione is the brain’s primary antioxidant defense, and there is evidence of increased oxidative stress in bipolar disorder. Therefore, we studied the potential benefit of NAC treatment in bipolar disorder and found that it impressively remedied residual depressive symptoms.”

John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, comments: “The preliminary evidence of efficacy of NAC is very interesting. This study might suggest a number of novel approaches to treating depression. In subsequent efforts to replicate this preliminary finding, it will be important to determine how much NAC reaches the brain after oral administration.”

As noted by both the authors and Dr. Krystal, additional studies will be necessary to further evaluate and replicate these findings.

Caution: As always, we caution against self-medicating, even with over-the-counter medications and supplements. Discuss this option with the doctor in charge of managing your medications before adding it to your treatment regimen.

Comments

8 Responses to “Treating Bipolar Depression with N-Acetyl Cysteine”

  1. Bipolar disorder is often difficult to recognize on September 10th, 2008 1:35 pm

    [...] Treating Bipolar Depression with N-Acetyl Cysteine [...]

  2. The Glutathione Benefits King on October 6th, 2008 7:08 pm

    Great post, i’ve got a friend who is bibolar – she has to take medication daily however sometimes she goes off it. last time she lasted 2 years before she had to get back on it though. she’s getting good at recognizing the signs and seeking medicine before the effects take over.
    I’m sending this to her. Thanks :)

  3. Gianna on October 14th, 2008 7:18 am

    You talk about antidepressants “unmasking the manic side of bipolar disorder”

    I know way too many people who figured out that the mania caused by antidepressants was simply an adverse drug reaction…they refused to continue on the med merry go round so many of us get stuck on and NEVER have an episode again…

    this is not unmasking what is there—its a toxic drug reaction. It’s really horrifying to think of all the people labeled bipolar because of an adverse drug reaction who then get stuck on toxic soul killing drugs for no good reason.

  4. Glutathione User on December 18th, 2008 8:54 pm

    Very informative post for glutathione user like me. It give’s us a deep information about the glutathione capsules that we drink. Thanks and keep it up

  5. The Himalayan Goji Juice Guy on February 9th, 2009 1:07 am

    We’ve been researching Dr. Krystal a fair bit lately. Lots of great studies and information. Were always interested in learning more about manic states, my friend is bi-polar – she’s always finding ways to keep stress levels down and finds she doesn’t need medication so long as she’s not stressed out.

    Great post.

  6. barbara on January 2nd, 2010 10:41 pm

    Diagnosed 13 months ago bipolar 1. I commend everyone taking all steps possible to help all
    with this debilitating disorder! Keep on Going
    as I keep on praying. Sincerely, Barbara

  7. Brian on March 11th, 2010 10:27 am

    I am trying to find nore success stories about treating depression with N-aceytl-cystine verses going on prescribed antidepressants. I was looking for recommendation of dossage and duration of time required for results. The scientific research in the artical is promising but I would not mind seeing more. Another question I had was do N-acetyl-cystine and glutithoine levels have any relation to SAM e levels?
    Thank You,

  8. Carl Rowe on July 26th, 2010 8:02 pm

    Glutathione is a major anti-oxidant,and immunomodulator which has profound effects upon the hormonal system, the nervous system, DNA synthesis,NK cell production, lymphocyte production and many other daily bodily functions.
    Glutathione has been found helpful in bi-polar disease and many other diseases which have a hormonal component.

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