For me, one of the most fascinating things about psychiatry is going back and forth between specific diagnoses and common factors. are allpsychiatricAre the disorders basically the same or are they radically different from each other?
- Is schizophrenia different fromBipolar disorder? And if so, how?
- It is importantDepressionBesides panic disorder? And if so, how?
The diagnosis in the DSM-5 (Diagnostic and Statistics Guide, 5th Edition) generally suggests that each disorder differs from the others in precise ways: Major depression is diagnosed when a person has five or more of nine symptoms for at least two weeks; while panic disorder requires four or more than a dozen other symptoms.
Therefore, if you only have four symptoms of depression, you cannot be diagnosed with major depression. And if you only have three panic disorder symptoms, you don't have any.HeDiagnosis. Fair enough, you have to draw the line somewhere. But is your four-symptom depression or three-symptom panic really any different than the person who has the requisite full set of symptoms?
To make matters worse, many people "meet the criteria" to have multiple DSM-5 psychiatric diagnoses at once. You may have panic disorderYsevere depression - along withsocial anxietySpecific disorders and phobias. So the question arises: Do you have two, three or four different problems? Couldn't all of your various diagnoses be attributed to a single problem in your brain, a series of brain circuits or centers with abnormally increased or decreased activity, causing few or many symptoms?
This may seem like an almost theological dispute, similar to how many angels dance on the head of a pin.
But in the real world, it's not trivial. If you ignore one of the diagnoses, such as panic disorder, and treat only the depression, you are likely to have a worse outcome than treating both conditions. Still, similar treatments often work for both conditions. Both SSRI drugs andcognitive behavior therapy(CBT) helps depression and panic disorder, although treatments may need to be adjusted for each disorder.
On the other hand, some treatments help a condition andnothe other. Bupropion is powerful.antidepressant, but not very effective for panic disorder, while lorazepam, a benzodiazepine, helps with panic disorder but may be counterproductive for depression. On the third page, so to speak, if you could identify common circuitry problems that underlie a variety of psychiatric disorders, perhaps you could find a single treatment that could help a variety of problems. About himfourOn the other hand, there is the possibility that people with a diagnosis (for example, major depression) could have any number of different circulatory abnormalities, just as their fever of 103 could be the result of a variety of bacterial or viral infections, or a variety of other causes can.
Lumper vs Splitter
So psychiatry is like many other fields: warring gangs of rags and splinters. Extreme lumpers claim that there is only one dimension of psychopathology (Caspi). Extreme fragments indicate thisexpectedcombat differs from PTSD violent attack differs from PTSDsexual assault, and that everyone benefits from different treatment approaches.
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What are you doingneuroscienceI must say? Over the past decade, thanks to an initiative sponsored by Thomas Insel, M.D., Ph.D., former director of the National Institute of Mental Health, researchers have overcome that controversy by focusing on circuitry in the brain. The 2008 Research Domain Criteria (RDoC) initiative focused research on identifying brain circuits that can go wrong in many different diseases, common abnormalities that can underlie many different diseases.
In general, research on brain circuitry generally supports lumpers: it is generally the same circuitry that goes awry in almost all psychiatric disorders, though perhaps with a different emphasis for different disorders.
Which brings me to N-acetylcysteine.
N-acetylcysteine, or NAC, is an over-the-counter compound that you can buy at your local health food store. As with dozens, if not hundreds of other compounds, NAC has its supporters and detractors, its enthusiasts and its skeptics. (And I'm generally skeptical of products from the herbal/supplement industry.)
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NAC is an amino acid found in many foods, but supplements give you a higher dose than you would on a daily basisDiet. It is typically taken in doses of 1,000 to 2,000 milligrams per day, usually in 600-milligram capsules taken 2 to 3 times daily, and aside from mild gastrointestinal side effects, NAC is generally well tolerated.[Note: Suffice it to say that before taking this or any dietary supplement, you should check with your doctor to see if they are right for you. In my psychiatric practice, I consider a NAC study to be similar to any other drug (or therapy) study: it requires the patient to receive an adequate dose for a reasonable period of time and to monitor its effects on key symptoms (and the effects secondary). for a long enough period of time to see if it helps.]
[PLEASE ALSO NOTE: The use of NAC for psychiatric symptoms is an off-label use. The only FDA-approved indication for NAC is treatment to prevent severe liver damage from acetaminophen poisoning. So if you plan to use NAC for psychiatric or other medical symptoms, please discuss this with your doctor to ensure it is safe and potentially beneficial]
What I find fascinating about NAC is that it is of great interest to neuroscientific researchers. There have been many studies of this compound, including imaging studies, and it has been studied in a myriad of conditions: depression, bipolar disorder,obsessive compulsive disorder, PTSD, schizophrenia,search, Eating Disorders, Alzheimer's and Addictions (Berk). NAC has also established medicinal uses as an anti-inflammatory drug in acetaminophen overdose to prevent liver failure. Clinical trials have shown promise in many (but not all) of the conditions in which it has been studied (Berk). Clearly more research is needed, both more clinical trials on different disorders and more basic research to see how NAC works in the brain.
Why does NAC help so many people with psychiatric diagnoses? Why does it work in so many conditions? That's what's exciting in my opinion. Are its benefits due to its anti-inflammatory effects? Or another mechanism? On a clinical level, NAC appears to help in daily work with patients who are concerned with extremely negative self-esteem that is difficult to control. Such thoughts are in depression anddistressDisorders, and also with eating disorders, schizophrenia, obsessive-compulsive disorder, etc. I have seen it help patients with such disorders when many other things, medication or psychotherapy, have not helped much.
NAC doesn't always work, but when it does, the disturbing irrational thoughts gradually decrease in intensity and frequency and often fade away. Negative thoughts (eg, “I'm a bad person” or “Nobody likes me”) or thoughts about other people (“Will the girl like me?”) or health problems (“Do I have AIDS? ”) passes reasonable evidence to the contrary, and which, despite all rational efforts to control it, creeps into consciousness hour after hour, day after day, seems to calm down or, if it persists, is less distressing, and can be observe from a greater distance, with less concern, orfearand they are less likely to trigger depression or other negative effects.
Which goes back to the old debates between psychiatric rags and splinters. Are NAC buffs more compatible with lumpers than splitters? Do you support RDoC enthusiasts eager to explore brain circuitry? I think in a way results like this favor the lumpers. The amelioration of irrational and difficult-to-control negative thoughts by NAC treatment in so many conditions makes it difficult to avoid the conclusion that some common underlying circuitry is involved.
On the other hand, it is not yet time for the splinter to go home defeated. For one, NAC doesn't work for everyone. But even if the circuitry for rumination is the same, why would some people probably accept it?hyperactiveDo black circles develop OCD and others develop bipolar disorder? And still others, despite intense pondering, do not meet the criteria foranymental disorder? It is possible that abnormal activity in certain brain circuits, beginning early in life, may lead to the development ofdifferentdifferent disorders over time depending on their life experiences, coping patterns, etc. But how and why do its effects vary so much from person to person?
To me, slob vs. slob debates are most useful when they help advance science and treatment. In that case, the goal posts are significantly reduced with the advent of NAC as a potentially useful treatment for a common symptom of many medical conditions.
How does NAC help with psychiatric disorders? ›
NAC in depression and anxiety
Some researchers believe that NAC treats depression by lowering inflammation and glutamate levels. A large meta-analysis — a review of many studies — found that NAC helped treat depressive symptoms.
PHILADELPHIA – N-acetylcysteine (NAC) is a naturally occurring molecule that replenishes antioxidants and shows improved brain metabolism and self-reported improvements in cognitive function in patients with multiple sclerosis, according to a study published in the journal, Frontiers in Neurology.How does NAC help schizophrenia? ›
Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia.How long does it take for NAC to work for depression? ›
According to one review of data from multiple individual studies (including data from 574 depression patients and healthy participants), NAC has been reported to potentially improve symptoms of depression and overall daily functioning within 3-6 months of use .Why does NAC make me feel so good? ›
NAC helps to replenish glutathione levels in the body. It also aids in regulating glutamate. These functions may help to improve brain health and benefit people with conditions such as Alzheimer's and Parkinson's diseases. NAC may help with psychiatric disorders and addictive behaviors.How does NAC make you feel? ›
NAC is likely safe for adults when provided as a prescription medication. However, high amounts may cause nausea, vomiting, diarrhea, and constipation ( 48 ). When inhaled, it can cause swelling in the mouth, runny nose, drowsiness, and chest tightness.What happens if you take NAC daily? ›
NAC may raise levels of homocysteine, an amino acid that is associated with heart disease. Be sure to have your doctor check your homocysteine level if you are taking NAC. Very high doses (more than 7 grams) of cysteine may be toxic to human cells and may even lead to death.Who should not take NAC? ›
If you have asthma or bleeding problems, your doctor may tell you to avoid NAC. You will likely be told to stop NAC 2 weeks before any elective surgery. If you're pregnant or breastfeeding, you must check with a doctor before using NAC supplements.Does NAC reduce brain aging? ›
N-acetyl-L-cysteine (NAC) restores cellular glutathione, a key antioxidant that drops with age. Studies suggest NAC reduces brain aging and the risk for neurodegenerative conditions. Scientifically reviewed by: Dr. Gary Gonzalez, MD, in February 2022.What are the negative effects of NAC? ›
Adverse Reactions and Drug Interactions
At dosages of 1,200 mg twice daily or lower, N-acetylcysteine is well tolerated. At these dosages, side effects are unusual, but may include nausea, vomiting, diarrhea, transient skin rash, flushing, epigastric pain, and constipation.
Does NAC calm nervous system? ›
NAC reversed the anxiety-like behavior and oxidative damage observed in stressed animals. Additional studies are needed to investigate the effects of this agent on glutamatergic modulation and inflammatory markers related to stress.How much NAC should I take for schizophrenia? ›
Effective Dosage: 2 grams per day (1 gram twice daily) orally. A case study of a woman with refractory schizophrenia showed improvements with 600 mg (0.6 grams) per day (as an add-on to two other antipsychotics).Does NAC help with intrusive thoughts? ›
While NAC isn't a natural cure for obsessions and compulsions, it does have a hand in reducing anxiety² among OCD patients. Another study³ revealed that when NAC is added to fluvoxamine—the antidepressant drug for OCD—it helps manage symptoms faster.When is the best time to take NAC morning or night? ›
When should you take NAC, morning or night? It can be taken any time of day that is most convenient. NAC is available in 500-, 600-, 750- and and 1,000-milligram tablets.Does NAC raise serotonin levels? ›
In the present study, NAC was effective in inducing serotonin levels, the 33% decrease of serotonin recorded in PPA-treated rats was only reduced to a value of 14% and 29% decrease in NAC-protected and treated rats, respectively.What foods are high in NAC? ›
NAC is made by the human liver by altering the amino acid cysteine and can be found in high-protein foods, such as meat, fish, seafood, chicken or turkey. Minor sources are eggs, whole-grain products such as breads and cereals, and some plants including broccoli, onions, and legumes.Does NAC increase dopamine? ›
A new study performed at the Thomas Jefferson University found that #N-acetylcysteine (NAC) could provide an increase in #dopamine levels as well as improving patients mental and physical abilities.Can NAC raise blood pressure? ›
Additionally, in human studies, using NAC as an adjunct to other antihypertensive therapies results in a decrease in blood pressure (38–40).Why was NAC banned? ›
The FDA claims that there's no evidence that NAC was used as a supplement prior to its use as a drug – so including NAC in a supplement makes the product an unapproved drug and thus illegal.Does NAC give you energy? ›
Conclusion. Dietary NAC did not affect energy status but enhanced the hepatic antioxidant capacity by increasing the activities of antioxidant enzymes in cold-stressed broilers.
Does NAC remove toxins from the body? ›
NAC stimulates glutathione biosynthesis, promotes detoxification, and acts directly as a scavenger of free radicals. It is a powerful antioxidant and a potential treatment option for diseases characterized by the generation of free oxygen radicals (3).Is NAC toxic to liver? ›
The present results confirm that NAC has significantly improved the liver functions during high dose busulphan treatment compared to the control group and hence NAC treatment may reduce the risk for SOS development.Can you suddenly stop taking NAC? ›
Do not stop taking this medicine until your doctor tells you to. If you vomit within 1 hour after taking NAC, you may need to take another dose.Can you take NAC all the time? ›
In most cases, it should be safe for adults to take 600 mg of NAC once or twice a day. 30 However, talk to your healthcare provider to be sure it won't interfere with other medications or existing medical conditions.What are the benefits of NAC for COVID? ›
N-acetyl-l-cysteine (NAC) is a precursor of reduced glutathione  that has antioxidant, anti-inflammatory and immunomodulating properties that may prove beneficial in modulating the excessive inflammatory activation during coronavirus disease (COVID-19) .Does NAC mess with your hormones? ›
How does NAC affect your hormones? Evidence suggests that NAC may help regulate levels of the sex hormone estrogen by inhibiting a series of enzymes — namely COX-2, prostaglandin E2, and aromatase — which results in estrogen reduction.When should I stop taking NAC? ›
NAC should be continued until APAP levels are undetectable, PT/INR is near normal, encephalopathy has resolved, and transaminases are normal or are down trending and AST < 1000 U/L. In the 21-hour IV protocol, the APAP levels and transaminases level testing should occur at 20 hours.Does NAC make you look younger? ›
Two necessary supplements for anyone hoping to stave off the ravages of the aging process are N-Acetyl Cysteine (NAC) and collagen. These two substances, especially when taken together, can have a remarkable and visible anti-aging effect and improve longevity.Is NAC good for dementia? ›
In addition to the uses quoted in the literature, NAC may be considered helpful in therapies to counteract neurodegenerative and mental health diseases. Furthermore, this compound has been evaluated for its neuroprotective potential in the prevention of cognitive aging dementia.Does NAC affect mood? ›
High-quality studies have demonstrated that NAC can improve depressive symptoms during maintenance phase treatment, the scores in MADRS and Bipolar Depression Rating Scale (BDRS), response rate, symptom remission, quality of life, and functioning.
Why is NAC not FDA approved? ›
As we discussed in a recent response to two citizen petitions, the FDA has determined that NAC is excluded from the dietary supplement definition under the FD&C Act because NAC was approved as a new drug before it was marketed as a dietary supplement or as a food.Does NAC get rid of inflammation? ›
N-acetylcysteine (NAC) is a powerful antioxidant and a scavenger of hydroxyl radicals. Recently, NAC has also been shown to have anti-inflammatory activities in tissues.How much NAC should I take daily for anxiety? ›
Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects. Current evidence supports its use as an adjunctive therapy clinically for psychiatric conditions, administered concomitantly with existing medications, with a recommended dosage between 2000 and 2400 mg/day.Does NAC help with sleep? ›
N-acetylcysteine (NAC): Supplementation with the antioxidant NAC has been shown to ameliorate signs and symptoms of sleep apnea, including apnea-related arousals, daytime sleepiness, and snoring, among others.Does NAC help with psychosis? ›
A daily dose of the medication N-acetylcysteine (NAC) for six months helped patients with psychosis improve their working memory.What vitamins stop intrusive thoughts? ›
Vitamin B12 and folate are thought to be effective in OCD treatment due to their associations with neurotransmitters. Depending on their antioxidant effect, zinc and selenium can be used in augmentation therapy for OCD.What medication will stop intrusive thoughts? ›
- Clomipramine (Anafranil)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Cognitive behavioral therapy is one strategy that is often successful in helping people manage intrusive thoughts. The process may help you to shift some of your general thought patterns, which can enable you to better manage these thoughts when they do occur and might lessen their frequency.Can you take NAC and magnesium at the same time? ›
Interactions between your drugs
No interactions were found between magnesium oxide and NAC.
When Should I Take NAC? Like other amino acid supplements, NAC should be taken either 30 minutes before, or two hours after, eating to avoid competing with protein for absorption.
Should I take NAC for Covid? ›
Despite greater baseline risk, use of NAC in COVID-19 patients was associated with significantly lower mortality (OR 0.56; 95%CI 0.47-0.67), a finding that remained significant in a multivariate analysis adjusting by baseline characteristics and concomitant use of corticosteroids.What does NAC do in the brain? ›
PHILADELPHIA – N-acetylcysteine (NAC) is a naturally occurring molecule that replenishes antioxidants and shows improved brain metabolism and self-reported improvements in cognitive function in patients with multiple sclerosis, according to a study published in the journal, Frontiers in Neurology.What is NAC for behavior? ›
N-acetylcysteine (NAC) is an over-the-counter, complementary medication used in a variety of medical settings. Recent studies have suggested that NAC may improve irritability, self-injurious behaviors, stereotypic and repetitive behavior, and hyperactivity in youth with autism spectrum disorder (ASD) (Table).Does NAC supplement help bipolar disorder? ›
In another study, it was revealed that NAC was suggestive of producing higher rates of remission for Mania, compared to a placebo. NAC may be useful as an adjunctive treatment in Major Depression in Bipolar Disorder.How does NAC help with anxiety? ›
On a clinical level, in day-to-day work with patients, NAC seems to help with ruminations, with difficult-to-control extreme negative self-thoughts. Such thoughts are common in depression and anxiety disorders, and also in eating disorders, schizophrenia, OCD, etc.Does NAC increase serotonin? ›
In the present study, NAC was effective in inducing serotonin levels, the 33% decrease of serotonin recorded in PPA-treated rats was only reduced to a value of 14% and 29% decrease in NAC-protected and treated rats, respectively.Does NAC block dopamine? ›
NAC may reduce dopamine through facilitating increased glutathione production, which has a significant role in reducing oxidative stress. Amphetamine use is associated with excessive release of dopamine and suppressed action of dopamine metabolites .What is the best vitamin for bipolar? ›
- Omega-3 Fatty Acids. ...
- Folate (Vitamin B9) ...
- N-Acetyl Cysteine (NAC) ...
- Vitamin D. ...
- Coenzyme Q10 (CoQ10) ...
- Magnesium. ...
The present data propose that NAC attenuated ASP neurotoxicity and improved neurological functions, suppressed brain inflammation, and oxidative stress responses and may be a useful strategy for treating ASP-induced neurotoxicity.Is NAC an antidepressant? ›
Recent studies have shown that N-acetyl cysteine (NAC), a glutamate modulator produces an antidepressant-like effect by normalization of the periterminal release of glutamate and/or antioxidant effects.