Off-label psychiatric applications of N-acetylcysteine (NAC) include its use as an adjunctive treatment in various psychiatric disorders such as schizophrenia, bipolar disorder, substance dependence, and obsessive-compulsive disorder (OCD).
NAC is thought to exert beneficial effects through its antioxidant properties and modulation of glutamatergic neurotransmission, which may help reduce symptoms in these conditions.
Specifically, NAC has been investigated for reducing negative symptoms and cognitive deficits in schizophrenia, improving mood stability in bipolar disorder, and aiding in the management of substance dependence by reducing cravings and withdrawal symptoms.
Although NAC is not licensed for these psychiatric indications, clinical studies and some guidelines acknowledge its potential off-label use as an adjunctive therapy in these areas.
However, current UK NICE guidelines and related documents do not provide formal recommendations for NAC in psychiatric disorders, reflecting the need for further robust evidence before routine clinical use.
Clinicians considering NAC for off-label psychiatric use should weigh the existing evidence, monitor for efficacy and safety, and consider individual patient factors.
5Key References
- Haloperidol SmPC
- Prochlorperazine SmPC
- NG181 - Rehabilitation for adults with complex psychosis
- Flupentixol SmPC
- Acetylcysteine SmPC
- CKS - Psychosis and schizophrenia
- CKS - Schizophrenia and psychosis
- CKS - Autism in adults
- Chlorpromazine hydrochloride SmPC
- CG185 - Bipolar disorder: assessment and management
- CG192 - Antenatal and postnatal mental health: clinical management and service guidance
- Trifluoperazine SmPC