The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Acta Psychiatr Scand. 2018 May;137(5):391-400. doi: 10.1111/acps.12862. Epub 2018 Feb 18.
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.
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.
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; I = 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.
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.
本系统评价和荟萃分析对随机对照试验（RCTs）进行了研究，以评估抗氧化药物辅助 N-乙酰半胱氨酸（NAC）治疗重度抑郁症（MDD）、双相情感障碍和精神分裂症的疗效和安全性。
研究人员独立检索了 PubMed、Cochrane Library、PsycINFO、中国知网（CNKI）、中国生物医学文献数据库（CBM）和万方数据库，并进行了筛选。计算了标准化均数差（SMD）、风险比及其 95%置信区间（CI）。
确定并分析了 6 项 NAC 治疗精神分裂症（3 项 RCT，n = 307）、双相情感障碍（2 项 RCT，n = 125）和 MDD（1 项 RCT，n = 269）的 RCT，结果显示，辅助 NAC 可显著改善精神分裂症患者的总体精神病理学（SMD = -0.74，95%CI：-1.43，-0.06；I² = 84%，P = 0.03），但对双相情感障碍的 Young 躁狂评定量表评估的抑郁和躁狂症状无显著影响，对 MDD 的主要抑郁症状仅有较小的影响。三种疾病中，NAC 的药物不良反应和停药率在 NAC 组和对照组之间相似。
辅助 NAC 似乎是一种安全的治疗方法，对精神分裂症有效，但对双相情感障碍或 MDD 无效。需要进一步开展高质量 RCT 来确定辅助 NAC 在治疗主要精神疾病中的作用。
