Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Clin Psychiatry. 2021 Feb 18;82(1):21f13891. doi: 10.4088/JCP.21f13891.
Major depressive disorder (MDD) and bipolar depression (BD) can often be difficult to treat. N-acetylcysteine (NAC) is a nutraceutical product that has been trialed in a large number of neuropsychiatric and medical disorders, with mixed results. Many randomized controlled trials (RCTs) have studied NAC augmentation as an intervention in MDD and BD. These RCTs were pooled in 2 recent meta-analyses. One meta-analysis with 7 RCTs (pooled N = 728) conducted in patients with MDD or BD found that NAC was not superior to placebo in the attenuation of depression ratings in either main or sensitivity analyses. The other meta-analysis with 6 RCTs (pooled N = 248) conducted in patients with BD found a small, imprecise effect size for NAC (standardized mean difference, 0.45; 95% confidence interval, 0.06-0.84). The advantage for NAC in this meta-analysis would almost certainly have been lost had the authors excluded from analysis 2 RCTs, both of which had problematic characteristics and findings and both of which also obtained a large and statistically significant advantage for NAC. At present, therefore, evidence does not encourage the use of NAC as an augmentation treatment for patients with MDD or BD. It remains to be seen whether NAC augmentation benefits depressed subpopulations, such as those with higher levels of inflammatory biomarkers at baseline.
重度抑郁症（MDD）和双相情感障碍（BD）的治疗往往较为困难。N-乙酰半胱氨酸（NAC）是一种营养保健品，已在大量神经精神和医学疾病中进行了试验，结果喜忧参半。许多随机对照试验（RCT）研究了 NAC 作为 MDD 和 BD 的干预措施的效果。这些 RCT 最近在两项荟萃分析中被汇总。一项荟萃分析纳入了 7 项 RCT（汇总 N=728 例），这些 RCT 纳入了 MDD 或 BD 患者，结果发现 NAC 在减轻抑郁评分方面并不优于安慰剂，无论是在主要分析还是敏感性分析中。另一项荟萃分析纳入了 6 项 RCT（汇总 N=248 例），这些 RCT 纳入了 BD 患者，结果显示 NAC 的效应量较小且不精确（标准化均数差，0.45；95%置信区间，0.06-0.84）。如果作者排除了 2 项 RCT 的分析，那么这项荟萃分析对 NAC 的优势几乎肯定会消失，这两项 RCT 均具有有问题的特征和结果，并且都获得了 NAC 的显著优势。因此，目前尚无证据鼓励将 NAC 用作 MDD 或 BD 患者的增效治疗方法。NAC 对抑郁亚人群（例如基线时炎症生物标志物水平较高的人群）是否有益，还有待观察。
