Eghdami Shayan, Eissazade Negin, Heidari Mokarar Mohsen, Boroon Mahsa, Orsolini Laura, Shalbafan Mohammadreza
Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran.
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Front Psychiatry. 2024 Sep 23;15:1421150. doi: 10.3389/fpsyt.2024.1421150. eCollection 2024.
Obsessive-compulsive disorder (OCD) ranks as the fourth most prevalent psychiatric disorder, with selective serotonin reuptake inhibitors (SSRIs) as its mainstay pharmacological treatment. However, approximately 40 to 60% of patients do not adequately respond to initial treatment, highlighting the need for alternative options. N-acetylcysteine (NAC) is one of the several medications that have been used in augmentation with SSRIs to enhance their efficacy.
We aimed to investigate the safety and efficacy of NAC, a glutamate-modulating agent, as an augmentation in the treatment of moderate to severe OCD.
We conducted a thorough search across PubMed, Scopus, Web of science, and ProQuest to identify relevant trials published until December 2023. The primary outcome of interest was the mean difference between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores before and after administrating augmented NAC among patients with moderate to severe OCD. Furthermore, we compared the occurrence of adverse drug events between the experimental and control groups.
We included six randomized controlled trials with 195 patients. The results of our study indicated a positive outcome for the experimental group in terms of the total Y-BOCS score when using the medication for a period of five to eight weeks (p-Value = 0.05). However, no significant difference was observed for durations shorter than five weeks or longer than 12 weeks. Additionally, no significant difference was found between the two groups in terms of the obsession and compulsion Y-BOCS scores. Furthermore, no significant differences were observed in terms of adverse events.
Augmentation of NAC with SSRIs may benefit patients with moderate to severe OCD. However, it is necessary to conduct additional multi-center trials over extended periods to develop a comprehensive strategy for action.
https://www.crd.york.ac.uk/prospero/, identifier CRD42023463683.
强迫症（OCD）是第四大常见精神障碍，选择性5-羟色胺再摄取抑制剂（SSRIs）是其主要药物治疗手段。然而，约40%至60%的患者对初始治疗反应不佳，这凸显了需要其他治疗选择。N-乙酰半胱氨酸（NAC）是几种与SSRIs联合使用以增强疗效的药物之一。
我们旨在研究谷氨酸调节剂NAC作为辅助药物治疗中重度强迫症的安全性和有效性。
我们全面检索了PubMed、Scopus、科学网和ProQuest，以识别截至2023年12月发表的相关试验。主要关注的结果是中重度强迫症患者在服用NAC辅助治疗前后耶鲁-布朗强迫症量表（Y-BOCS）评分的平均差异。此外，我们比较了实验组和对照组药物不良事件的发生率。
我们纳入了六项随机对照试验，共195名患者。我们的研究结果表明，实验组在使用该药物五至八周时，Y-BOCS总分有积极结果（p值=0.05）。然而，在短于五周或长于12周的疗程中未观察到显著差异。此外，两组在强迫观念和强迫行为的Y-BOCS评分方面没有显著差异。而且，在不良事件方面也未观察到显著差异。
SSRIs联合NAC辅助治疗可能对中重度强迫症患者有益。然而，有必要进行更多长期的多中心试验，以制定全面的治疗策略。
