Studies indicate that N-acetylcysteine (NAC), a dietary supplement, may help with obsessive-compulsive disorder (OCD) by regulating dopamine, decreasing overactivity in the brain, and reducing inflammation. However, more research is needed. The most effective treatment for OCD is exposure and response prevention (ERP) therapy, but using NAC alongside therapy may offer some additional support in managing the condition.
If you’re active on social media, and care about wellness or mental health, it’s likely you’ve heard about N-acetylcysteine, or NAC—an increasingly popular supplement primarily known for treating respiratory diseases and managing Tylenol overdoses. In addition to its role in these areas, NAC has gained attention for its potential mental health benefits, as research indicates it may help alleviate symptoms of conditions such as depression, anxiety, and obsessive-compulsive disorder (OCD).
If you have OCD, adding NAC to your treatment plan may help to decrease stress and anxiety. However, the supplement is in no way a “cure-all,” and should not be seen as a replacement for exposure and response prevention (ERP) therapy. Additionally, the effects of NAC can vary from person to person, and more research is needed to fully understand its safety and efficacy.
Read on to learn more about what NAC is, how it may help with OCD, and what you need to know before pursuing it as a treatment option.
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What is NAC?
NAC is an antioxidant that is used as a prescription drug and a dietary supplement for a variety of health conditions, such as respiratory conditions—because it can help thin mucus and clear airways. NAC is also commonly prescribed to treat acetaminophen (Tylenol) overdose, as it can help to prevent liver damage. As a dietary supplement, NAC is believed to improve immune system health, reduce inflammation, and may even have some anti-aging properties. NAC typically comes in pill form, but it can also be found in powder for those who have difficulty swallowing pills.
Can NAC boost your mental health?
So, what about mental health? Some research shows that NAC can also improve mental health conditions through the regulation of glutamate and dopamine, two chemical messengers that can impact brain function and mood. Let’s take a closer look at what NAC does:
- Decreases glutamate: Higher levels of glutamine are associated with some mental health conditions, like OCD, substance use disorder, and schizophrenia. By potentially decreasing glutamine in certain brain regions, NAC may provide benefits for people dealing with these conditions.
- Regulating dopamine: OCD compulsions can be reinforced by the reward system in the brain, which involves dopamine. If you have OCD, it’s possible that regulating dopamine levels through NAC use might lessen your motivation to engage in compulsive behaviors.
- Lowering inflammation: In addition to its impact on dopamine and glutamine, NAC is thought to decrease inflammation throughout the body. Because brain inflammation is thought to play a part in conditions like depression—which commonly occurs alongside OCD—lower inflammation could help with depression and OCD symptom management.
Despite these potential benefits, there aren’t enough conclusive studies to fully support NAC’s effectiveness for mental health. More research is needed to understand its potential benefits and risks.
Can NAC treat OCD symptoms?
In order to better understand how best to treat OCD, let’s get clear on what exactly OCD is, and how it works. OCD is a chronic mental health condition, which is characterized by obsessions—unwanted and recurrent intrusive thoughts, feelings, urges, images, and sensations that cause anxiety. In an attempt to alleviate this distress, you may engage in compulsions, which are repetitive behaviors or mental rituals performed to reduce distress, neutralize your thoughts, or prevent something bad from happening.
According to licensed therapist Tracie Ibrahim, MA, LMFT, CST, there is currently no longitudinal, peer-reviewed, meta-analyzed data to support using NAC to treat OCD. In other words, while some studies suggest that there may be potential benefits, NAC hasn’t been tested on enough people with OCD for long enough periods of time, to confirm the supplement helps for the condition.
There are currently five randomized trials that have tested the efficacy of NAC for OCD, four of which reported reductions in symptom severity at NAC dosages of 2000 to 3000mg per day, which looks like taking two to three capsules daily, depending on the dosage of each pill. Note that several of these studies relied on smaller groups of trial participants, making it harder to generalize the findings to the larger OCD population. Further research is needed.
It’s important to know that the first line of treatment for OCD is ERP therapy. Additionally, medications, such as selective-serotonin reuptake inhibitors (SSRIs), are often prescribed to help manage symptoms—ultimately making it easier for you to engage in ERP therapy. While it’s possible NAC could be utilized similarly, as a supplemental tool in conjunction with ERP therapy, there haven’t been studies that directly compare NAC, ERP therapy, and/or selective serotonin-reuptake inhibitors (SSRIs) for OCD. This research is needed to determine the extent to which NAC might be effective as a standalone or supplemental treatment.
Is NAC safe?
NAC is not FDA-approved for mental health conditions such as OCD. “It’s not been determined if NAC is safe, let alone effective to treat OCD symptoms,” Ibrahim says. “Very little has been done in the way of researching NAC and its effectiveness and safety for use for OCD or related disorders at this time.”
NAC may have some side effects, which is why it’s important to talk to your provider before taking new supplements.
Side effects of NAC include:
- Nausea
- Vomiting
Other lesser seen side effects of NAC may include:
- Difficulty breathing or swallowing
- Fever
- Hives, rash, or itching
- Reddening of the skin
- Swelling of the eyes, face, or inside the nose (signs of an allergic reaction)
- Unusual tiredness or weakness
It’s important to seek immediate medical attention if you experience signs of a serious reaction to NAC.
The most effective treatment for OCD
Although NAC may be effective as a supplementary treatment, it comes with some risks, and Ibrahim says it should only be used alongside ERP therapy.
ERP is a specialized form of cognitive behavioral therapy (CBT) designed to treat OCD. In ERP therapy, you’ll work with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, while resisting the urge to engage in compulsions. The goal is to help you build tolerance to the anxiety these thoughts cause, and reduce the need to engage in rituals to alleviate that anxiety.
For example, if you deal with recurring intrusive thoughts or mental images related to causing harm, ERP might look like gradually exposing yourself to situations that trigger these obsessions, while resisting the urge to immediately respond. This could look like thinking about holding a knife, without performing any compulsions to neutralize your feelings of distress.
ERP is highly successful; 80% of people with OCD experience a reduction in symptoms within eight to 16 weeks. Since NAC may help regulate mood, it could be a helpful supplemental tool if you’re struggling to manage any ERP exercises at all due to extreme anxiety or stress. ERP therapy takes work, and while the exercises are gradual, it can be difficult to dive in if your OCD is extremely severe, or you’re experiencing co-occurring conditions that make it difficult to find motivation.
That being said, SSRIs are a more proven treatment addition for OCD. You should keep in mind that NAC is not FDA-approved, may cause side-effects, and more research is needed to understand its impacts. Before adding NAC or any supplement to your treatment plan, it’s important to talk with your physician and therapist to ensure it’s safe and suitable for your specific needs.
Bottom line
NAC is a supplement that may reduce symptoms of OCD. However, more research is needed to fully understand its effectiveness and safety, particularly for mental health conditions. If you do decide to try NAC, make sure to discuss your plans with a health provider, and remember: ERP therapy remains the first line of treatment for OCD, whereas NAC should only be considered as a potential supplementary option.
Key Takeaways
- N-acetylcysteine (NAC) is an antioxidant that may help regulate mood and motivation, decrease overactivity in the brain, reduce inflammation, and prevent cell damage.
- Although some research shows that NAC can be useful in reducing symptoms of OCD and other mental health conditions, more studies are needed to confirm its long-term effectiveness and safety.
- While NAC may provide potential benefits for OCD, it should be viewed as a supplementary treatment rather than a replacement for established first-line therapies such as exposure and response prevention (ERP) therapy.