A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans with Posttraumatic Stress Disorder and Substance Use Disorders.
Reviewed by: Dr. Alan Gaby, M.D.
Author: Back SE, et al
Reference: A double-blind, randomized, controlled pilot trial of N-acetylcysteine in Veterans with posttraumatic stress disorder and substance use disorders. J Clin Psychiatry 2016;77:e1439-e1446.
Design: Randomized, double-blind, placebo-controlled trial.
Participants: Thirty-five military Veterans (34 male; mean age, 49 years) with both posttraumatic stress disorder (PTSD) and substance use disorder (SUD).
Study Medication and Dosage: N-acetylcysteine (NAC; 2,400 mg per day) or placebo for 8 weeks. All patients received cognitive-behavioral therapy for SUD.
Primary Outcome Measures: Severity of PTSD symptoms and amount of drug craving.
Key Findings: Mean severity of PTSD symptoms improved to a significantly greater degree with NAC than with placebo (32% vs. 3%; p < 0.05). Mean amount of drug craving also improved to a significantly greater extent with NAC than with placebo (81% vs. 32%; p < 0.05).
Practice Implications: Glutamate synapses in the nucleus accumbens region of the brain are involved in both PTSD and SUD, which are conditions that frequently occur together. The presence of a subnormal concentration of glutamate in the nucleus accumbens may increase compulsive or addictive behaviors and heighten cravings. Treatment with NAC has been shown to increase glutamate concentrations in the nucleus accumbens, and NAC has been used successfully to treat addictions to tobacco, marijuana, and gambling.[i] The results of the present study suggest that NAC, when used in combination with psychotherapy, is also beneficial in the treatment of PTSD coexisting with SUD.
[i] Gaby AR. Addiction. In Gaby AR. Nutritional Medicine, 2nd edition. 2017, Concord NH, chapter 276; doctorgaby.com.