This week, we revisit N-acetylcysteine with CBT, community care for pregnant patients with catatonia, and a new look at Cushing syndrome.
NAC Doesn’t Appear To Help Patients With PTSD, Alcohol Use Disorder
A large clinical trial – published this week in The Journal of Clinical Psychiatry – has found that N-acetylcysteine (NAC) fails to provide any additional benefit when combined with therapy for patients living with both posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD).
The randomized, double-blind, placebo-controlled study enrolled nearly 200 adults between the ages of 21 and 65 who met DSM-5 criteria for both conditions. Participants received either NAC (2,400 mg/day) or a placebo for 12 weeks, alongside weekly individual cognitive behavioral therapy (CBT) for AUD. The study’s authors charted outcomes such as PTSD severity, alcohol use, cravings, and depression symptoms. The team continued to follow-up for a year.
Both groups showed dramatic improvements in PTSD symptoms, alcohol consumption, craving, and depression. For example, average daily drinks fell from nearly seven at baseline to less than three by week 12. And self-reported PTSD scores tumbled 17 points.
That being said, the researchers failed to identify any notable differences between those taking NAC and those on the placebo. Retention remained high for both groups, with more than 80% completing treatment, and the participants tolerated NAC with a lack of excess adverse events.
Researchers did note that the findings contrast with smaller pilot trials that had suggested that NAC might reduce PTSD symptoms and craving, particularly in veterans or abstinent individuals. They cautioned that timing of abstinence, dosage, or treatment setting could influence outcomes. As a result, the research advocated for more research to clarify NAC’s potential role.
For now, the results indicate that NAC, when added to CBT, is safe, but not any more effective than placebo for treating co-occurring PTSD and AUD.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- The Primary Care Companion for CNS Disorders features a case study that illustrates the importance of a multidisciplinary approach to catatonia in pregnancy.
- JCP also boasts new research that suggests that clozapine might not be more effective than other second-generation antipsychotics for treatment-resistant schizophrenia.
- Another PCC case study shows that Cushing syndrome can present with severe psychosis that improves after surgical treatment.
- And new JCP research reports on how levomilnacipran consistently inhibits both serotonin and norepinephrine reuptake at all therapeutic doses.
- And, our periodical series on “Emerging Approaches in Schizophrenia” returns.
