New Study Finds that Add-On Therapy Improves Depressive Symptoms in Bipolar Disorder

New study published in Biological Psychiatry

Philadelphia, PA, September 2, 2008 – Lingering depression is a serious and common problem in bipolar disorder, and does not resolve well with existing treatments. Because individuals with both depression and bipolar disorder experience a glutathione deficiency, an antioxidant that protects cells from toxins, researchers in a new study scheduled for publication in the September 15th issue of Biological Psychiatry sought to evaluate whether N-acetyl cysteine (NAC), an over-the-counter supplement that increases brain glutathione, might help alleviate depressive symptoms.

Dr. Michael Berk and colleagues, in a randomized, double-blind, placebo-controlled trial, evaluated the mood symptoms of individuals with bipolar disorder, half of whom received placebo and half of whom received NAC, as an add-on therapy to their usual treatment. Over the 24 weeks of the study, NAC was well tolerated, and induced a marked and significant improvement in depressive symptoms. Ashley Bush, M.D., Ph.D., the article’s corresponding author, further explains: “Glutathione is the brain’s primary antioxidant defense, and there is evidence of increased oxidative stress in bipolar disorder. Therefore, we studied the potential benefit of NAC treatment in bipolar disorder and found that it impressively remedied residual depressive symptoms.”

John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, comments: “The preliminary evidence of efficacy of NAC is very interesting. This study might suggest a number of novel approaches to treating depression. In subsequent efforts to replicate this preliminary finding, it will be important to determine how much NAC reaches the brain after oral administration.” As noted by both the authors and Dr. Krystal, additional studies will be necessary to further evaluate and replicate these findings. However, as Dr. Berk observes, “Brain glutathione metabolism appears to be a valuable new treatment target for psychiatric disorders, and we hope the impressive results of this study opens up a new treatment option.”

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Notes to Editors:
The article is “N-Acetyl Cysteine for Depressive Symptoms in Bipolar Disorder—A Double-Blind Randomized Placebo-Controlled Trial” by Michael Berk, David L. Copolov, Olivia Dean, Kristy Lu, Sue Jeavons, Ian Schapkaitz, Murray Anderson-Hunt, and Ashley I. Bush. Drs. Berk, Copolov, Dean, and Bush are from The Mental Health Research Institute of Victoria, Victoria, Australia. Dr. Berk, along with Drs. Lu, Schapkaitz, and Anderson-Hunt, is also affiliated with the Department of Clinical and Biomedical Sciences, The University of Melbourne, Geelong, Australia. Dr. Berk is also with Orygen Youth Health, Melbourne, Australia. Dr. Copolov is also affiliated with Monash University, Clayton, Australia. Dr. Jeavons is affiliated with Bendigo Health, Bendigo, Australia. Dr. Bush is also from the Department of Pathology, The University of Melbourne, Geelong, Australia; and the Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts. The article appears in Biological Psychiatry, Volume 64, Issue 6 (September 15, 2008), published by Elsevier.

The authors’ disclosures of financial and conflicts of interests are available in the article. Dr. Krystal's disclosures of financial and conflicts of interests are available here. Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or ja.dawkins@elsevier.com to obtain a copy or to schedule an interview.

About Biological Psychiatry
This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

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