Objective: Obsessive-compulsive disorder (OCD) is a disabling mental illness for which pharmacological
and psychosocial interventions are all too often inadequate. This demonstrates the need for more targeted
therapeutics. Recent preclinical and clinical studies have implicated the dysfunction of glutamatergic neurotransmission
in the pathophysiology of OCD. Moreover, there are studies suggesting that neuroimmune abnormalities
may play an important role in the pathogenesis of OCD. N-acetyl cysteine (NAC) is a safe and readily available
agent that would modify the synaptic release of glutamate in subcortical brain regions via modulation of the
cysteine-glutamate antiporter. The modulation of inflammatory pathways may also play a role in the benefits seen
following NAC treatment. Therefore NAC can be considered a neuroprotective agent.
Methods: This paper explores the role of NAC in the treatment of OCD conditions refractory to first-line pharmacological
interventions, reviewing the clinical studies published in the last decade.
Results: The possible benefit mechanisms of NAC for this disorder will be discussed, as well as the role of vitamin
D supplementation, given its specific property of stimulating the formation of glutathione in the brain.
Conclusion: Nutraceutical supplementation in treatment resistance OCD may be important not only for improving
obsessive-compulsive symptomatology, but also from a psychological perspective, given its better acceptance
by the patients compared to pharmacological treatment.
Keywords: Obsessive-compulsive disorder, N-acetyl cysteine, Vitamin D, Glutamate, Inflammation, nutraceutics.
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