N-Acetylcysteine for Schizophrenia: Hope for Improved Cognition!

By: Jadon Webb, M.D., Ph.D.

Schizophrenia can be a hard illness to treat. The main medications used are the antipsychotics, which can be very effective but don't work for everyone, and can have some significant side effects. They also usually don't work very well for improving brain fog, poor motivation, and other cognitive problems that very commonly occur in psychosis. 

But there is hope of new treatments that may be able to help with this. 

N-Acetylcysteine (NAC) is a powerful antioxidant related to the natural amino acid cysteine. It has been used for decades as an antidote to medication overdose and to break up thick mucus in people having trouble breathing. It also has building evidence for helping with schizophrenia symptoms.

Most importantly, NAC may help improve so-called “negative symptoms” of schizophrenia such as low motivation, lack of desire to socialize, and inability to feel good emotions. It also seems to improve short term memory, which can be greatly impaired in psychosis. 

Most conventional antipsychotic medications do not improve negative symptoms of psychosis or cognitive impairment, even though these symptoms can sometimes be the most difficult part of having schizophrenia. Being able to treat these symptoms is a wonderful thing!

NAC is also cheap and usually safe even at high doses. The most common side effect is nausea and upset stomach. Many patients who try NAC also notice an improvement in mood, and it may also be one of the useful treatments for depression. NAC is not an FDA-approved treatment of schizophrenia and so this is off-label, but there have been multiple academic studies supporting its use. 

Schizophrenia can be a challenge to fully treat, but there is hope! New ideas like this are giving more treatment options than ever before. 

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