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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Questionmark on May 12, 2011, at 15:36:16
I've been taking n-acetyl-cysteine for over a month now at 3g/day and i do not seem to notice anything-- acute or chronic effects. Not even any side effects. (i'm trying it for any help for OCD, or depression or anxiety.)
There was a thread on here before that had some remarkable praise for it. Also, it seems a lot of people notice some effects -- at least side effects -- at doses as low as 600 to 1000 mg. I'm usually pretty substance sensitive so i'm confused.
Someone in the thread (i forget who, sorry) mentioned it can take 4 months at 3g/day to achieve benefit. So i'm sticking it out for the 4 months. But just wondering if anyone had an idea why i would not be noticing anything at all, or if they had any advice-- or evidence-based encouragement.
Shouldn't i be noticing SOMEthing at 3g/day?
Posted by SLS on May 13, 2011, at 5:46:03
In reply to NAC High Dose But No Effect, posted by Questionmark on May 12, 2011, at 15:36:16
> I've been taking n-acetyl-cysteine for over a month now at 3g/day and i do not seem to notice anything-- acute or chronic effects. Not even any side effects. (i'm trying it for any help for OCD, or depression or anxiety.)
> There was a thread on here before that had some remarkable praise for it. Also, it seems a lot of people notice some effects -- at least side effects -- at doses as low as 600 to 1000 mg. I'm usually pretty substance sensitive so i'm confused.
> Someone in the thread (i forget who, sorry) mentioned it can take 4 months at 3g/day to achieve benefit. So i'm sticking it out for the 4 months. But just wondering if anyone had an idea why i would not be noticing anything at all, or if they had any advice-- or evidence-based encouragement.
> Shouldn't i be noticing SOMEthing at 3g/day?NAC has been observed to take at least 6 months to produce results.
- Scott
Posted by SLS on May 13, 2011, at 6:06:13
In reply to Re: NAC High Dose But No Effect, posted by SLS on May 13, 2011, at 5:46:03
Here is some stuff regarding NAC and depressive disorders.
It seems that 8 weeks is the absolute minimum that one needs to take NAC in order to produce results.
- Scott
-----------------------------------------------------------------------------
Biol Psychiatry. 2008 Sep 15;64(6):468-75. Epub 2008 Jun 5.
N-acetyl cysteine for depressive symptoms in bipolar disorder--a double-blind randomized placebo-controlled trial.
Berk M, Copolov DL, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Bush AI.
SourceThe Mental Health Research Institute of Victoria, Victoria, Australia.
Abstract
BACKGROUND:Treatment-resistant subthreshold depression is a major problem in bipolar disorder. Both depression and bipolar disorder are complicated by glutathione depletion. We hypothesized that treatment with N-acetyl cysteine (NAC), a safe, orally bioavailable precursor of glutathione, may improve the depressive component of bipolar disorder.
METHODS:A randomized, double-blind, multicenter, placebo-controlled study of individuals (n = 75) with bipolar disorder in the maintenance phase treated with NAC (1 g twice daily) adjunctive to usual medication over 24 weeks, with a 4-week washout. The two primary outcomes were the Montgomery Asberg Depression Rating Scale (MADRS) and time to a mood episode. Secondary outcomes included the Bipolar Depression Rating Scale and 11 other ratings of clinical status, quality of life, and functioning.
RESULTS:NAC treatment caused a significant improvement on the MADRS (least squares mean difference [95% confidence interval]: -8.05 [-13.16, -2.95], p = .002) and most secondary scales at end point. Benefit was evident by 8 weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Improvements were lost after washout. There was no effect of NAC on time to a mood episode (log-rank test: p = .968) and no significant between-group differences in adverse events. Effect sizes at end point were medium to high for improvements in MADRS and 9 of the 12 secondary readouts.
CONCLUSIONS:NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.
Comment inBiol Psychiatry. 2008 Nov 1;64(9):e1.
PMID:
18534556
[PubMed - indexed for MEDLINE]Publication Types, MeSH Terms, Substances
LinkOut - more resources-----------------------------------------------------------------------------
Biol Psychiatry. 2008 Sep 15;64(6):468-75. Epub 2008 Jun 5.
N-acetyl cysteine for depressive symptoms in bipolar disorder--a double-blind randomized placebo-controlled trial.
Berk M, Copolov DL, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Bush AI.
SourceThe Mental Health Research Institute of Victoria, Victoria, Australia.
Abstract
BACKGROUND:Treatment-resistant subthreshold depression is a major problem in bipolar disorder. Both depression and bipolar disorder are complicated by glutathione depletion. We hypothesized that treatment with N-acetyl cysteine (NAC), a safe, orally bioavailable precursor of glutathione, may improve the depressive component of bipolar disorder.
METHODS:A randomized, double-blind, multicenter, placebo-controlled study of individuals (n = 75) with bipolar disorder in the maintenance phase treated with NAC (1 g twice daily) adjunctive to usual medication over 24 weeks, with a 4-week washout. The two primary outcomes were the Montgomery Asberg Depression Rating Scale (MADRS) and time to a mood episode. Secondary outcomes included the Bipolar Depression Rating Scale and 11 other ratings of clinical status, quality of life, and functioning.
RESULTS:NAC treatment caused a significant improvement on the MADRS (least squares mean difference [95% confidence interval]: -8.05 [-13.16, -2.95], p = .002) and most secondary scales at end point. Benefit was evident by 8 weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Improvements were lost after washout. There was no effect of NAC on time to a mood episode (log-rank test: p = .968) and no significant between-group differences in adverse events. Effect sizes at end point were medium to high for improvements in MADRS and 9 of the 12 secondary readouts.
CONCLUSIONS:NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.
Comment inBiol Psychiatry. 2008 Nov 1;64(9):e1.
PMID:
18534556
[PubMed - indexed for MEDLINE]
-----------------------------------------------------------------------------
Posted by Johnny Baklava on May 13, 2011, at 11:06:47
In reply to NAC High Dose But No Effect, posted by Questionmark on May 12, 2011, at 15:36:16
I've been taking NAC off and on for almost two years. I started about two summers ago when I had a horrible bronchial infection. I had read about NAC's effects on clearing the lungs, and I do believe it helped, though I might have taken it too late in the sickness. I continued to take it, alternating between 1 gram a day and 500mg, because I didn't want to backslide into sickness. Then in the winter I decided to stop taking it since I take so many things anyway. Almost immediately I felt a dip in mood. After about a week of this, I decided to resume the NAC, and my mood ticked up a bit. The effect feels, for lack of a better word, tingly. Like a sort of low grade, comfortable tingle that's not quite a buzz but a little electric. I feel like it just supports me a bit. Around the same time I noticed broken capillaries on my face and wondered if the long-term use of NAC was leeching my body of minerals, since it can affect zinc levels, so I switched to a reduced glutathione product that wasn't quite as strong as the NAC but I didn't feel the dip when I switched. Now I take 500mg of NAC a day and a little extra cysteine and Vitamin C. I may try to come off again to see if I notice anything.
Posted by torridcalm on May 13, 2011, at 12:28:50
In reply to NAC High Dose But No Effect, posted by Questionmark on May 12, 2011, at 15:36:16
3g seems high I just started NAC too and take 1200mg a day and with give it 3-4 months, have you tryed SAMe it works for me hours after I swallow it.
Posted by mogger on May 15, 2011, at 0:25:31
In reply to Re: NAC High Dose But No Effect » Questionmark, posted by torridcalm on May 13, 2011, at 12:28:50
It took 9 weeks for me to start to see noticeable effects. my pdoc says it takes 6 months for maximum effects. he said to be patient.
Posted by SLS on May 15, 2011, at 6:37:59
In reply to Re: NAC High Dose But No Effect, posted by mogger on May 15, 2011, at 0:25:31
> It took 9 weeks for me to start to see noticeable effects.
That's great. Are you bipolar? In what ways has NAC improved your condition?
Thanks.
- Scott
Posted by mogger on May 15, 2011, at 11:16:25
In reply to Re: NAC High Dose But No Effect » mogger, posted by SLS on May 15, 2011, at 6:37:59
Scott,
I have OCD and unipolar clinical depression. The benefits of it have creeped up on me over a long period and I am actually on 5400mg a day divided into 3 doses. It has lifted my mood considerably and has broken my anxiety about traveling and changing jobs. It forces me to move onto a different thought which is great. How are you doing?
Joseph
Posted by SLS on May 15, 2011, at 12:12:06
In reply to Re: NAC High Dose But No Effect » SLS, posted by mogger on May 15, 2011, at 11:16:25
> Scott,
>
> I have OCD and unipolar clinical depression. The benefits of it have creeped up on me over a long period and I am actually on 5400mg a day divided into 3 doses. It has lifted my mood considerably and has broken my anxiety about traveling and changing jobs. It forces me to move onto a different thought which is great. How are you doing?
>
> Joseph
Hi Joseph.I am significantly improved. Thanks for asking.
The rate of my improvement is very slow, though. I guess I don't have much of a choice but to be patient. I wouldn't be surprised if it took another 12-18 months for me to attain full remission. However, I am pretty convinced that I am heading in that direction. Believe it or not, I think adding phosphatidylserine (PS) has accelerated my rate of recovery. I would like to try adding fish oil omega-3, and possibly NAC.
Currently, I am taking:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mg
PS 200mg
- Scott
Posted by mogger on May 15, 2011, at 13:21:44
In reply to Re: NAC High Dose But No Effect » mogger, posted by SLS on May 15, 2011, at 12:12:06
Scott,
I can't tell you how thrilled I am to hear that you are feeling better as you have hung in there for so long and it is paying off. Just shows your strength.
Omega 3 Mood by Country Life is an awesome fish oil that I use which has balanced out my moods. I take 4 grams of EPA a day, so 4 capsules in the morning and 4 at night. Felt a bit weird at first but then calmed down and after 2 weeks I felt a difference. My pdoc says that 4 grams of EPA is the minimum dose for anti depressant and anxiety relief. If you are up for NAC I have found the best brand to be swansonvitamins.com. It has the least fillers and is extremely fairly priced. Such great news again to hear of your progress,
Joseph
Posted by Christ_empowered on May 15, 2011, at 17:51:13
In reply to Re: NAC High Dose But No Effect, posted by mogger on May 15, 2011, at 0:25:31
I take 2.4 grams NAC daily (1.2 gramsx2), and it seems to work at boosting my other meds (celexa and abilify) rather than acting as an antidepressant agent in its own right.
I'd personally recommend that you maybe re-work your meds and keep taking the NAC, just based on my own experience.
Posted by SLS on May 15, 2011, at 19:08:57
In reply to Re: NAC High Dose But No Effect » SLS, posted by mogger on May 15, 2011, at 13:21:44
> I can't tell you how thrilled I am to hear that you are feeling better as you have hung in there for so long and it is paying off.
Thanks, Joseph. That means a lot to me.
> Omega 3 Mood by Country Life is an awesome fish oil that I use which has balanced out my moods. I take 4 grams of EPA a day, so 4 capsules in the morning and 4 at night. Felt a bit weird at first but then calmed down and after 2 weeks I felt a difference. My pdoc says that 4 grams of EPA is the minimum dose for anti depressant and anxiety relief. If you are up for NAC I have found the best brand to be swansonvitamins.com. It has the least fillers and is extremely fairly priced. Such great news again to hear of your progress,
I appreciate your recommendations. Thanks.
Be well.
- Scott
Posted by torridcalm on May 15, 2011, at 20:03:44
In reply to Re: NAC High Dose But No Effect » mogger, posted by SLS on May 15, 2011, at 19:08:57
omega 3 mood County Life is one of the best, most are crap. check out the International fish oil standards rateing system. There is perscription fish oil, Lovsa FDA approved for triglyerides or colesteriol. I believe Nardic Naterals makes lovasa. I like omega mood's ratio of epa dha if memory serves me. 2.1 or higher is what I look for. I can't afford it anymore so eat wild salmon rare and hope that makes it to my brain. I buy bulk frozen salmon individuals packed on those factory ships, Do you think the fish oil is viable after being frozen, it should be right?
Posted by Questionmark on May 18, 2011, at 1:42:07
In reply to Re: NAC High Dose But No Effect » mogger, posted by SLS on May 15, 2011, at 19:08:57
Thank you so much, everyone, for the info. That is encouraging.
.. Yeah, SLS that Is good to hear you're doing well. You're on Nardil now, huh? i don't think you were last i recall, though it's been a little while. .. Best [non-abusive] antidepressant in existence, as far as i'm concerned. Continued good fortune to you.
Posted by SLS on May 18, 2011, at 5:10:17
In reply to Re: NAC High Dose But No Effect, posted by Questionmark on May 18, 2011, at 1:42:07
> Thank you so much, everyone, for the info. That is encouraging.
>
> .. Yeah, SLS that Is good to hear you're doing well. You're on Nardil now, huh? i don't think you were last i recall, though it's been a little while. .. Best [non-abusive] antidepressant in existence, as far as i'm concerned. Continued good fortune to you.Thanks.
I added Nardil to my treatment regime at the end of last August. It did not start working until the end of November. Sometimes I feel like I am "stuck" at some level of illness. The rate of improvement is frustratingly slow. However, the trend is towards remission (I hope). I recently added lithium and phosphatidylserine. I was not expecting an acute antidepressant effect from either of these two substances. My rationale for doing this was to promote the growth of new neuronal membrane to form neurites (dendritic), so as to recover atrophied brain tissue and strengthen old connections. To my surprise, I experienced a more acute and stable antidepressant response of somewhat greater magnitude.
I am far from attaining remission. I expect it to take another 12-18 months unless my recovery accelerates. This is far better than not responding at all, of course. I guess my brain was FUBB.
- Scott
Posted by Questionmark on May 18, 2011, at 17:22:07
In reply to Re: NAC High Dose But No Effect » Questionmark, posted by SLS on May 18, 2011, at 5:10:17
i understand the stuck feeling. i feel that way often. ... It can be very wearing.
It's unfortunate you don't consider yourself to be near full remission. i thought that's sort of what you meant. But still, as you said, it's good to be much better than baseline, or worse.
i wish i could end w a sage piece of advice, but i have no idea. However... i sincerely hope your improvement continues to climb.
> > Thank you so much, everyone, for the info. That is encouraging.
> >
> > .. Yeah, SLS that Is good to hear you're doing well. You're on Nardil now, huh? i don't think you were last i recall, though it's been a little while. .. Best [non-abusive] antidepressant in existence, as far as i'm concerned. Continued good fortune to you.
>
> Thanks.
>
> I added Nardil to my treatment regime at the end of last August. It did not start working until the end of November. Sometimes I feel like I am "stuck" at some level of illness. The rate of improvement is frustratingly slow. However, the trend is towards remission (I hope). I recently added lithium and phosphatidylserine. I was not expecting an acute antidepressant effect from either of these two substances. My rationale for doing this was to promote the growth of new neuronal membrane to form neurites (dendritic), so as to recover atrophied brain tissue and strengthen old connections. To my surprise, I experienced a more acute and stable antidepressant response of somewhat greater magnitude.
>
> I am far from attaining remission. I expect it to take another 12-18 months unless my recovery accelerates. This is far better than not responding at all, of course. I guess my brain was FUBB.
>
>
> - Scott
Posted by Questionmark on May 18, 2011, at 17:46:56
In reply to Re: NAC High Dose But No Effect » Questionmark, posted by torridcalm on May 13, 2011, at 12:28:50
Btw has anyone (or anyone you know) had benefit for SA issues from NAC? i don't think i've seen or heard anything regarding effectiveness for this.
And torridcalm i have tried SAM-e, but it always seems to only make me feel more anxious and stressed, w negligible effect on my mood, etc. Thanks though.
Posted by SLS on May 18, 2011, at 17:52:23
In reply to Re: NAC High Dose But No Effect » SLS, posted by Questionmark on May 18, 2011, at 17:22:07
Your kind sentiments and support are greatly appreciated. Thanks.
- Scott
> i understand the stuck feeling. i feel that way often. ... It can be very wearing.
> It's unfortunate you don't consider yourself to be near full remission. i thought that's sort of what you meant. But still, as you said, it's good to be much better than baseline, or worse.
> i wish i could end w a sage piece of advice, but i have no idea. However... i sincerely hope your improvement continues to climb.
>
>
> > > Thank you so much, everyone, for the info. That is encouraging.
> > >
> > > .. Yeah, SLS that Is good to hear you're doing well. You're on Nardil now, huh? i don't think you were last i recall, though it's been a little while. .. Best [non-abusive] antidepressant in existence, as far as i'm concerned. Continued good fortune to you.
> >
> > Thanks.
> >
> > I added Nardil to my treatment regime at the end of last August. It did not start working until the end of November. Sometimes I feel like I am "stuck" at some level of illness. The rate of improvement is frustratingly slow. However, the trend is towards remission (I hope). I recently added lithium and phosphatidylserine. I was not expecting an acute antidepressant effect from either of these two substances. My rationale for doing this was to promote the growth of new neuronal membrane to form neurites (dendritic), so as to recover atrophied brain tissue and strengthen old connections. To my surprise, I experienced a more acute and stable antidepressant response of somewhat greater magnitude.
> >
> > I am far from attaining remission. I expect it to take another 12-18 months unless my recovery accelerates. This is far better than not responding at all, of course. I guess my brain was FUBB.
> >
> >
> > - Scott
Posted by SLS on May 18, 2011, at 17:59:11
In reply to Re: NAC High Dose But No Effect, posted by Questionmark on May 18, 2011, at 17:46:56
> i have tried SAM-e, but it always seems to only make me feel more anxious and stressed, w negligible effect on my mood, etc. Thanks though.
My experience with S-AMe (S-Adenosyl Methionine) was very similar to yours.
- Scott
Posted by mogger on May 19, 2011, at 1:01:17
In reply to NAC High Dose But No Effect, posted by Questionmark on May 12, 2011, at 15:36:16
Try not to get discouraged about nothing yet. You are doing the right thing by sticking with it. Nac has been the most interesting supplement i have taken as it has been so slow going. I didn't have side effects nor do now. My doc says full benefits aren't achieved for six months. I am sensitive to supplements and pharmaceuticals as well so this stumped me. Don't expect side effects.
Posted by SLS on May 19, 2011, at 2:43:28
In reply to Re: NAC High Dose But No Effect » Questionmark, posted by mogger on May 19, 2011, at 1:01:17
> Try not to get discouraged about nothing yet. You are doing the right thing by sticking with it. Nac has been the most interesting supplement i have taken as it has been so slow going. I didn't have side effects nor do now. My doc says full benefits aren't achieved for six months. I am sensitive to supplements and pharmaceuticals as well so this stumped me. Don't expect side effects.
I am not terribly sure about this, but taking NAC with its attendant conversion into glutathione acts as an antioxidant to protect mitochondria. Mitochondrial damage and dysfunction are noted in depressive disorders. It probably takes time for the pool of mitochondria to be effectively renewed; the rate of which is determined by their turnover rate. This could easily take months. It is important to reduce psychosocial stress to prevent further damage to the new mitochondria. Psychotherapy might allow for a quicker recovery by reducing psychosocial stress, even before there is any response to biological treatment.
- Scott
Posted by Questionmark on May 23, 2011, at 19:28:02
In reply to Re: NAC High Dose But No Effect » mogger, posted by SLS on May 19, 2011, at 2:43:28
Posted by larryhoover on May 29, 2011, at 23:09:55
In reply to international fish oil standards, posted by torridcalm on May 15, 2011, at 20:03:44
> omega 3 mood County Life is one of the best, most are crap. check out the International fish oil standards rateing system. There is perscription fish oil, Lovsa FDA approved for triglyerides or colesteriol. I believe Nardic Naterals makes lovasa. I like omega mood's ratio of epa dha if memory serves me. 2.1 or higher is what I look for. I can't afford it anymore so eat wild salmon rare and hope that makes it to my brain. I buy bulk frozen salmon individuals packed on those factory ships, Do you think the fish oil is viable after being frozen, it should be right?
Absolutely. Freezing is an excellent way to preserve polyunsaturated fatty acids. If your fish, when thawed, does not have a "fishy" smell, then you can be assured that the fatty acids are good to go. The vacuum packing in those freezer packs severely limits oxidation of the fatty acids, which is further slowed by the low temperature.
Prescription fish oil is a cash grab, trying to create an unnecessary and artificial product out of a natural food concentrate.
Lar
Posted by larryhoover on May 29, 2011, at 23:49:33
In reply to NAC High Dose But No Effect, posted by Questionmark on May 12, 2011, at 15:36:16
I think that I'd like to provide a general recommendation to supplement with NAC. It's just one of the regular supplements that I take. If you're properly replete with NAC, you have provided yourself with a high degree of stress resiliency.
NAC is an antioxidant in its own right. It need not be converted to glutathione to have a beneficial effect. It is a fair to good scavenger of a variety of reactive oxygen species, and can serve as a sacrificial binding agent to some toxic heavy metals such as mercury. Highly structured proteins such as enzymes depend on cysteine-cysteine bonds for their unique 3-dimensional form. Far better to sacrifice blood-borne or intra-cellular NAC that to lose enzyme function, to say nothing of the fact that e.g. mercury bound to cysteine can be excreted.
And then there's the growing realization that much of the physical distress that accompanies mental health issues is mediated by mitochondrial dysfunction. Mitochondria are the energy factories of every cell, but they throw off reactive oxygen species as part of their production of cellular energy. In the absence of sufficient antioxidant support, they will destroy themselves. That's where your vitamin E and NAC and selenium (preferentially as seleno-methionine) come into play. Your mitochondria are your cells playing with fire (quite literally....that's where food is burned in oxygen), and your antioxidants are your firemen, to keep the oxidation under control. If the mitochondria are permitted to destroy themselves, the cell will die.
The point I want to make is that you need not experience an overt benefit from NAC to have benefited from it. It gives you maximal resiliency. It helps to keep your liver healthy. It directly promotes brain glutathione activity levels. It's just a smart supplement to take.
Rhetorical question: How do you know when you've prevented an adverse mental state? IMHO, you don't. You just didn't have one that you might have had.
Lar
Posted by torrid on May 31, 2011, at 9:44:11
In reply to Re: international fish oil standards » torridcalm, posted by larryhoover on May 29, 2011, at 23:09:55
larry another question, I stay away from farm raised due to the pcb's and mercury. I buy salmon that says "wild caught", wondering if there a is a little double talk in that statement. Are they farm raised and then released? would you trust salmon from south america? The alaskan salmon is triple the price, and how many lb's a month would I have to eat to reach 10 grams a day? it's impossible isn't it? I eat about 5 lb's a month of salmon. Trout, what do you think about trout caught in warm climates, would that be a good sorce of eda's and dha's
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