Background
Although pathological gambling (PG) is relatively common, pharmacotherapy research
for PG is limited. N-acetyl cysteine (NAC), an amino acid, seems to restore extracellular
glutamate concentration in the nucleus accumbens and therefore offers promise in reducing
addictive behavior.
Methods
Twenty-seven subjects (12 women) with DSM-IV PG were treated in an 8-week open-label
trial of NAC with responders (defined as a ≥ 30% reduction in Yale Brown Obsessive
Compulsive Scale Modified for Pathological Gambling [PG-YBOCS] total score at end
point) randomized to 6 weeks of double-blind NAC or placebo.
Results
The PG-YBOCS scores decreased from a mean of 20.3 ± 4.1 at baseline to 11.8 ± 9.8
at the end of the open-label phase (p < .001). Sixteen of 27 subjects (59.3%) met responder criteria. The mean effective
dose of NAC was 1476.9 ± 311.3 mg/day. Of 16 responders, 13 entered the double-blind
phase. Of those assigned to NAC, 83.3% still met responder criteria at the end of
the double-blind phase, compared with only 28.6% of those assigned to placebo.
Conclusions
The efficacy of NAC lends support to the hypothesis that pharmacological manipulation
of the glutamate system might target core symptoms of reward-seeking addictive behaviors
such as gambling. Larger, longer, placebo-controlled double-blind studies are warranted.
Key Words
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Article info
Publication history
Published online: April 24, 2007
Accepted:
November 23,
2006
Received in revised form:
November 7,
2006
Received:
October 12,
2006
Identification
Copyright
© 2007 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
