The evidence base for the pharmacological treatment of bipolar II disorder, a condition where depressive symptoms are the hallmark, is limited. With high rates of misdiagnosis and lack of clarity about appropriate management, there is an important void in treatment research in bipolar II depression, which is all the more salient given the high prevalence of the disorder.
In a recent study, undertaken by researchers at the University of Melbourne and Monash University, a small subset of patients with bipolar II disorder, were found to benefit from the administration of a compounded amino acid formulation including N-acetyl cysteine. Six of the seven participants achieved full remission (post 6 months of therapy) of both depressive and manic symptoms, compared only 1 participant in the placebo group.
N-acetyl cysteine, a precursor of glutathione, is an important antioxidant in the brain and reduces oxidative stress. Increased oxidative stress and altered glutathione metabolism have been reported in bipolar and major depressive disorder. Previous randomised control trials investigating bipolar patients on mood stabilisers have found that those patients administered adjunctive N-acetyl cysteine (2g/daily) showed a significant improvement in depression, mania, quality of life, as well as social and occupational functioning compared to placebo. Hence, in reinforcing the findings from the afore-mentioned study, it appears that N-acetyl cysteine should undergo further research to confirm its beneficial effects on patients with bipolar depression.
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