N -Acetylcysteine for Nonsuicidal Self-Injurious Behavior in Adolescents: An Open-Label Pilot Study

Kathryn R Cullen, Bonnie Klimes-Dougan, Melinda Westlund Schreiner, Patricia Carstedt, Nicholas Marka, Kaz J Nelson, Michael J. Miller, Kristina M Reigstad, Ana Westervelt, Meredith L Gunlicks-Stoessel, Lynn E Eberly

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25 Scopus citations


Background: Nonsuicidal self-injury (NSSI) is common in adolescents and young adults, and few evidence-based treatments are available for this significant problem. N-acetylcysteine (NAC) is a widely available nutritional supplement that has been studied in some psychiatric disorders relevant to NSSI including mood and addictive disorders. This pilot study tested the use of NAC as a potential treatment for NSSI in youth. Methods: Thirty-five female adolescents and young adults with NSSI aged 13-21 years were enrolled in this study that had an open-label, single-arm study design. All participants were given oral NAC as follows: 600 mg twice daily (weeks 1-2), 1200 mg twice daily (weeks 3-4), and 1800 mg twice daily (weeks 5-8). Patients were seen every 2 weeks throughout the trial, at which time youth reported the frequency of NSSI episodes. Levels of depression, impulsivity, and global psychopathology were measured at baseline and at the end of the trial using the Beck Depression Inventory-II (BDI-II), Barratt Impulsivity Scale, and Symptoms Checklist-90 (SCL-90). Results: About two-thirds of the enrolled female youth completed the trial (24/35). NAC was generally well tolerated in this sample. NAC treatment was associated with a significant decrease in NSSI frequency at visit 6 and visit 8 compared to baseline. We also found that depression scores and global psychopathology scores (but not impulsivity scores) decreased after NAC treatment. Decrease in NSSI was not correlated with decrease in BDI-II or SCL-90 scores, suggesting these might be independent effects. Conclusion: We provide preliminary evidence that NAC may have promise as a potential treatment option for adolescents with NSSI. The current results require follow-up with a randomized, placebo-controlled trial to confirm efficacy.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalJournal of child and adolescent psychopharmacology
Issue number2
StatePublished - Mar 2018

Bibliographical note

Funding Information:
The authors would like to first and foremost thank the young people and their families who volunteered their time to participate in this study. This clinical trial was primarily funded by the University of Minnesota, Academic Health Center with a Faculty Research Development grant awarded to Dr. K.R.C. and Dr. L.E.E. Additionally, many of the adolescents and young adults who participated in this study also participated in a baseline neuroimaging study that was funded by the National Institute of Mental Health (R21MH091366), which provided some additional support for the recruitment and assessment of this sample. Finally, we would like to thank Lori LaRiviere, MD for her important contributions to the study early on in the project.

Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc.


  • N-acetylcysteine (NAC)
  • adolescent
  • nonsuicidal self-injurious behavior (NSSI)


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