N-Acetylcysteine for Trichotillomania (and more)

December 29, 2017 at 1:49 pm

Over the past several years, I have shared (or over-shared) the details of my journey with anxiety and depression. Lots of people have said to me, “I can’t believe how open you are.” For many, struggling with mental illness is a private battle. But it was never hard for me to tell my friends, family, and the Internet about the darkness and fear that were plaguing me. I wasn’t ashamed.

But.

For quite a while, but particularly the past couple of years, I have been battling another mental disorder that I have felt some shame about, and I haven’t felt comfortable publicly acknowledging it until now. I’m not sure exactly why this has been harder, but I think it’s partly because I didn’t really know for a long time that some of my strange habits were actually considered a disorder. And this particular disorder isn’t often talked about (at least not vocally or in public). It’s also, admittedly, really bizarre. Even the name is bizarre.


Trichotillomania

I have a body-focused repetitive behavior (BFRB) disorder called trichotillomania. Basically, what that means is that I compulsively pull out my hair. Some people with “trich” pull out their eyebrows or eyelashes. Some pull out arm or leg hair. This disorder runs in my extended family, and each of those who have struggled with it have targeted different areas of the body. Often those with trich also have a skin-picking disorder in conjunction with the hair-pulling. In my case, I primarily pull hair from the crown of my head, pick at my split ends, and pick at the dry skin on my heels. Weird, I know. As much as I can see how bizarre and undesirable my hair-pulling is, I also can’t seem to stop. For the past couple of years, it has been especially bad. Super lame.

The Internet is mercifully full of people talking about trich and supporting each other in dealing with it. One particular young woman named Allie Malin has been very open on YouTube about her struggle, and her courage was part of what inspired me to talk about my trich on this blog. This is one of her first videos about hair-pulling:

 

She has videos spanning several years, discussing her experiences with trich as well as tips for disguising bald patches and regrowth and suggestions to help reduce urges or prevent pulling.

Enter N-acetylcysteine (NAC)

It was from Allie that I learned about a supplement that has helped reduce pulling for some of those who suffer with trich. It’s called N-acetylcysteine (NAC), a form of the amino acid cysteine. NAC is an amazing substance whether you have trich or not. Among its reported benefits:

  • It helps the body produce glutathione, an important antioxidant that aids with toxin removal, supports the liver, and eliminates free radicals in the body.
  • It can reduce or prevent cold and flu symptoms.
  • It is a natural treatment for Polycystic Ovarian Syndrome (PCOS).
  • It is used to reduce miscarriages.
  • It is helpful for addiction recovery, reducing urges for desired substances.
  • It reduces hangover symptoms resulting from excessive alcohol consumption.
  • It is regularly used in emergency rooms to treat patients who overdose on acetaminophen, saving their livers and their lives.
  • It reduces inflammation in the body.

There are a lot more benefits I could list. Truly I’m amazed I’ve never heard of NAC before.

NAC and Glutamate

One aspect of NAC that was especially intriguing to me was its effect on glutamate in the brain/body. I’ve written before about my glutamate sensitivity, and I’ve discussed my belief that glutamate has been a primary contributor to my anxiety and depression. When I learned that NAC was a glutamate modulator, I knew I had stumbled on a missing key for my particular mental health challenges. Psychology Today explains:

As usual it all goes back to glutamate, the excitatory neurotransmitter of doom. In short, having too much glutamate around is to your neurons rather like whipping your horse to go and go and go until you kill it. Horses and brains need time at pasture, chilling out and eating appropriate foods, and sometimes a nice rubdown and brushing. Well, NAC seems to be able to get into some tricky areas of the brain and do some amazing management of glutamate.

This discovery has been very, very exciting for me. As soon as I made the NAC-glutamate connection, I knew I had to order this supplement ASAP. What’s even better, though, is that NAC can do much more than help trich sufferers. It’s actually beneficial for virtually anyone with a mental illness.

NAC for Mental Health

NAC has been studied as a treatment for anxiety, depression, OCD, schizophrenia, bipolar disorder, anorexia, autism, Alzheimers, epilepsy, and probably a whole lot more. And NAC has basically always produced favorable results. Umm…

I almost never use all-caps on my blogs, but in this case I feel caps are warranted. WHY IS NO ONE TALKING ABOUT THIS? Why have none of the doctors or psychiatric professionals I have met with said anything to me about NAC? I agree with Jordan Fallis (a journalist who suffered for many years before finding healing and relief in part as a result of NAC):

Overall, it’s clear to me that NAC should be a first-line treatment for mental illness. . . . The fact that NAC improves so many different mental disorders tells me that it’s much closer to treating the root cause of these brain afflictions than standard psychiatric care.

Dr. Emily Deans, a board certified adult psychiatrist practicing in Massachusetts, has also written about NAC and its beneficial impact on mental health. Highlighting trichotillomania, schizophrenia, bipolar disorder, and OCD, she says:

In most of the [NAC] studies, there were more adverse events and side effects in the placebo arm than in the treatment arm. Many of the studies were as long as 6 months, which is a lifetime for randomized controlled clinical trials, and all of the studies had positive effects. That is pretty astounding, considering how pharmaceutical companies have no doubt spent millions and millions chasing down bipolar depression, for example, without much to show for it.

Guys. Tell everyone you know about NAC. I’m serious. People need to know about it.

NAC and Me 

So a few weeks ago I ordered myself some NAC on Amazon. I had to peruse the reviews and ingredients on several different versions before I found one I felt good about (you can find a photo-link to it on my blog’s sidebar). Because my body is very sensitive, I was worried that this magical-unicorn-substance-I-had-such-high-hopes-for might produce a weird physical reaction in my body (as new supplements often do for me). But I gingerly took my first capsule and waited.

What have I noticed so far? I’ve had zero negative reactions. (Happy dance.) I do think it is reducing my trichy urges. Taking one capsule (600 mg) each morning, I find that my pulling basically goes away until late-afternoon or evening. I’m thinking that taking another capsule in the afternoon should take care of my evening urges.

I’ve also noticed another unexpected benefit of NAC. We’ve been on vacation for the holidays which means that my diet hasn’t been optimal. In other words, I’ve been eating more monosodium glutamate (MSG) and processed foods (toxins) than usual. Usually this spells h-e-a-d-a-c-h-e-s and other yucky stuff for me. But I haven’t had any headaches or negative response to the foods that usually bother me. (Happy dance again.) My guess is that this happy surprise stems from both the glutamate-modulating effects of NAC and its detoxing and liver support.

Safety Precautions

Being pregnant, occasionally still nursing my 2-year-old, and taking an SSRI medication, I wanted to be sure that NAC would be safe. So far, my research seems to suggest that NAC is very likely safe and even beneficial in these circumstances.

  • SSRIs and NAC. Apparently, like high-EPA omega-3s, NAC may actually help SSRI medications work better. I may even reduce my (already very low) medication dose since I’m now taking both NAC and EPA. “NAC has been used adjunctively with various pharmacotherapies, particularly SSRI medication, without negative interactions. . . . Promising new research highlights the potential of NAC to potentiate the antidepressant activity of certain SSRIs and tricyclic antidepressants” (Source).
  • Pregnancy and NAC. Taking NAC actually seems to reduce miscarriage and pregnancy complications and produce healthier babies. A miscarriage research website has gathered studies on NAC and pregnancy. Among the results listed:
      • NAC boosts the chance of pregnancy continuing past 20 weeks by 190%.
      • NAC boosts ovulation, progesterone, endometrial thickness, and pregnancy rates in PCOS women.
      • NAC may protect the fetus and mother from inflammation.
      • NAC reduces mercury levels in woman and fetus.
      • NAC prevents heart disease in offspring induced by maternal low protein diet.
      • NAC helps prevent diabetes-induced birth defects and miscarriage.
      • NAC helps protect placenta from high homocysteine levels.
      • NAC reduces the incidence of birth defects caused by maternal consumption of alcohol.
  • Breastfeeding and NAC. I haven’t seen a lot of information about the safety of taking NAC while nursing. There appears to be no pharmacokinetic information about whether NAC crosses into breast milk. However, given the overwhelming benefits associated with NAC, I personally feel confident that it’s not likely to harm a breastfeeding infant. Obviously each mother should determine her own comfort level in consultation with trusted experts and make an informed decision.  This statement shared on a trichotillomania forum is comforting, however:

My mother-in-law is amazing, and is a pretty boss lactation consultant with the state. I asked her about taking NAC while breastfeeding, and she didn’t know – so she emailed a NICU pharmacist at U of Washington, and here is the answer!

‘Another interesting question. The short answer is, it is not a problem. The longer answer is as follows. . . . After ingestion of NAC very little NAC, less than 5%, is absorbed by children and adults and makes the systemic circulation. Most of the NAC is converted in the liver, after absorption, to cysteine. . . . In the NICU we actually give cysteine to the premature neonates in their TPN. The mother’s NAC supplements are therefore converted to cysteine during absorption. Most of what will enter the breast milk is only cysteine, an amino acid commonly found in breast milk and formula. . . . So the baby is probably only getting a little more cysteine in the breast milk when the mother is taking NAC.’

 

So… NAC is my new BFF. It feels like a God-send (and probably is). If/when it eliminates my trich, I will definitely post an update. In the meantime, I’ll be enjoying its many other benefits.

Do you have trichotillomania or another BFRB? What has helped you? Do you take NAC? What benefits have you noticed? Please share in the comments!