How can N-acetyl cysteine (NAC) and S-adenosyl methionine (SAMe) be effectively integrated into child and adolescent psychiatric treatment? In this episode, we dive deep into the world of NAC and SAMe and explore their potential applications, dosage, side effects, and more.

Faculty: David Rosenberg, M.D.
 Host: Richard Seeber, M.D.

  * Learn more about our memberships here
  * Earn 1.25 CME: Natural Medications in Child and Adolescent Psychiatry
  * Administration of N-Acetylcysteine and S-Adenosylmethionine in Children and Adolescents

Hi, and welcome to the Psychopharmacology Institute Podcast.

Richard Sieber, and this is the place where we share clinical pearls to keep you updated in the field.

Today is the fourth episode of our series on natural medications in child and adolescent psychiatry.

In this episode, we'll delve into the application and administration of N-acetylcysteine, or NAC, and S-adenosylmethionine, or SAMe, in young populations.

While there's no standardized dosing regimen for either of these medications, various studies suggest ranges that we'll explore today.

It's commonly used in hospitals to manage acetaminophen overdoses due to its capacity to restore the body's stores of glutathione, a critical antioxidant that helps the liver neutralize toxins.

In the context of psychiatry, NAC has been researched for its potential benefits in conditions such as bipolar disorder, depression, OCD, and substance use disorders.

NAC's therapeutic potential is thought to arise from its modulation of glutamate, a critical neurotransmitter involved in reward pathways, learning, and memory.

By regulating glutamate levels and reducing oxidative stress, NAC may improve symptoms in a wide range of psychiatric disorders.

So why don't we learn more about this as well as Sam E.

David Rosenberg, who's professor and chair of the Department of Psychiatry and Behavioral Neurosciences, as well as the Chief of Child Psychiatry and Psychology at the Wayne State University School of Medicine in Detroit, Michigan.

Before we begin, please remember that here at the PI, we're committed to offering reliable, unbiased, and scientifically substantiated educational content, entirely independent from influence of the pharmaceutical industry.

Let's turn to video 7, Administration of NAC in SAMI in children and adolescents.

Dosage for NAC, there's no standardized dosing regimen that's been established for NAC, but doses typically range between 600 milligrams to 3000 milligrams per day in current studies.

The side effects for NAC, reported side effects of NAC are generally rare but can include GI symptoms such as nausea, vomiting, diarrhea, and constipation.

Less common side effects include rashes, fatigue, nervousness, fever, headache, sedation, and hypotension.

For SAMe dosage and administration, standard dosages for SAMe have not been established in youth.

Evidence from current studies supports initiating treatment using a starting dose of 200 milligrams with additional 200 milligram increases every 5 to 10 days.

A typical full dose in Children can range anywhere between 400 and 800 milligrams.

This compares with 400 to 1600 milligrams in adults, although higher doses can be used if tolerated.

Maximal dose is often limited by an increase in anxiety.

Similar to psychostimulants, The primary dose is administered in the morning, but additional doses can be added during the day.

Some partial improvement may appear in 1 to 2 weeks, but the usual time lag is anywhere between 2 to 8 weeks for the full antidepressant effect.

SAMI is a naturally occurring substance and thus reported side effects are generally minimal.

Reported side effects of SAMI can include the following, anxiety, insomnia, agitation, GI symptoms, such as dyspepsia, anorexia, nausea or vomiting, diarrhea, constipation, and flatulence.

Anxiety symptoms do appear to increase in many youth, especially in those with previous anxiety symptoms.

SAMI does not appear to induce mania more readily than any other antidepressants.

Nevertheless, routine monitoring precautions are advisable and clinicians need to monitor for side effects associated with the psychostimulant and tricyclic antidepressant properties of SAMe, including mania and possible rare serotonin syndrome.

Key take-home points here are no standard dosing regimen has been established for NAC or SAMI.

Doses of NAC have generally ranged anywhere between

to up to 3, 000 mg per day in current studies.

Reported side effects of NAC are generally rare, but may include GI symptoms such as nausea, vomiting, diarrhea, and constipation.

SAMe is a naturally occurring substance and thus reported side effects are also typically minimal.

However, clinicians need to monitor for side effects associated with the psychostimulant and tricyclic antidepressant properties of SAMe.

Rosenberg about the administration of NAC and SAMe in children and adolescents.

As the dinosomethionine, or SAMe, is evolved in the synthesis of neurotransmitters, which makes it a potential treatment option for depression and psychiatric conditions, There's some evidence suggesting that it might play a role in treating depression, either on its own or as an adjunct to other treatments.

However, high-quality research is needed to firmly establish its effectiveness.

It's important to note, too, that while there are suggested dose ranges for both NAC and SAMe, no standard regimen has been established.

Doses of NAC typically range from 600 to 3, 000 mg per day, while a full dose of SAMe in children may range between 400 to 800 milligrams compared with 400 to 1600 milligrams total daily dose in adults.

NAC, for instance, may cause gastrointestinal symptoms such as nausea and diarrhea, whereas SAMe may cause dry mouth, nausea, diarrhea, a feeling of restlessness or mood elevation, and insomnia.

Remember that although natural substances like NAC and SAMe can offer an alternative or complement to conventional treatments, they shouldn't be considered a replacement.

It's crucial to take into account the quality and extent of the available evidence, potential side effects of medication options, and possible interactions with other treatments.

The content for today's podcast comes from a video lecture titled Natural Medications in Child and Adolescent Psychiatry.

By subscribing to any of our bronze, silver, or gold memberships, you'll have the opportunity to earn 1.25 CME credits.

If you'd like to learn more about these memberships, you can click the link down in the show notes.

Thanks very much for joining me on today's episode.

Richard Seaver, and I look forward to seeing you


Speaker 0: Hi, and welcome to the Psychopharmacology Institute Podcast.

Speaker 1: I'm your host, Dr. Richard Sieber, and this is the place where we share clinical pearls to keep you updated in the field. Today is the fourth episode of our series on natural medications in child and adolescent psychiatry. In this episode, we'll delve into the application and administration of N-acetylcysteine, or NAC, and S-adenosylmethionine, or SAMe, in young populations. While there's no standardized dosing regimen for either of these medications, various studies suggest ranges that we'll explore today.

So, NAC is a valuable medication. It's commonly used in hospitals to manage acetaminophen overdoses due to its capacity to restore the body's stores of glutathione, a critical antioxidant that helps the liver neutralize toxins. In the context of psychiatry, NAC has been researched for its potential benefits in conditions such as bipolar disorder, depression, OCD, and substance use disorders. NAC's therapeutic potential is thought to arise from its modulation of glutamate, a critical neurotransmitter involved in reward pathways, learning, and memory. By regulating glutamate levels and reducing oxidative stress, NAC may improve symptoms in a wide range of psychiatric disorders.

So why don't we learn more about this as well as Sam E. Our faculty today is Dr. David Rosenberg, who's professor and chair of the Department of Psychiatry and Behavioral Neurosciences, as well as the Chief of Child Psychiatry and Psychology at the Wayne State University School of Medicine in Detroit, Michigan. Before we begin, please remember that here at the PI, we're committed to offering reliable, unbiased, and scientifically substantiated educational content, entirely independent from influence of the pharmaceutical industry. Alright, let's take a listen now to Dr.

David Rosenberg.

Speaker 2: Let's turn to video 7, Administration of NAC in SAMI in children and adolescents. Dosage for NAC, there's no standardized dosing regimen that's been established for NAC, but doses typically range between 600 milligrams to 3000 milligrams per day in current studies. The side effects for NAC, reported side effects of NAC are generally rare but can include GI symptoms such as nausea, vomiting, diarrhea, and constipation. Less common side effects include rashes, fatigue, nervousness, fever, headache, sedation, and hypotension. For SAMe dosage and administration, standard dosages for SAMe have not been established in youth.

Evidence from current studies supports initiating treatment using a starting dose of 200 milligrams with additional 200 milligram increases every 5 to 10 days. A typical full dose in Children can range anywhere between 400 and 800 milligrams. This compares with 400 to 1600 milligrams in adults, although higher doses can be used if tolerated. Maximal dose is often limited by an increase in anxiety. Similar to psychostimulants, The primary dose is administered in the morning, but additional doses can be added during the day.

Some partial improvement may appear in 1 to 2 weeks, but the usual time lag is anywhere between 2 to 8 weeks for the full antidepressant effect. Side effects of S-adenosylmethionine. SAMI is a naturally occurring substance and thus reported side effects are generally minimal. Reported side effects of SAMI can include the following, anxiety, insomnia, agitation, GI symptoms, such as dyspepsia, anorexia, nausea or vomiting, diarrhea, constipation, and flatulence. Anxiety symptoms do appear to increase in many youth, especially in those with previous anxiety symptoms.

SAMI does not appear to induce mania more readily than any other antidepressants. Nevertheless, routine monitoring precautions are advisable and clinicians need to monitor for side effects associated with the psychostimulant and tricyclic antidepressant properties of SAMe, including mania and possible rare serotonin syndrome. Key take-home points here are no standard dosing regimen has been established for NAC or SAMI. Doses of NAC have generally ranged anywhere between

Speaker 0: 600

Speaker 2: to up to 3, 000 mg per day in current studies. Reported side effects of NAC are generally rare, but may include GI symptoms such as nausea, vomiting, diarrhea, and constipation. SAMe is a naturally occurring substance and thus reported side effects are also typically minimal. However, clinicians need to monitor for side effects associated with the psychostimulant and tricyclic antidepressant properties of SAMe.

Speaker 1: We just heard from Dr. Rosenberg about the administration of NAC and SAMe in children and adolescents. As the dinosomethionine, or SAMe, is evolved in the synthesis of neurotransmitters, which makes it a potential treatment option for depression and psychiatric conditions, There's some evidence suggesting that it might play a role in treating depression, either on its own or as an adjunct to other treatments. However, high-quality research is needed to firmly establish its effectiveness. It's important to note, too, that while there are suggested dose ranges for both NAC and SAMe, no standard regimen has been established.

Doses of NAC typically range from 600 to 3, 000 mg per day, while a full dose of SAMe in children may range between 400 to 800 milligrams compared with 400 to 1600 milligrams total daily dose in adults. NAC and SAMe may induce side effects. NAC, for instance, may cause gastrointestinal symptoms such as nausea and diarrhea, whereas SAMe may cause dry mouth, nausea, diarrhea, a feeling of restlessness or mood elevation, and insomnia. Remember that although natural substances like NAC and SAMe can offer an alternative or complement to conventional treatments, they shouldn't be considered a replacement. It's crucial to take into account the quality and extent of the available evidence, potential side effects of medication options, and possible interactions with other treatments.

The content for today's podcast comes from a video lecture titled Natural Medications in Child and Adolescent Psychiatry. By subscribing to any of our bronze, silver, or gold memberships, you'll have the opportunity to earn 1.25 CME credits. If you'd like to learn more about these memberships, you can click the link down in the show notes. Thanks very much for joining me on today's episode. This is Dr.

Richard Seaver, and I look forward to seeing you

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Child Psychiatry: NAC and SAMe