{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:00:07Z","timestamp":1791864007620,"version":"4.3.4"},"reference-count":83,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Oxidative stress is defined as the imbalance between the production of free radicals and their removal by antioxidants, leading to accumulation and subsequent organ and tissue damage. Antioxidant status and its role in the accumulation of free radicals has been observed in a number of psychological disorders. Glutathione is commonly referred to as the principal antioxidant of the brain and, therefore, plays a critical role in maintaining redox homeostasis. Reduced levels of glutathione in the brain increase its vulnerability to oxidative stress, and may be associated with the development and progression of several psychiatric disorders. Within this review, we focus on analyzing potential associations between the glutathione antioxidant pathway and psychiatric disorders: major depressive disorder, schizophrenia, bipolar disorder, and generalized anxiety disorder. Our research suggests that studies regarding these four disorders have shown decreased levels of GSH in association with diseased states; however, conflicting results note no significant variance in glutathione pathway enzymes and\/or metabolites based on diseased state. In studying the potential of NAC administration as an adjunct therapy, various studies have shown NAC to augment therapy and\/or aid in symptomatic management for psychiatric disorders, while contrasting results exist within the literature. Based on the conflicting findings throughout this review, there is room for study regarding the potential role of glutathione in the development and progression of psychiatric disorders. Our findings further suggest a need to study such pathways with consideration of the interactions with first-line pharmacotherapy, and the potential use of antioxidants as supplemental therapy.<\/jats:p>","DOI":"10.3390\/clinpract13040070","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T00:54:41Z","timestamp":1688604881000},"page":"768-779","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Potential Role of Glutathione Antioxidant Pathways in the Pathophysiology and Adjunct Treatment of Psychiatric Disorders"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-8467","authenticated-orcid":false,"given":"Nicole","family":"Poladian","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inesa","family":"Navasardyan","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0120-4289","authenticated-orcid":false,"given":"William","family":"Narinyan","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6184-3624","authenticated-orcid":false,"given":"Davit","family":"Orujyan","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2586-1160","authenticated-orcid":false,"given":"Vishwanath","family":"Venketaraman","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1124\/jpet.116.237503","article-title":"Oxidative Stress and the Central Nervous System","volume":"360","author":"Salim","year":"2017","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1016\/j.bbagen.2012.09.008","article-title":"Glutathione synthesis","volume":"1830","author":"Lu","year":"2013","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/978-1-60761-756-3_18","article-title":"Measurement of Oxidized\/Reduced Glutathione Ratio","volume":"648","author":"Owen","year":"2010","journal-title":"Methods Mol. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Aoyama, K. (2021). Glutathione in the Brain. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22095010"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/cc13786","article-title":"Elevated malondialdehyde levels in sepsis-something to \u2018stress\u2019 about?","volume":"18","author":"Weiss","year":"2014","journal-title":"Crit. Care"},{"key":"ref_6","first-page":"184","article-title":"Diagnostic Performance of Increased Malondialdehyde Level and Oxidative Stress in Patients with Schizophrenia","volume":"58","author":"Orhan","year":"2021","journal-title":"Noro Psikiyatr Ars."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1089\/ars.2010.3586","article-title":"Glutathione Peroxidase-1 in Health and Disease: From Molecular Mechanisms to Therapeutic Opportunities","volume":"15","author":"Lubos","year":"2011","journal-title":"Antioxid. Redox Signal."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1007816","DOI":"10.3389\/fnut.2022.1007816","article-title":"Glutathione: A Samsonian life-sustaining small molecule that protects against oxidative stress, ageing and damaging inflammation","volume":"9","author":"Labarrere","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/HJR.0b013e32828622d7","article-title":"Effects of exercise training on the glutathione antioxidant system","volume":"14","author":"Elokda","year":"2007","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/ajcn\/77.1.189","article-title":"Vitamin C augments lymphocyte glutathione in subjects with ascorbate deficiency","volume":"77","author":"Lenton","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Minich, D.M., and Brown, B.I. (2019). A Review of Dietary (Phyto)Nutrients for Glutathione Support. Nutrients, 11.","DOI":"10.3390\/nu11092073"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1503\/jpn.100057","article-title":"N-acetylcysteine in psychiatry: Current therapeutic evidence and potential mechanisms of action","volume":"36","author":"Dean","year":"2011","journal-title":"J. Psychiatry Neurosci."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Tardiolo, G., Bramanti, P., and Mazzon, E. (2018). Overview on the Effects of N-Acetylcysteine in Neurodegenerative Diseases. Molecules, 23.","DOI":"10.3390\/molecules23123305"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/0148607111434963","article-title":"Oxidative stress","volume":"36","author":"Preiser","year":"2012","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1142608","DOI":"10.3389\/fpsyt.2023.1142608","article-title":"Can glutathione be a biomarker for suicide risk in women 18 months postpartum?","volume":"14","author":"Trettim","year":"2023","journal-title":"Front. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jeon, P., Limongi, R., Ford, S.D., Branco, C., Mackinley, M., Gupta, M., Powe, L., Th\u00e9berge, J., and Palaniyappan, L. (2021). Glutathione as a Molecular Marker of Functional Impairment in Patients with At-Risk Mental State: 7-Tesla 1H-MRS Study. Brain Sci., 11.","DOI":"10.3390\/brainsci11070941"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Juchnowicz, D., Dzikowski, M., Rog, J., Waszkiewicz, N., Karaku\u0142a, K.H., Zalewska, A., Maciejczyk, M., and Karakula-Juchnowicz, H. (2021). Pro\/Antioxidant State as a Potential Biomarker of Schizophrenia. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184156"},{"key":"ref_18","unstructured":"World Health Organization (2023, April 24). (2023, March 31). Depressive disorder (Depression). WHO. Available online: www.who.int\/news-room\/fact-sheets\/detail\/depression."},{"key":"ref_19","unstructured":"Association, A.P. (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF02193525","article-title":"Suicidal ideation and suicide attempts: Comorbidity with depression, anxiety disorders, and substance abuse disorder","volume":"244","author":"Bronisch","year":"1994","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"690130","DOI":"10.3389\/fpsyt.2021.690130","article-title":"Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies","volume":"12","author":"Cai","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1017\/S1461145711000617","article-title":"Prefrontal cortex glutathione S-transferase levels in patients with bipolar disorder, major depression and schizophrenia","volume":"14","author":"Gawryluk","year":"2011","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1017\/S1461145710000805","article-title":"Decreased levels of glutathione, the major brain antioxidant, in post-mortem prefrontal cortex from patients with psychiatric disorders","volume":"14","author":"Gawryluk","year":"2011","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.psyneuen.2016.11.031","article-title":"Oxidative stress, inflammation and treatment response in major depression","volume":"76","author":"Lindqvist","year":"2017","journal-title":"Psychoneuroendocrinology"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ait Tayeb, A.E.K., Poinsignon, V., Chappell, K., Bouligand, J., Becquemont, L., and Verstuyft, C. (2023). Major Depressive Disorder and Oxidative Stress: A Review of Peripheral and Genetic Biomarkers According to Clinical Characteristics and Disease Stages. Antioxidants, 12.","DOI":"10.3390\/antiox12040942"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.neulet.2014.03.056","article-title":"In vivo (1)H MRS study of potential associations between glutathione, oxidative stress and anhedonia in major depressive disorder","volume":"569","author":"Lapidus","year":"2014","journal-title":"Neurosci. Lett."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.4088\/JCP.14r09179","article-title":"Oxidative stress and antioxidant parameters in patients with major depressive disorder compared to healthy controls before and after antidepressant treatment: Results from a meta-analysis","volume":"76","author":"Gurpegui","year":"2015","journal-title":"J. Clin. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/hup.829","article-title":"Major depressive disorder is accompanied with oxidative stress: Short-term antidepressant treatment does not alter oxidative\u2013antioxidative systems","volume":"22","author":"Sarandol","year":"2007","journal-title":"Hum. Psychopharmacol."},{"key":"ref_29","first-page":"290","article-title":"The effect of different antidepressant drugs of oxidative stress after lipopolysaccharide administration in mice","volume":"10","author":"Morsy","year":"2011","journal-title":"EXCLI J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"609421","DOI":"10.1155\/2012\/609421","article-title":"Preclinical and Clinical Evidence of Antioxidant Effects of Antidepressant Agents: Implications for the Pathophysiology of Major Depressive Disorder","volume":"2012","author":"Behr","year":"2012","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1007\/s12035-020-02212-w","article-title":"Increasing Nrf2 Activity as a Treatment Approach in Neuropsychiatry","volume":"58","author":"Morris","year":"2021","journal-title":"Mol. Neurobiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1002\/jps.24482","article-title":"Intravenous Administration of Stable-Labeled N-Acetylcysteine Demonstrates an Indirect Mechanism for Boosting Glutathione and Improving Redox Status","volume":"104","author":"Zhou","year":"2015","journal-title":"J. Pharm. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e492","DOI":"10.1038\/tp.2014.131","article-title":"N-Acetylcysteine improves mitochondrial function and ameliorates behavioral deficits in the R6\/1 mouse model of Huntington\u2019s disease","volume":"5","author":"Wright","year":"2015","journal-title":"Transl. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Dogaru, I.A., Puiu, M.G., Manea, M., and Dionisie, V. (2022). Current Perspectives on Pharmacological and Non-Pharmacological Interventions for the Inflammatory Mechanism of Unipolar Depression. Brain Sci., 12.","DOI":"10.3390\/brainsci12101403"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hans, D., Rengel, A., Hans, J., Bassett, D., and Hood, S. (2022). N-Acetylcysteine as a novel rapidly acting anti-suicidal agent: A pilot naturalistic study in the emergency setting. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263149"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1017\/neu.2017.2","article-title":"Adjunctive N-acetylcysteine in depression: Exploration of interleukin-6, C-reactive protein and brain-derived neurotrophic factor","volume":"29","author":"Hasebe","year":"2017","journal-title":"Acta Neuropsychiatr."},{"key":"ref_37","unstructured":"World Health Organization (2023, April 24). Mental Disorders. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mental-disorders."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jad.2008.04.013","article-title":"Oxidative stress markers in bipolar disorder: A meta-analysis","volume":"111","author":"Andreazza","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.jpsychires.2006.07.013","article-title":"Serum S100B and antioxidant enzymes in bipolar patients","volume":"41","author":"Andreazza","year":"2007","journal-title":"J. Psychiatr. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/00004850-200403000-00006","article-title":"Antioxidant enzyme activities and oxidative stress in affective disorders","volume":"19","author":"Ozcan","year":"2004","journal-title":"Int. Clin. Psychopharmacol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.jpsychires.2012.12.006","article-title":"In vivo glutathione levels in young persons with bipolar disorder: A magnetic resonance spectroscopy study","volume":"47","author":"Lagopoulos","year":"2013","journal-title":"J. Psychiatr. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.neuroscience.2006.11.010","article-title":"Role of glutathione in neuroprotective effects of mood stabilizing drugs lithium and valproate","volume":"144","author":"Cui","year":"2006","journal-title":"Neuroscience"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/bdi.12980","article-title":"Oxidative stress parameters and antioxidants in patients with bipolar disorder: Results from a meta-analysis comparing patients, including stratification by polarity and euthymic status, with healthy controls","volume":"23","author":"Gurpegui","year":"2021","journal-title":"Bipolar Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.neuroscience.2007.10.041","article-title":"The effect of mood stabilizer lithium on expression and activity of glutathione s-transferase isoenzymes","volume":"151","author":"Shao","year":"2008","journal-title":"Neuroscience"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.neulet.2009.03.022","article-title":"Mood stabilizing drugs lamotrigine and olanzapine increase expression and activity of glutathione s-transferase in primary cultured rat cerebral cortical cells","volume":"455","author":"Bakare","year":"2009","journal-title":"Neurosci. Lett."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jpsychires.2013.11.011","article-title":"Oxidative stress in early stage Bipolar Disorder and the association with response to lithium","volume":"50","author":"Zarate","year":"2014","journal-title":"J. Psychiatr. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jad.2011.06.005","article-title":"The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: An open label trial","volume":"135","author":"Berk","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1007\/s00213-021-05789-9","article-title":"The effect of N-acetylcysteine on bipolar depression: A systematic review and meta-analysis of randomized controlled trials","volume":"238","author":"Pittas","year":"2021","journal-title":"Psychopharmacology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.neubiorev.2010.10.008","article-title":"Oxidative stress in schizophrenia: An integrated approach","volume":"35","author":"Bitanihirwe","year":"2011","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"301","DOI":"10.2174\/157015911795596595","article-title":"Oxidative stress in schizophrenia","volume":"9","author":"Vovk","year":"2011","journal-title":"Curr. Neuropharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/0019-5545.39753","article-title":"Evaluation of antioxidant deficit in schizophrenia","volume":"50","author":"Dadheech","year":"2008","journal-title":"Indian J. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e1215","DOI":"10.1038\/tp.2017.178","article-title":"Reduction of plasma glutathione in psychosis associated with schizophrenia and bipolar disorder in translational psychiatry","volume":"7","author":"Nucifora","year":"2017","journal-title":"Transl. Psychiatry"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/BF02912908","article-title":"Oxidative stress, \u03b1-tocopherol, ascorbic acid and reduced glutathione status in schizophrenics","volume":"21","author":"Dadheech","year":"2006","journal-title":"Indian J. Clin. Biochem."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.pnpbp.2009.06.018","article-title":"Decreased glutathione levels and antioxidant enzyme activities in untreated and treated schizophrenic patients","volume":"33","author":"Raffa","year":"2009","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1155\/2006\/248387","article-title":"Altered Glutathione Redox State in Schizophrenia","volume":"22","author":"Yao","year":"2006","journal-title":"Dis. Markers"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s002130100860","article-title":"Nitrite content and antioxidant enzyme levels in the blood of schizophrenia patients","volume":"158","author":"Srivastava","year":"2001","journal-title":"Psychopharmacology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s11427-010-0013-8","article-title":"A meta-analysis of oxidative stress markers in schizophrenia","volume":"53","author":"Zhang","year":"2010","journal-title":"Sci. China Life Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/0019-5545.43627","article-title":"A comparative study of oxidative stress and interrelationship of important antioxidants in haloperidol and olanzapine treated patients suffering from schizophrenia","volume":"50","author":"Singh","year":"2008","journal-title":"Indian J. Psychiatry"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Caruso, G., Grasso, M., Fidilio, A., Tascedda, F., Drago, F., and Caraci, F. (2020). Antioxidant Properties of Second-Generation Antipsychotics: Focus on Microglia. Pharmaceuticals, 13.","DOI":"10.3390\/ph13120457"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"555","DOI":"10.2147\/NDT.S283395","article-title":"Comparative Study of the Effects of Atypical Antipsychotic Drugs on Plasma and Urine Biomarkers of Oxidative Stress in Schizophrenic Patients","volume":"17","author":"Nowak","year":"2021","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1007\/s43440-021-00318-z","article-title":"Impact of repeated co-treatment with escitalopram and aripiprazole on the schizophrenia-like behaviors and BDNF mRNA expression in the adult Sprague\u2013Dawley rats exposed to glutathione deficit during early postnatal development of the brain","volume":"73","author":"Lech","year":"2021","journal-title":"Pharmacol. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/0004867419893439","article-title":"Meta-analysis of randomised controlled trials with N-acetylcysteine in the treatment of schizophrenia","volume":"54","author":"Yolland","year":"2019","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.biopsych.2008.03.004","article-title":"N-acetyl cysteine as a glutathione precursor for schizophrenia\u2014A double-blind, randomized, placebo-controlled trial","volume":"64","author":"Berk","year":"2008","journal-title":"Biol. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.schres.2018.03.012","article-title":"Effects of 12-month, double-blind N-acetyl cysteine on symptoms, cognition and brain morphology in early phase schizophrenia spectrum disorders","volume":"199","author":"Breier","year":"2018","journal-title":"Schizophr. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/WNF.0000000000000001","article-title":"N-acetylcysteine as an adjunct to risperidone for treatment of negative symptoms in patients with chronic schizophrenia: A randomized, double-blind, placebo-controlled study","volume":"36","author":"Farokhnia","year":"2013","journal-title":"Clin. Neuropharmacol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/IJPSYM.IJPSYM_322_17","article-title":"Role of Novel Dietary Supplement N-acetyl Cysteine in Treating Negative Symptoms in Schizophrenia: A 6-Month Follow-up Study","volume":"40","author":"Tharoor","year":"2018","journal-title":"Indian J. Psychol. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/schbul\/sbx093","article-title":"N-acetylcysteine in a Double-Blind Randomized Placebo-Controlled Trial: Toward Biomarker-Guided Treatment in Early Psychosis","volume":"44","author":"Conus","year":"2017","journal-title":"Schizophr. Bull."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1093\/schbul\/sbac065","article-title":"N-Acetylcysteine (NAC) in Schizophrenia Resistant to Clozapine: A Double-Blind, Randomized, Placebo-Controlled Trial Targeting Negative Symptoms","volume":"48","author":"Neill","year":"2022","journal-title":"Schizophr. Bull."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/nrn1429","article-title":"The developmental origins of anxiety","volume":"5","author":"Gross","year":"2004","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2174\/1570159X11666131120223530","article-title":"Oxidative Imbalance and Anxiety Disorders","volume":"12","author":"Krolow","year":"2014","journal-title":"Curr. Neuropharmacol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jns.2007.06.028","article-title":"Chlorogenic acid, a polyphenol from Prunus domestica (Mirabelle), with coupled anxiolytic and antioxidant effects","volume":"262","author":"Bouayed","year":"2007","journal-title":"J. Neurol. Sci."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1016\/j.bbi.2008.06.005","article-title":"Evidence that oxidative stress is linked to anxiety-related behaviour in mice","volume":"22","author":"Rammal","year":"2008","journal-title":"Brain Behav. Immun."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1038\/nature04250","article-title":"Glyoxalase 1 and glutathione reductase 1 regulate anxiety in mice","volume":"438","author":"Hovatta","year":"2005","journal-title":"Nature"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"88","DOI":"10.9758\/cpn.2018.16.1.88","article-title":"The Diagnostic Value of Malondialdehyde, Superoxide Dismutase and Catalase Activity in Drug Na\u00efve, First Episode, Non-Smoker Generalized Anxiety Disorder Patients","volume":"16","author":"Camkurt","year":"2018","journal-title":"Clin. Psychopharmacol. Neurosci."},{"key":"ref_75","first-page":"617","article-title":"Diagnosis and management of generalized anxiety disorder and panic disorder in adults","volume":"91","author":"Locke","year":"2015","journal-title":"Am. Fam. Physician"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S0009-2797(00)00172-1","article-title":"Antioxidant defense against antidepressants in C6 and 1321N1 cells","volume":"127","author":"Slamon","year":"2000","journal-title":"Chem. Interact."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4103\/0253-7613.106435","article-title":"Evaluation of sesamol and buspirone in stress induced anxiety in mice","volume":"45","author":"Kumar","year":"2013","journal-title":"Indian J. Pharmacol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.pbb.2015.08.006","article-title":"N-acetylcysteine prevents stress-induced anxiety behavior in zebrafish","volume":"139","author":"Mocelin","year":"2015","journal-title":"Pharmacol. Biochem. Behav."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s40263-022-00907-3","article-title":"The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders","volume":"36","author":"Bradlow","year":"2022","journal-title":"CNS Drugs"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1159\/000512117","article-title":"N-Acetylcysteine Attenuates the Anxiety-Like Behavior and Spatial Cognition Impairment Induced by Doxorubicin and Cyclophosphamide Combination Treatment in Rats","volume":"106","author":"Kitamura","year":"2020","journal-title":"Pharmacology"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.bbr.2016.10.010","article-title":"Anxiolytic properties of N-acetylcysteine in mice","volume":"317","author":"Santos","year":"2017","journal-title":"Behav. Brain Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1089\/cap.2012.0066","article-title":"Treatment with Adjunctive N-Acetylcysteine in an Adolescent with Selective Serotonin Reuptake Inhibitor-Resistant Anxiety","volume":"22","author":"Strawn","year":"2012","journal-title":"J. Child Adolesc. Psychopharmacol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1111\/bph.15456","article-title":"N-acetylcysteine as a new prominent approach for treating psychiatric disorders","volume":"178","author":"Smaga","year":"2021","journal-title":"Br. J. Pharmacol."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/13\/4\/70\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:06:33Z","timestamp":1760126793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/13\/4\/70"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,5]]},"references-count":83,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["clinpract13040070"],"URL":"https:\/\/doi.org\/10.3390\/clinpract13040070","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,5]]}}}