As an add-on in OCD, NAC is particularly good, especially with skin picking. It is a supplement, not a prescription: we target 2.4 to 3 grams, working up over a few weeks, and apart from smell and taste the main risk is allergy.
When we reach for it
As an add-on in OCD it is particularly good, especially with skin picking. It is a supplement, not a prescribed medication.
“Lamotrigine is a reasonable option. N-acetylcysteine is particularly good, especially with skin picking. That's a supplement. It's not a prescribed medication. I've been reading more and more about Ondansetron as potentially one of the most effective add-ons for OCD”
30:36Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
How we use it
Going by the available studies of NAC in OCD, we usually target 2.4 to 3 grams. We use the Now Foods 600 milligram capsules: start with two, then go up to 1,200 milligrams twice a day after a few weeks, once it is tolerated.
“I go off of the available studies for NAC and OCD, and I usually target something between 2.4 to 3 grams of NAC. I have had patients complain of the taste or smell, though”
34:42Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025 Also said in 1 more episode
“I tend to use for NAC the Now Foods 600 milligram. I usually start with two of the 600 milligrams and then go up to 1,200 milligrams twice a day after a few weeks once it's tolerated”
35:39Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025 Other than smell and taste, it has few adverse effects. The main risk is allergy, as with any other medication.
“Other than smell and taste, there's not a whole lot of adverse effects from NAC. The main risk is allergy, like any other medication, allergic reaction”
36:04Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.