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To the Editor In JAMA Psychiatry, Grant and colleagues1 demonstrated the efficacy of N-acetylcysteine (NAC) in the treatment of excoriation disorder (ED). The same group had previously reported the benefits of NAC for adults with trichotillomania (TTM).2 In both studies, NAC was used in monotherapy in otherwise treatment-free patients. In the DSM-5, ED and TTM were included under the umbrella of obsessive-compulsive disorder (OCD) and related disorders because of similarities regarding phenotypic expression and common putative neurobiological underpinnings between these disorders and OCD. When used for treatment-resistant OCD, NAC was not more effective than placebo as a selective serotonin reuptake inhibitor (SSRI) augmentation strategy.3
Costa DLC, Diniz JB, Miguel EC. How Similar Are the Disorders Included Under the Umbrella of Obsessive-Compulsive Disorder and Related Disorders?. JAMA Psychiatry. 2016;73(8):877. doi:10.1001/jamapsychiatry.2016.1342