title: A review of current evidence for acetyl-l-carnitine in the treatment of depression.
abstract: Despite numerous antidepressants available, many patients with depression do not achieve adequate response rendering needs for novel antidepressants with different mechanism of actions. Acetyl-l-carnitine (ALC) is a potential antidepressant with novel mechanism of action because of its diverse functions related with neuroplasticity. Animal and cellular models suggest that ALC's neuroplasiticity effect, membrane modulation, and neurotransmitter regulation may play an important role in treatment of depression. Four randomized clinical studies (RCT) demonstrated the superior efficacy of ALC over placebo (PBO) in patients with depression. Two RCTs showed its superior efficacy over PBO in dysthymic disorder, and 2 other RCTs showed that it is equally effective as fluoxetine and amisulpride in treatment of dysthymic disorder. ALC was also effective in improving depressive symptoms in patients with fibromyalgia and minimal hepatic encephalopathy. It was also found to be equally tolerable to PBO and better tolerable than fluoxetine and amisulpride. In conclusion, ALC may be potentially effective and tolerable next treatment option with novel action mechanisms for patients with depression, in particular older population and patients with comorbid medical conditions who are vulnerable to adverse events from antidepressants. However, more clinical trial data with adequately-powered, well-designed and advanced methodology will be mandatory to conclude whether ALC as a monotherapy or augmentation agent may be efficacious and clinically beneficial for depression.
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
authors.forename: Sheng-Min
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, College of Medicine, Korea University, Republic of Korea.
authors.forename: Changsu
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
authors.forename: Soo-Jung
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
authors.affiliation: Global Medical Education, New York, NY, USA.
authors.forename: Prakash S
authors.initials: PS
authors.lastname: Masand
authors.affiliation: Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea; Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: pae@catholic.ac.kr.
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
mesh_terms: D000108:Acetylcarnitine / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D012372:ROC Curve; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D014803:Vitamin B Complex; D000108:Acetylcarnitine
keywords: Acetyl-l-carnitine; Action mechanism; Antidepressant; Carnitine; Depression