Editor's comment: Depression is often a comorbidity with fibromyalgia. This study is a review of clinical trials evaluating the use of acetyl-l-carnitine in the treatment of depression. It includes a 2007 study that focused on the treatment of depressive symptoms in fibromyalgia patients.
Acetyl L-Carnitine (ALC) is a delivery form for L-carnitine, a vitamin-like nutrient that is responsible for transporting long chain fatty acid "fuel" into the cells' energy producing mitrochondria. ALC is able to travel through the blood-brain barrier and plays a role in formation of the brain chemical acetylcholine - a "neurotransmitter."
A review of current evidence for acetyl-l-carnitine in the treatment of depression.
By S.M. Wang, et al.
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.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Source: Journal of Psychiatric Research, February 15, 2014. Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU.