Recent findings suggested short-term efficacy of D-cycloserine augmentation of cognitive behavioral therapy for anxiety, obsessive-compulsive disorder, PTSD and phobia disorders.
“Anxiety, obsessive-compulsive, and posttraumatic stress disorders constitute the most prevalent group of mental disorders, collectively affecting up to 30% of individuals at some point in their lives,” David Mataix-Cols, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “One promising strategy is the administration of D-cycloserine, a partial N-methyl-D-aspartate agonist that facilitates fear extinction in animals and reduces return of fear when given before or shortly after extinction training. Despite several initial trials showing promising results in humans with anxiety disorders, larger trials conducted within the past 5 years have produced mixed results.”
To assess efficacy of D-cycloserine in augmenting CBT for anxiety, OCD and PTSD and interactions between antidepressants and D-cycloserine, researchers conducted a systematic review and meta-analysis of 21 double-blind randomized clinical trials among 1,047 study participants. Analysis included studies that explored D-cycloserine as an augmentation strategy for exposure-based CBT among individuals with a specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, OCD or PTSD.
Participants who received D-cycloserine had lower symptom severity at posttreatment and follow-up, compared with those who received placebo.
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Thus, D-cycloserine in this study did not ameliorate schizophrenic symptoms. However, the fact that they actually worsened suggests that NMDA systems may be involved in the pathogenesis of schizophrenia. Further placebo-controlled studies with lower dosages of D-cycloserine, preferably in drug-free patients, are necessary to evaluate if D-cycloserine is of use for the treatment of patients with schizophrenia.