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| |  SFN: D-cycloserine May Give New Boost to Phobia Psychotherapy By Roberta Friedman, PhD NEW ORLEANS, LA -- November 12, 2003 -- D-cycloserine, an old standby in tuberculosis therapy, may find new use in boosting the effectiveness of psychotherapy, according to early work reported here November 10th at the Society for Neuroscience 33rd Annual Meeting. "It is promising. It's a small study, but it comes right out of the animal work [on phobia extinction]," stated Michael Davis, PhD, a co-author and Professor of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, United States. Emory University investigators used virtual reality to simulate a ride in a glass elevator for people afraid of heights. They tested D-cycloserine in a suboptimal set of two sessions of this phobia-extinction therapy. More sessions are usually required to extinguish the phobia. Anxiety was rated 1 week later, and then 3 months later. Thirty patients participated, with 10 receiving placebo, and 10 each taking 1 of 2 doses of D-cycloserine. Not much difference was demonstrated between the high-dose group and the low-dose group, and in fact, the higher dose, 100 mg, used for tuberculosis, was slightly poorer at aiding the therapy than the 10-mg dose, Dr. Davis said. Anxiety was rated with a Subjective Units of Discomfort scale, which showed a 10% to 20% improvement for placebo-treated patients after 2 sessions, but a 50% to 60% improvement when the agent was taken before the sessions. The difference was statistically significant, Dr. Davis said. Dr. Davis said the idea would be to "take the drug before you go to your therapist. That gets around the tolerance that often happens in the brain [with many psychoactive drugs]." "There are lots of cognitive enhancers that drug companies are trying to develop," Dr. Davis noted, "[that] have contacted me [to test this paradigm] as a prelude to clinical tests." D-cycloserine would be worth a try as an aid to therapy for obsessive compulsive disorder (OCD), Dr. Davis feels, and for generalized anxiety disorder, as well as post traumatic stress. Trials of the drug in all of these disorders are planned. OCD is particularly amenable to extinction therapy, Dr. Davis pointed out, and that therapy is "absolutely more effective" than treatment with serotonin drugs. Benefit after extinction therapy, he said, "lasts longer," compared to treatment with selective serotonin reuptake inhibitors. With the aid of this therapy, patients would be more likely to complete a shorter course of extinction therapy -- which is expensive and unpleasant, although effective for 80% of those who stay the course, said lead investigator Mark Barad, MD, PhD, psychologist, University of California-Los Angeles, United States, who also presented at the symposium. Extinction is not an erasure, Dr. Barad explained, since the patient's fear remains. Any cost-effective way to pare down the psychotherapy that best addresses phobias would be welcomed by insurance payers, both investigators agreed.
[Study title: The Role of NMDA Receptors in Extinction. Abstract 327.2]
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