Joni F Baker1, Marshall E Cates2, David R Luthin3. 1. Pharmacy Resident, Oregon State Hospital, Salem, Oregon, jbaker4@samford.edu. 2. Professor of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, Alabama. 3. Professor of Pharmaceutical Sciences, Samford University McWhorter School of Pharmacy, Birmingham, Alabama.
Abstract
INTRODUCTION: Posttraumatic stress disorder (PTSD) is a common and serious psychiatric illness. Exposure therapy is a type of cognitive behavioral therapy that is considered a first-line treatment option for PTSD. D-cycloserine (DCS) enhances fear extinction/exposure therapy in patients with various anxiety disorders, presumably via its N-methyl-D-aspartate receptor partial agonist effects. The aim of this paper is to review the published literature regarding the efficacy of DCS in the treatment of PTSD. METHODS: A literature search for placebo-controlled trials assessing the use of DCS as the primary study drug in PTSD was conducted for trials published before June 2015 using PubMed, Ovid International Pharmaceutical Abstracts, and www.clinicaltrials.gov. The search terms were variations of "cycloserine" and "posttraumatic stress disorder." RESULTS: Seven clinical trials were analyzed, including 2 trials comparing DCS with placebo as add-on treatment to ongoing stable pharmacotherapy and 5 trials that compared DCS with placebo given prior to exposure therapy. D-cycloserine as adjunctive therapy showed no benefit in 1 trial and limited benefit in the other. As an enhancement of exposure therapy, DCS showed beneficial effects in 1 trial, detrimental effects in 1 trial, and inconclusive effects in 3 trials. DISCUSSION: Current literature does not adequately support the use of DCS as adjunctive therapy without psychotherapy, but limitations of the 2 studies that exist make firm conclusions unfeasible. D-cycloserine might have a role in augmentation of exposure therapy. Future studies should consider receptor selectivity, administration time with respect to peak cerebrospinal fluid concentrations, number of exposure therapy sessions, and dose.
INTRODUCTION: Posttraumatic stress disorder (PTSD) is a common and serious psychiatric illness. Exposure therapy is a type of cognitive behavioral therapy that is considered a first-line treatment option for PTSD. D-cycloserine (DCS) enhances fear extinction/exposure therapy in patients with various anxiety disorders, presumably via its N-methyl-D-aspartate receptor partial agonist effects. The aim of this paper is to review the published literature regarding the efficacy of DCS in the treatment of PTSD. METHODS: A literature search for placebo-controlled trials assessing the use of DCS as the primary study drug in PTSD was conducted for trials published before June 2015 using PubMed, Ovid International Pharmaceutical Abstracts, and www.clinicaltrials.gov. The search terms were variations of "cycloserine" and "posttraumatic stress disorder." RESULTS: Seven clinical trials were analyzed, including 2 trials comparing DCS with placebo as add-on treatment to ongoing stable pharmacotherapy and 5 trials that compared DCS with placebo given prior to exposure therapy. D-cycloserine as adjunctive therapy showed no benefit in 1 trial and limited benefit in the other. As an enhancement of exposure therapy, DCS showed beneficial effects in 1 trial, detrimental effects in 1 trial, and inconclusive effects in 3 trials. DISCUSSION: Current literature does not adequately support the use of DCS as adjunctive therapy without psychotherapy, but limitations of the 2 studies that exist make firm conclusions unfeasible. D-cycloserine might have a role in augmentation of exposure therapy. Future studies should consider receptor selectivity, administration time with respect to peak cerebrospinal fluid concentrations, number of exposure therapy sessions, and dose.
Authors: Rianne A de Kleine; Gert-Jan Hendriks; Wendy J C Kusters; Theo G Broekman; Agnes van Minnen Journal: Biol Psychiatry Date: 2012-04-04 Impact factor: 13.382
Authors: Jasper A J Smits; David Rosenfield; Michael W Otto; Mark B Powers; Stefan G Hofmann; Michael J Telch; Mark H Pollack; Candyce D Tart Journal: Biol Psychiatry Date: 2013-01-16 Impact factor: 13.382
Authors: Jasper A J Smits; David Rosenfield; Michael W Otto; Luana Marques; Michelle L Davis; Alicia E Meuret; Naomi M Simon; Mark H Pollack; Stefan G Hofmann Journal: J Psychiatr Res Date: 2013-07-16 Impact factor: 4.791
Authors: Stefan G Hofmann; Alicia E Meuret; Jasper A J Smits; Naomi M Simon; Mark H Pollack; Katherine Eisenmenger; Michael Shiekh; Michael W Otto Journal: Arch Gen Psychiatry Date: 2006-03
Authors: Chadi G Abdallah; Lynnette A Averill; Teddy J Akiki; Mohsin Raza; Christopher L Averill; Hassaan Gomaa; Archana Adikey; John H Krystal Journal: Annu Rev Pharmacol Toxicol Date: 2018-09-14 Impact factor: 13.820
Authors: Patricia T Spangler; James C West; Catherine L Dempsey; Kyle Possemato; Danielle Bartolanzo; Pablo Aliaga; Carlos Zarate; Meena Vythilingam; David M Benedek Journal: J Clin Psychiatry Date: 2020-10-27 Impact factor: 4.384
Authors: Lauren A M Lebois; Antonia V Seligowski; Jonathan D Wolff; Sarah B Hill; Kerry J Ressler Journal: Annu Rev Clin Psychol Date: 2019-01-30 Impact factor: 18.561
Authors: Boyoung Lee; Santosh Pothula; Min Wu; Hyeyeon Kang; Matthew J Girgenti; Marina R Picciotto; Ralph J DiLeone; Jane R Taylor; Ronald S Duman Journal: Mol Psychiatry Date: 2022-04-14 Impact factor: 13.437
Authors: Sabra S Inslicht; Andrea N Niles; Thomas J Metzler; Sa'ar L Lipshitz; Christian Otte; Mohammed R Milad; Scott P Orr; Charles R Marmar; Thomas C Neylan Journal: Neuropsychopharmacology Date: 2021-11-19 Impact factor: 8.294