D-cycloserine Augmentation in Behavioral Therapy for Obsessive-compulsive Disorder: a Meta-analysis

Overview

Journal Drug Des Devel Ther

Specialty Pharmacology

Date 2015 May 12

PMID 25960632

Citations 6

Authors

Jing Xia

Yanqiu Du

Jiyang Han

Guo Liu

Xumei Wang

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the overall effect of D-cycloserine (DCS) augmentation on exposure and response prevention (ERP) therapy for obsessive-compulsive disorder (OCD).

Methods: Clinical studies on the effect of DCS augmentation on ERP therapy for OCD compared to placebo were included for meta analysis. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Meta-analyses were performed with a random-effect model or a fixed-effect model using the Cochrane Review Manager (RevMan, version 5.2) to calculate the odds ratio and the mean difference, with their corresponding 95% confidence intervals.

Results: A total of six studies was included in the current meta-analyses, and their data were extracted. Among them, four were for analyses of DCS and Y-BOCS at midtreatment, six for analysis at posttreatment, and four at 3-month follow-up. Besides, three of the six eligible studies were included in the meta-analysis of the DCS and Clinical Global Impression-Severity Scale at posttreatment, and three in the meta-analysis of DCS and proportions of treatment responders and of subjects attaining clinical remission status criteria at posttreatment. Our meta-analyses do not reveal a significant effect of DCS augmentation in ERP therapy for OCD patients, except when measured at midtreatment. Compared to the placebo group, DCS augmentation did show a trend toward significantly lower/decreased Y-BOCS; when measured at posttreatment and in the subpopulation of DCS taken before some of the ERP sessions, DCS augmentation showed a trend toward significantly lower/decreased Y-BOCS.

Conclusion: Our result suggested that with the careful optimization of DCS-augmented ERP therapy by fine-tuning timing and dosing of DCS administration and number and frequency of ERP sessions, DCS may enhance the efficacy of ERP therapy in reducing the symptomatic severity of OCD patients, especially at early stage of the treatment; therefore, DCS augmentation could possibly reduce treatment cost, reduce treatment drop and refusal rate, and help to improve access to the limited number of experienced therapists.

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References

Siegmund A, Golfels F, Finck C, Halisch A, Rath D, Plag J . D-cycloserine does not improve but might slightly speed up the outcome of in-vivo exposure therapy in patients with severe agoraphobia and panic disorder in a randomized double blind clinical trial. J Psychiatr Res. 2011; 45(8):1042-7. DOI: 10.1016/j.jpsychires.2011.01.020. View

Storch E, Merlo L, Bengtson M, Murphy T, Lewis M, Yang M . D-cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2007; 22(4):230-7. DOI: 10.1097/YIC.0b013e32819f8480. View

Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E . Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):593-602. DOI: 10.1001/archpsyc.62.6.593. View

McGuire J, Lewin A, Geller D, Brown A, Ramsey K, Mutch J . Advances in the treatment of pediatric obsessive-compulsive d-cycloserine with exposure and response prevention. Neuropsychiatry (London). 2013; 2(4). PMC: 3808983. DOI: 10.2217/npy.12.38. View

Storch E, Mariaskin A, Murphy T . Psychotherapy for obsessive-compulsive disorder. Curr Psychiatry Rep. 2009; 11(4):296-301. DOI: 10.1007/s11920-009-0043-8. View

Hofmann S . Enhancing exposure-based therapy from a translational research perspective. Behav Res Ther. 2007; 45(9):1987-2001. PMC: 2174693. DOI: 10.1016/j.brat.2007.06.006. View

Kushner M, Kim S, Donahue C, Thuras P, Adson D, Kotlyar M . D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry. 2007; 62(8):835-8. DOI: 10.1016/j.biopsych.2006.12.020. View

Choi D, Rothbaum B, Gerardi M, Ressler K . Pharmacological enhancement of behavioral therapy: focus on posttraumatic stress disorder. Curr Top Behav Neurosci. 2011; 2:279-99. DOI: 10.1007/7854_2009_10. View

Jenike M . Clinical practice. Obsessive-compulsive disorder. N Engl J Med. 2004; 350(3):259-65. DOI: 10.1056/NEJMcp031002. View

10.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

11.

Goodman W, Price L, Rasmussen S, Mazure C, Fleischmann R, Hill C . The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989; 46(11):1006-11. DOI: 10.1001/archpsyc.1989.01810110048007. View

12.

Singer H, Morris C, Grados M . Glutamatergic modulatory therapy for Tourette syndrome. Med Hypotheses. 2009; 74(5):862-7. DOI: 10.1016/j.mehy.2009.11.028. View

13.

Onur O, Schlaepfer T, Kukolja J, Bauer A, Jeung H, Patin A . The N-methyl-D-aspartate receptor co-agonist D-cycloserine facilitates declarative learning and hippocampal activity in humans. Biol Psychiatry. 2010; 67(12):1205-11. DOI: 10.1016/j.biopsych.2010.01.022. View

14.

Amaral O, Roesler R . Targeting the NMDA receptor for fear-related disorders. Recent Pat CNS Drug Discov. 2008; 3(3):166-78. DOI: 10.2174/157488908786242470. View

15.

Davis M . Role of NMDA receptors and MAP kinase in the amygdala in extinction of fear: clinical implications for exposure therapy. Eur J Neurosci. 2002; 16(3):395-8. DOI: 10.1046/j.1460-9568.2002.02138.x. View

16.

Ressler K, Rothbaum B, Tannenbaum L, Anderson P, Graap K, Zimand E . Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. 2004; 61(11):1136-44. DOI: 10.1001/archpsyc.61.11.1136. View

17.

Walsh K, McDougle C . Psychotherapy and medication management strategies for obsessive-compulsive disorder. Neuropsychiatr Dis Treat. 2011; 7:485-94. PMC: 3173031. DOI: 10.2147/NDT.S13205. View

18.

Vloet T, Simons M, Herpertz-Dahlmann B . [Psychotherapeutic and pharmacological treatment of pediatric obsessive-compulsive disorder]. Z Kinder Jugendpsychiatr Psychother. 2011; 40(1):29-39. DOI: 10.1024/1422-4917/a000147. View

19.

Davis M, Ressler K, Rothbaum B, Richardson R . Effects of D-cycloserine on extinction: translation from preclinical to clinical work. Biol Psychiatry. 2006; 60(4):369-75. DOI: 10.1016/j.biopsych.2006.03.084. View

20.

Wilhelm S, Buhlmann U, Tolin D, Meunier S, Pearlson G, Reese H . Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder. Am J Psychiatry. 2008; 165(3):335-41. DOI: 10.1176/appi.ajp.2007.07050776. View