Augmentation of Behavior Therapy With d -Cycloserine for Obsessive-Compulsive Disorder

• Published in: The American journal of psychiatry 2008-03, Vol.165 (3), p.335-341
• Main Authors: Wilhelm, Sabine, Buhlmann, Ulrike, Tolin, David F., Meunier, Suzanne A., Pearlson, Godfrey D., Reese, Hannah E., Cannistraro, Paul, Jenike, Michael A., Rauch, Scott L.
• Format: Article
• Language: English
• Subjects: Adult; Animals; Associated treatments; Behavior; Behavior Therapy - methods; Behavior therapy. Cognitive therapy; Biological and medical sciences; Combined Modality Therapy; Cycloserine - pharmacology; Cycloserine - therapeutic use; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Female; Follow-Up Studies; Humans; Implosive Therapy - methods; Medical sciences; Mental depression; Neuropharmacology; Neuroses; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - drug therapy; Obsessive-Compulsive Disorder - therapy; Pharmacology. Drug treatments; Placebos; Psychiatric Status Rating Scales - statistics & numerical data; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Rats; Receptors, N-Methyl-D-Aspartate - agonists; Secondary Prevention; Severity of Illness Index; Studies; Therapy; Treatment Outcome; Treatments
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2007.07050776

Objective: This study examined whether d -cycloserine, a partial agonist at the N -methyl- d -aspartate (NMDA) glutamatergic receptor, enhances the efficacy of behavior therapy for obsessive-compulsive disorder (OCD). Method: A randomized, double-blind, placebo-controlled trial investigating d -cycloserine versus placebo augmentation of behavior therapy was conducted in 23 OCD patients. Patients first underwent a diagnostic interview and pretreatment evaluation, followed by a psychoeducational treatment planning session. Then they received 10 behavior therapy sessions. Treatment sessions were conducted twice per week. One hour before each of the behavior therapy sessions, the participants received either d -cycloserine, 100 mg, or a placebo. Results: Relative to the placebo group, the d -cycloserine group's OCD symptoms were significantly more improved at mid-treatment, and the d -cycloserine group's depressive symptoms were significantly more improved at posttreatment. Conclusions: These data provide support for the use of d -cycloserine as an augmentation of behavior therapy for OCD and extend findings in animals and other human disorders suggesting that behavior therapy acts by way of long-term potentiation of glutamatergic pathways and that the effects of behavior therapy are potentiated by an NMDA agonist.