D-cycloserine may improve behavioral therapy treatment for anxiety

Anxiety is a normal human response to stress, but in some, it can develop into a disabling disorder of excessive and irrational fears, such as obsessive-compulsive disorder, panic disorder, or posttraumatic stress disorder. Effective treatments are available and can involve either behavioral therapy or medications. Although “it makes intuitive sense that combining these two treatments would result in even better results,” David Tolin, Ph.D. notes that has unfortunately not yet been the case and the majority of the evidence suggests that combined therapy is no more effective than behavior therapy alone, and in some cases can even be less effective. However, Dr. Tolin is one of the three authors on a meta-analysis scheduled for publication on June 15th in Biological Psychiatry, in which they evaluated a potentially important new treatment paradigm for anxiety.

Dr. Tolin explains the impetus behind their analysis: “Recently, several researchers have tried a radically different approach: instead of just throwing two effective monotherapies at the problem, they have instead looked at medications that specifically target the biological mechanisms that make psychotherapy work in the first place.” John H. Krystal, M.D., Editor of Biological Psychiatry and another of the study’s authors, adds that “there has now been a sufficient amount of research in this area to take a step back to look at the basic research conducted in animals and the initial clinical trials.”

This research effort has involved the addition of D-cycloserine, an old drug long approved by the U.S. Food and Drug Administration for the treatment of tuberculosis, to exposure-based fear treatment in animals and humans. The meta-analysis, a pooling of the published literature on this approach, provides evidence that D-cycloserine enhances the learning process in the brain, indicating that, unlike many other medications, it may improve the effectiveness of behavioral therapy.

There is a caveat, however, as the authors also discovered that tolerance may develop to this effect. Dr. Krystal comments that, if so, “it may be best used before therapy sessions to ‘warm up the brain’ and make it more responsive to the treatment sessions rather than as a daily treatment.”

Dr. Tolin makes an additional, important observation regarding this line of work: “Another very exciting aspect of this work is that it’s one of the few really good examples of translational research in psychiatry: taking basic science from the laboratory, in this case animal studies, and translating that research into useful interventions for humans.” Although additional research is clearly necessitated, this confirmation of the effectiveness of D-cycloserine is a positive step forward in improving treatments for individuals suffering with anxiety disorders.

###

Notes to Editors:

The article is “A Meta-Analysis of D-Cycloserine and the Facilitation of Fear Extinction and Exposure Therapy” by Melissa M. Norberg, John H. Krystal and David F. Tolin. Drs. Norberg and Tolin are affiliated with The Institute of Living in Hartford, Connecticut. Dr. Tolin, along with Dr. Krystal, is also affiliated with Yale University School of Medicine, New Haven, Connecticut. Dr. Krystal is also with the VA Connecticut Healthcare System. The article appears in Biological Psychiatry, Volume 63, Issue 12 (June 15, 2008), published by Elsevier.

Contact Jayne M. Dawkins at (215) 239-3674 or .(JavaScript must be enabled to view this email address) to obtain a copy or to schedule an interview.

About Biological Psychiatry
This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

Biological Psychiatry is ranked 4th out of the 95 Psychiatry titles and 16th out of 199 Neurosciences titles on the 2006 ISI Journal Citations Reports® published by Thomson Scientific.

About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier’s 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect, MD Consult, Scopus, bibliographic databases, and online reference works.

Elsevier is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc, a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier’s ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).