D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders
Year: 2017
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.
Source: JAMA Psychiatry
Authors: David Mataix-Cols, Lorena Fernández de la Cruz, Benedetta Monzani, David Rosenfield, Erik Andersson, Ana Pérez-Vigil, Paolo Frumento, Rianne A. de Kleine, JoAnn Difede, Boadie W. Dunlop, Lara J. Farrell, Daniel Geller, Maryrose Gerardi, Adam J. Guastella, Stefan G. Hofmann, Gert-Jan Hendriks, Matt G. Kushner, Francis S. Lee, Eric J. Lenze, Cheri A. Levinson, Harry McConnell, Michael W. Otto, Jens Plag, Mark H. Pollack, Kerry J. Ressler, Thomas L. Rodebaugh, Barbara O. Rothbaum, Michael S. Scheeringa, Anja Siewert-Siegmund, Jasper A. J. Smits, Eric A. Storch, Andreas Ströhle, Candyce D. Tart, David F. Tolin, Agnes van Minnen, Allison M. Waters, Carl F. Weems, Sabine Wilhelm, Katarzyna Wyka, Michael Davis, Christian Rück, Margaret Altemus, Page Anderson, Judith Cukor, Claudia Finck, Gary R. Geffken, Fabian Golfels, Wayne K. Goodman, Cassidy Gutner, Isobel Heyman, Tanja Jovanovic, Adam B. Lewin, Joseph P. McNamara, Tanya K. Murphy, Seth Norrholm, Paul Thuras
Institutions: Region Stockholm, Karolinska Institutet, Stockholm Health Care Services, King's College London, Southern Methodist University, Radboud University Nijmegen, Weill Cornell Medicine, Emory University, Griffith University, Harvard University, Massachusetts General Hospital, The University of Sydney, Boston University, University of Minnesota, Washington University in St. Louis, University of Louisville, Stiftung Charité, Charité - Universitätsmedizin Berlin, Rush University Medical Center, McLean Hospital, Tulane University, The University of Texas at Austin, University of South Florida, New Mexico VA Health Care System, Yale University, Iowa State University, City University of New York, CUNY Graduate School of Public Health and Health Policy, Georgia State University, University of Florida Health, University of Florida, Icahn School of Medicine at Mount Sinai, Great Ormond Street Hospital, University College London, Minneapolis VA Health Care System
Language: English
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2581718547