Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder.
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).


METHODS
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.
Wilhelm
Sabine
S
Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. wilhelm@psych.mgh.harvard.edu
Buhlmann
Ulrike
U
Tolin
David F
DF
Meunier
Suzanne A
SA
Pearlson
Godfrey D
GD
Reese
Hannah E
HE
Cannistraro
Paul
P
Jenike
Michael A
MA
Rauch
Scott L
SL
D000328:Adult; D000818:Animals; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003523:Cycloserine / Q000494:pharmacology / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D010919:Placebos; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D051381:Rats; D016194:Receptors, N-Methyl-D-Aspartate / Q000819:agonists; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
D010919:Placebos; D016194:Receptors, N-Methyl-D-Aspartate; D003523:Cycloserine