D-cycloserine (DCS) enhancement of exposure therapy in panic disorder with agoraphobia: a randomized controlled trial (WC2010-085)

Background

Starting date: 01/10/2010
Panic Disorder + Agoraphobia (PD+AGO) is an anxiety disorder that is among the most prevalent disorders in mental health care. Currently, a form of behaviour therapy (exposure therapy, ET) is the treatment of choice, either alone or in combination with serotonin reuptake inhibitors (SSRI’s). Although ET has proven to result in symptom reduction in about 60% of patients, a significant number of individuals fail to respond sufficiently to treatment. Procedurally, exposure is based on extinction of conditioned fear. Recent work in rodents and humans has demonstrated that acute treatment with D-Cycloserine (DCS), a partial agonist of the N-Methyl-D-aspartate (NMDA)-receptor, enhances the learning and memory processes underlying extinction of fear. It is of great interest to study whether addition of DCS to exposure therapy in patients with anxiety disorders leads to improvement of treatment effect, speed of therapy effect and/ or, as a consequence, diminished costs. In obsessive compulsive disorder (OCD), the first clinical studies performed so-far strongly suggest that DCS, administered either within 1 hour before or directly after exposure therapy, enhances the effect of the therapy in the first 5-6 sessions. In panic disorder –the “model” anxiety disorder-, DCS has barely been investigated, but first results of enhancement with DCS of interoceptive exposure to panic sensations suggest enhanced treatment effect and higher remission rates in patients. This study aims at extending current knowledge about the enhancing effects of DCS in panic disorder with agoraphobia.