Dutch Test D-cycloserine To Improve PTSD Outcomes

While psychotherapy, including exposure therapy, is the common treatment for PTSD, it is not always effective. In a recent study, Dutch researchers examined whether that treatment could be improved by administering D-cycloserine (DCS) to promote neuroplasticity.¹

Supplementary use of DCS, a partial agonist at the glutamatergic N-methyl-D-aspartate receptor, has shown promise in enhancing treatment effects in other anxiety disorders.

For the study, published in the journal Biological Psychiatry, researchers from Radboud University Nijmegen, Behavioural Science Institute, NijCare, the Netherlands, recruited 67 mixed trauma patients, recruited from regular referrals, with a primary PTSD diagnosis satisfying DSM-IV criteria. Participants received up to 10 weekly sessions of exposure therapy.

In the randomized, double-blind, placebo-controlled trial, 50 mg DCS or placebo was administered one hour before each session of exposure therapy. Although DCS did not enhance overall treatment effects, participants who received DCS showed stronger treatment response, the authors reported.

“Exploratory session-by-session analyses revealed that DCS yielded higher symptom reduction in those participants that had more severe pretreatment PTSD and needed longer treatment,” they added.

“Our study showed that some PTSD patients respond well and fast to exposure. And, for them, there seems no need to augment the therapy. In contrast, those patients with severe PTSD symptoms and who fail to respond to exposure sessions may benefit from augmentation with DCS,” explained first author Dr. Rianne de Kleine. “It seems that DCS is beneficial for exactly those patients we aimed for: the more severe patients who do not respond to first-line treatment.”

“This approach may have important implications for the treatment of PTSD,” added John H. Krystal, MD, Biological Psychiatry editor, the Robert L. McNeil Jr. Professor of Translational Research and chair of the Department of Psychiatry at the Yale University School of Medicine, New Haven, CT. “Two decades of brain research suggests that severe psychological stress causes atrophy of some of the fine connections in the brain and reductions in the volume of brain regions involved in emotion and memory. Thus, individuals with PTSD may have deficits in neuroplasticity that get in the way of effective treatment.

“D-cycloserine may reduce this deficit in neuroplasticity and increase the response to psychotherapy, in this case a psychotherapy approach that involves exposing people to reminders and memories of the trauma,” he said.1: de Kleine RA, Hendriks GJ, Kusters WJ, Broekman TG, van Minnen A. A Randomized Placebo-Controlled Trial of d-Cycloserine to Enhance Exposure Therapy for Posttraumatic Stress Disorder. Biol Psychiatry. 2012 Jun 1;71(11):962-8. Epub 2012 Apr 4. PubMed PMID: 22480663

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