Randomized placebo-controlled D-cycloserine with cognitive behavior therapy for
pediatric posttraumatic stress.
Author(s): Scheeringa MS(1), Weems CF.
Affiliation(s): Author information:
(1)1 Department of Psychiatry and Behavioral Sciences, Tulane University School
of Medicine , New Orleans, Louisiana.
Publication date & source: 2014, J Child Adolesc Psychopharmacol. , 24(2):69-77
Abstract Objective: Research on D-cycloserine (DCS), a partial
N-methyl-d-aspartic acid (NMDA) agonist, has suggested that it may enhance
exposure-based therapies for anxiety disorders. RESULTS with DCS in adult
posttraumatic stress disorder (PTSD) have been conflicting; however, no data have
been reported on children with PTSD. Although many individuals with PTSD respond
to exposure-based cognitive behavioral therapy (CBT), there are subgroups of
individuals who are nonresponders, and many responders still have substantial
residual symptoms. This randomized, triple-blind, placebo-controlled study tested
DCS as an adjunct to CBT to improve and speed treatment response for PTSD in
youth.METHODS: Seven to 18 year-old youth with exposure to trauma and PTSD were
offered a 12 session, manualized CBT treatment. Those who remained in treatment
at the fifth session were randomly allocated (n=57) to either CBT and DCS or CBT
and placebo.
RESULTS: Youth in the CBT and DCS group had significant reductions in symptoms,
but these reductions were not greater than those in the CBT and placebo group.
There was a trend toward DCS speeding PTSD symptom recovery during the
exposure-based sessions, and evidence that the CBT and DCS group better
maintained stability of gains on inattention ratings from posttreatment to the 3
month follow-up.
CONCLUSIONS: This initial study of CBT and DCS to treat pediatric PTSD provided
suggestive and preliminary evidence for more rapid symptom recovery and
beneficial effects on attention, but did not show an overall greater effect for
reducing PTSD symptoms. It appears that augmentation with DCS represents unique
challenges in PTSD. Because PTSD involves complex, life-threatening trauma
memories, as opposed to the imagined dreadful outcomes of other anxiety
disorders, the use of DCS may require greater attention to how its use is coupled
with exposure-based techniques. DCS may have inadvertently enhanced
reconsolidation of trauma memories rather than more positive and adaptive
memories. In addition, the results suggest that future research could focus on
the longer-term benefits of DCS on attention and ways to capitalize on
attention-enhancing therapies. ClinicalTrials.gov registry: Effect of
D-cycloserine on Treatment of Posttraumatic Stress Disorder (PTSD) in Youth,
#NCT01157416,
http://clinicaltrials.gov/ct2/results?term=NCT01157416&Search=Search , and
D-cycloserine Adjunctive Treatment for Posttraumatic Stress Disorder (PTSD) in
Adolescents, #NCT01157429,
http://clinicaltrials.gov/ct2/results?term=NCT01157429&Search=Search .
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