Study Suggests Augmenting CBT With D-Cycloserine May Not Benefit Youth With OCD

Cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) is known to help patients with pediatric obsessive-compulsive disorder (OCD), but many remain symptomatic after receiving therapy. While some studies have suggested taking the NMDA partial agonist D-cycloserine before E/RP sessions may help to amplify CBT response, a study published yesterday in JAMA Psychiatry found D-cycloserine augmentation of CBT did not confer additional benefit relative to placebo among youth with OCD.

Eric Storch, Ph.D., of the University of South Florida and colleagues recruited 206 youth aged 7 to 17 with a primary diagnosis of OCD (including a score of at least 16 on the Children’s Yale-Brown Obsessive Compulsive Scale [CY-BOCS]) to receive 10 family-based CBT sessions over 8 weeks. After three initial CBT sessions, 142 youth were randomly assigned to take D-cycloserine (25 or 50 mg) or placebo 1 hour before weekly CBT sessions involving E/RP exercises. The CY-BOCS and Clinical Global Impressions–Severity (CGI-S) were administered at randomization, biweekly, midtreatment, and posttreatment.

The researchers found that the D-cycloserine plus CBT group and placebo plus CBT group declined at similar rates per assessment point on the CY-BOCS total score (−2.31 and −2.03, respectively) and CGI-S (−0.29 and −0.23, respectively). They also found no evidence to suggest concomitant antidepressant medication adversely moderated outcomes.

“The meaningful improvement demonstrated by an abbreviated family-based CBT course independent of D-cycloserine … highlights the importance of CBT dissemination,” the authors noted. “[B]ecause D-cycloserine does not universally enhance or expedite symptom reductions for youth with OCD, other safe and tolerable approaches to enhance fear extinction in E/RP should be explored.”

In a related editorial, Stefan Hofmann, Ph.D., of Boston University reflected on what the findings might mean for future studies considering D-cycloserine as an augmentation strategy.

For related information, see the Psychiatric News article “Antidepressants May Inhibit D-Cycloserine From Improving Symptoms in People With OCD.”

(Image: iStock/Izabela Habur)