Enhancing exposure therapy for PTSD using d-cycloserine

Abstract

There are several effective treatment approaches for posttraumatic stress disorder (PTSD). These include pharmacotherapy, psychotherapy, and a multitude of augmentation strategies which seek to combine different medications and therapy to enhance treatment efficacy. There are some data to support pharmacotherapy as an effective form of treatment for PTSD (Stein, Ipser, and Seedat, Cochrane Database Syst Rev 25:CD002795, 2006). However, exposure therapy (ET) is the only treatment with sufficient empirical evidence to be recommended by the Institute of Medicine (IOM, Treatment of posttraumatic stress disorder: An assessment of the evidence. The National Academies Press, Washington, DC, 2008). Still, due to the avoidant nature of PTSD, ET does not work for everyone. This chapter investigates different augmentation strategies which include adding an antipsychotic medication to the ongoing SSRI pharmacotherapy, adding an SSRI to cognitive behavioral therapy (CBT), and finally, adding a medication called d-Cycloserine (DCS) acutely during ET. Dcs has been shown to enhance the extinction of fear in rodents (Walker, Ressler, Lu, and Davis, The Journal of Neuroscience, 22(6), 2343–2351, 2002) as well as during ET for humans for a number of anxiety disorders (Ressler et al., Archives of General Psychiatry, 61(11), 1136–1144, 2004; Otto et al., Biological Psychiatry, 67(4), 365–370, 2010). Its effect on PTSD, however, is largely unknown. Along with reviewing the literature on DCS, this chapter introduces a number of studies currently underway investigating the effect of DCS on ET for PTSD.