Randomized placebo-controlled D-cycloserine with cognitive behavior therapy for pediatric posttraumatic stress

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• D-cycloserine (DCS), an N-methyl-d-aspartate (NMDA) agonist, has shown potential in enhancing exposure-based therapies for anxiety disorders.
• Previous research on DCS for adult PTSD yielded conflicting results, with no studies on pediatric PTSD.
• Cognitive behavioral therapy (CBT) is effective for PTSD, but some individuals do not respond or have residual symptoms.

Purpose of the Study:

• To investigate the efficacy of DCS as an adjunct to CBT in improving and accelerating treatment response for PTSD in youth.
• To assess whether DCS augmentation speeds up symptom reduction and enhances long-term outcomes in pediatric PTSD.

Main Methods:

• A randomized, triple-blind, placebo-controlled study involving 57 youth aged 7-18 with trauma exposure and PTSD.
• Participants received 12 sessions of manualized CBT, with random allocation to either CBT plus DCS or CBT plus placebo from the fifth session onwards.

Main Results:

• Both CBT and DCS groups showed significant symptom reductions, with no statistically significant difference between them.
• A trend suggested that DCS might accelerate PTSD symptom recovery during exposure therapy sessions.
• The CBT and DCS group demonstrated better maintenance of gains in inattention ratings from posttreatment to 3-month follow-up.

Conclusions:

• This study provides preliminary evidence that augmenting CBT with DCS in pediatric PTSD may offer benefits in terms of faster symptom recovery and improved attention.
• However, DCS did not demonstrate an overall superior effect in reducing PTSD symptoms compared to placebo.
• Further research is needed to explore the optimal use of DCS in PTSD treatment, considering the complex nature of trauma memories and potential effects on memory reconsolidation, and to investigate its longer-term benefits on attention.