Citation

Difede J, Cukor J, Wyka K, Olden M, Hoffman H, Lee FS, Altemus M. Neuropsychopharmacology 2014; 39(5): 1052-1058.

Affiliation

1] Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA [2] NewYork-Presbyterian Hospital, New York, NY, USA.

Copyright

(Copyright © 2014, Nature Publishing Group)

DOI

10.1038/npp.2013.317

PMID

24217129

Abstract

Viewing PTSD as a disorder of emotional learning, this study used a cognitive-enhancer synergistically with virtual reality exposure therapy (VRE) for the treatment of PTSD. The main objective was to determine if a novel pharmacotherapy, D-cycloserine (DCS), enhanced the efficacy of the psychotherapy. Pre-clinical studies suggest that when fear extinction occurs during DCS administration, neuroplasticity may be enhanced. VRE therapy is a particularly promising format to test the hypothesis that DCS enhances extinction learning, as sensory fear cues are standardized across patients. In a pilot randomized, double-blind, placebo controlled trial, 100 mg of DCS or placebo was administered 90 min before each weekly VRE session, to ensure peak plasma concentrations during the sessions, in 25 patients with chronic PTSD. The primary outcome measure was the Clinician Administered PTSD Scale (CAPS). Secondary outcome measures included the Beck Depression Inventory-II and the State-Trait Anger Expression Inventory-2. Assessments occurred at: pretreatment, following sessions 3, 6, 10, posttreatment, and at six-months. The difference in CAPS between the VRE-DCS (n=13) and VRE-placebo (n=12) groups increased over time beginning at six weeks, with medium to large between-group effect sizes immediately posttreatment and six months later (d=0.68 and d=1.13, respectively). A similar pattern was observed for depression, anger expression, and sleep. PTSD remission rates were significantly greater for the VRE-DCS group (46% vs 8% at posttreatment; 69% vs 17% at six-months). Patients in the VRE-DCS group showed earlier and greater improvement in PTSD symptoms compared to the VRE-placebo group. These results suggest a promising new treatment for PTSD.Neuropsychopharmacology accepted article preview online, 12 November 2013. doi:10.1038/npp.2013.317.

Language: en