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D-cycloserine augmentation in behavioral therapy for obsessive-compulsive disorder: a meta-analysis

Authors Xia J, Du Y, Han J, Liu G, Wang X, Yu X

Received 7 June 2014

Accepted for publication 30 July 2014

Published 21 April 2015 Volume 2015:9 Pages 2101—2117

DOI https://doi.org/10.2147/DDDT.S68994

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Shu-Feng Zhou


Jing Xia,1 Yanqiu Du,2 Jiyang Han,1 Guo Liu,1 Xumei Wang1

1Department of Psychiatry, Shengjing Hospital of China Medical University, Heping District Shenyang, Liaoning, People’s Republic of China; 2Department of Medicine, Shenyang Ninth People’s Hospital, Tiexi District, Shenyang, Liaoning, People’s Republic of China

Objective: To evaluate the overall effect of D-cycloserine (DCS) augmentation on exposure and response prevention (ERP) therapy for obsessive-compulsive disorder (OCD).
Methods: Clinical studies on the effect of DCS augmentation on ERP therapy for OCD compared to placebo were included for meta analysis. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Meta-analyses were performed with a random-effect model or a fixed-effect model using the Cochrane Review Manager (RevMan, version 5.2) to calculate the odds ratio and the mean difference, with their corresponding 95% confidence intervals.
Results: A total of six studies was included in the current meta-analyses, and their data were extracted. Among them, four were for analyses of DCS and Y-BOCS at midtreatment, six for analysis at posttreatment, and four at 3-month follow-up. Besides, three of the six eligible studies were included in the meta-analysis of the DCS and Clinical Global Impression – Severity Scale at posttreatment, and three in the meta-analysis of DCS and proportions of treatment responders and of subjects attaining clinical remission status criteria at posttreatment. Our meta-analyses do not reveal a significant effect of DCS augmentation in ERP therapy for OCD patients, except when measured at midtreatment. Compared to the placebo group, DCS augmentation did show a trend toward significantly lower/decreased Y-BOCS; when measured at posttreatment and in the subpopulation of DCS taken before some of the ERP sessions, DCS augmentation showed a trend toward significantly lower/decreased Y-BOCS.
Conclusion: Our result suggested that with the careful optimization of DCS-augmented ERP therapy by fine-tuning timing and dosing of DCS administration and number and frequency of ERP sessions, DCS may enhance the efficacy of ERP therapy in reducing the symptomatic severity of OCD patients, especially at early stage of the treatment; therefore, DCS augmentation could possibly reduce treatment cost, reduce treatment drop and refusal rate, and help to improve access to the limited number of experienced therapists.

Keywords: D-cycloserine, obsessive-compulsive disorder, exposure and response prevention, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impression – Severity Scale (CGI-S)

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