The Use of D-Cycloserine to Augment CBT for Pediatric OCD
Status:
Unknown status
Trial end date:
2014-07-01
Target enrollment:
Participant gender:
Summary
Pediatric obsessive compulsive disorder (OCD) is a relatively common and often severe
condition that can become chronic if untreated. One of the most effective treatments for OCD
is a type of cognitive behavioral therapy called exposure and response prevention (ERP). ERP
involves presenting a patient with feared objects or situations (the content of their
obsessional fears) in a gradual manner while helping them use coping techniques to refrain
from engaging in rituals (compulsions). Despite several studies suggesting that ERP is an
effective treatment for pediatric OCD, many youngsters fail to respond to this treatment, or
respond only partially.
An exciting recent finding from animal research is the ability of an established antibiotic
(traditionally used to treat Tuberculosis), D-cycloserine (trade name: Seromycin) to enhance
certain types of learning among rats. The type of learning that is enhanced is called
extinction learning and many researchers believe that extinction learning is the equivalent
process to what occurs during ERP; it is the process whereby repeated exposure to the object
of fear without any bad outcome causes the object to cease being associated with danger.
Several clinical trials using ERP and other forms of exposure treatment for adults with
anxiety disorders reproduced this finding from the animal literature; pairing DCS with
exposure treatment (comparable to extinction learning) resulted in greater fear reduction
than when no DCS was administered. The effects of DCS on exposure treatment for anxiety
disorders among children has been tested only preliminarily in one study of children with OCD
and results were unclear with children who received DCS augmentation showing non-significant
but increased levels of improvement as compared with children who did not receive DCS
augmentation.
In this study, 26 youngsters ages 7-17 with a primary diagnosis of OCD will be recruited and
assigned at random to one of the two treatment conditions. Youth in the DCS condition of the
study will receive 50 mg DCS 1 hr prior to each treatment session, while youth in the placebo
condition receive an identical placebo capsule 1 hr prior to each treatment augmentation
session. All participants will receive 180 minutes of CBT for OCD 4 days per week for 2 weeks
during their study participation (as included in IOP already). All families complete a
thorough evaluation no more than 5 days prior to receiving DCS on their 9th treatment visit
in IOP (third week), and at mid-treatment augmentation (after the 12th IOP treatment
session), post-treatment augmentation (after the 16th IOP treatment session), and 3-month
follow-up (12 weeks after the 16th IOP treatment session). The primary aim of this study is
to obtain preliminary data comparing the effects of the acute administration of DCS versus
placebo on symptom response to exposure treatment for pediatric OCD. Results from this study
will help to inform and refine future studies, and eventually, impact treatments for
pediatric OCD.