d -Cycloserine Augmentation for Behavioral Therapy

• Published in: The American journal of psychiatry Vol. 165; no. 8; p. 1050
• Main Authors: SHIM, SEONG S., HAMMONDS, MICHAEL D., VRABEL, MATTHEW M.
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.08.2008
• Subjects: Alzheimer's disease; Antimetabolites - pharmacology; Antimetabolites - therapeutic use; Cognitive Therapy - methods; Combined Modality Therapy; Cycloserine - pharmacology; Cycloserine - therapeutic use; Glycine - antagonists & inhibitors; Health psychology; Humans; Neuroses; Obsessive-Compulsive Disorder - drug therapy; Obsessive-Compulsive Disorder - therapy; Schizophrenia; Therapy
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2008.08030455

Since the NMDA receptor is crucial in the domains of learning and memory, the Wilhelm et al. study sought to enhance the learning that occurs during behavioral therapy sessions by potentiating the NMDA receptor via stimulation of the glycine site using D-cycloserine. D-Cycloserine is effective in stimulating the glycine site only within the narrow range of low doses (50-125 mg daily [1,2]), acting as a partial glycine agonist. At higher doses, D-cycloserine does not show efficacy (3) and can exacerbate schizophrenia symptoms (4), since D-cycloserine blocks full activation of the glycine site at these doses, acting as a full glycine antagonist. In contrast, full agonists such as glycine and D-serine stimulate the glycine site more potently and improve learning and memory more effectively within the high-dose range, as shown in their efficacy in the treatment of cognitive symptoms in schizophrenia (4). Thus, full glycine agonists are likely to be more effective and safer relative to D-cycloserine in augmenting behavioral therapy for the treatment of OCD.