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June 4, 2012 Rhiannon Bugno, Editorial Office PTSD Psychotherapy is Enhanced with D-Cycloserine
Reports new study in Biological Psychiatry

Philadelphia, PA, June 4, 2012 – Posttraumatic stress disorder (PTSD) is among the most
common, distressing, and disabling medical consequences of combat or other extremely stressful life
events. The first-line treatment for PTSD is exposure therapy, a type of behavioral therapy where
patients confront their fears in a safe environment. Although it is an effective treatment, many patients
still experience symptoms after treatment and there is a relatively high drop-out rate.
In an effort to improve existing treatments, a new study appearing in Biological Psychiatry this week
has tested a novel hypothesis about the treatment of PTSD derived from prior work in animal models
and other anxiety disorders. They examined whether the impact of psychotherapy could be enhanced
by administering D-cycloserine (DCS), a drug that does not directly treat the symptoms of PTSD, but
rather promotes neuroplasticity, i.e., makes brain circuits better able to remodel themselves in the
context of experience.
To test this, researchers recruited individuals with PTSD, all of whom received up to 10 weekly
sessions of exposure therapy. They were randomized to receive doses of either DCS or placebo
before each session, but did not know which they were receiving. The severity of their symptoms was
assessed before and after treatment.
All patients experienced a reduction in symptoms due to the exposure therapy, regardless of whether
they had received DCS augmentation or placebo. However, DCS did enhance the effects of exposure
therapy in a specific subgroup of patients. Those who had more severe PTSD prior to treatment and
needed longer treatment had a greater reduction in symptoms when they received DCS, compared to
those who received placebo.
“Our study showed that some PTSD patients respond well and fast to exposure and for them, there
seems no need to augment the therapy. In contrast, those patients with severe PTSD symptoms and
who fail to respond to exposure sessions may benefit from augmentation with DCS,” explained first
author Dr. Rianne de Kleine. “It seems that DCS is beneficial for exactly those patients we aimed for:
the more severe patients who do not respond to first-line treatment.”
“This approach may have important implications for the treatment of PTSD. Two decades of brain
research suggests that severe psychological stress causes atrophy of some of the fine connections in
the brain and reductions in the volume of brain regions involved in emotion and memory. Thus,
individuals with PTSD may have deficits in neuroplasticity that get in the way of effective treatment,”
commented Dr. John Krystal, Editor of Biological Psychiatry. “D-cycloserine may reduce this deficit in
neuroplasticity and increase the response to psychotherapy, in this case a psychotherapy approach
that involves exposing people to reminders and memories of the trauma.”
The authors conclude that additional work is warranted to explore whether this combination can
become an effective intervention to treat the symptoms of PTSD.
The article is “A Randomized Placebo-Controlled Trial of D-Cycloserine to Enhance Exposure Therapy
for Posttraumatic Stress Disorder” by Rianne A. de Kleine, Gert-Jan Hendriks, Wendy J.C. Kusters,
Theo G. Broekman, and Agnes van Minnen (doi: 10.1016/j.biopsych.2012.02.033). The article
appears in Biological Psychiatry, Volume 71, Issue 11 (June 1, 2012), published by Elsevier.
Notes for editors
Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at
+1 214 648 0880 orJournalists wishing to interview the authors may
contact Rianne de Kleine at +31 248200802 or
The authors’ affiliations, and disclosures of financial and conflicts of interests are available in the
article.
John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of
Medicine and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of
financial and conflicts of interests are availabl

About Biological Psychiatry
is the official journal of t whose purpose is to
promote excellence in scientific research and education in fields that investigate the nature, causes,
mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission,
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major psychiatric disorders.
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Media contact
Rhiannon Bugno
Editorial Office, Biological Psychiatry
+1 214 648 0880

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