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Pharmacological interventions
Antidepressant use with d-Cycloserine may block fear extinction
  1. Angela Fang,
  2. Sabine Wilhelm
  1. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Sabine Wilhelm, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA; swilhelm{at}

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ABSTRACT FROM: Andersson E, Hedman E, Enander J, et al. d-Cycloserine vs placebo as adjunct to cognitive behavioral therapy for obsessive-compulsive disorder and interaction with antidepressants: a randomized clinical trial. JAMA Psychiatry 2015;72:659–67.

What is already known on this topic

d-Cycloserine (DCS) is a partial agonist at the N-methyl-d-aspartate receptor, which facilitates extinction learning in animal models and augments exposure therapy in humans with anxiety disorders and obsessive-compulsive disorder (OCD).1 In OCD, there have been other small randomised, placebo-controlled trials, in children and adults, examining DCS augmentation of exposure therapy, with inconsistent findings as to whether DCS is superior to placebo at post-treatment or follow-up.2–4 This study, which examined the efficacy of DCS augmentation of a validated internet-based cognitive–behavioural therapy (ICBT) for OCD, is the first large-scale trial on DCS augmentation of CBT for OCD, and contributes to a growing body of literature on the moderators of DCS efficacy, suggesting that DCS is not universally effective.

Methods of the study

Andersson and …

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  • Competing interests SW has received research support in the form of free medication and matching placebo from Forest Laboratories for the current clinical trial. SW is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programmes supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications and New Harbinger Publications from Oxford University Press. She has also received salary support from Novartis. SW has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette’s Syndrome Association. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as associate editor on the journal Depression and Anxiety.

  • Provenance and peer review Commissioned; internally peer reviewed.