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D-cycloserine augmentation of behavior therapy for anxiety and
obsessive-compulsive disorders: A meta-analysis
#MMPMID28282427
Bürkner PC
; Bittner N
; Holling H
; Buhlmann U
PLoS One
2017[]; 12
(3
): e0173660
PMID28282427
show ga
OBJECTIVE: The present meta-analysis investigates whether the antibiotic
D-cycloserine (DCS), a partial agonist at the glutamatergic N-methyl-D-aspartate
receptor, can augment the effect of behavior therapy in humans with anxiety and
obsessive-compulsive disorders. METHOD: A keyword-based computer search was
conducted using common electronic databases. Only studies investigating the
effect of DCS in humans with anxiety and obsessive-compulsive disorders were
included, resulting in 23 studies with a combined sample size of 1314 patients.
Effect sizes were coded as Hedges' g and SMCC, the latter also incorporating
differences in pre-treatment values. Bayesian multilevel meta-analysis was
applied to take dependencies of effect sizes obtained from the same study into
account. RESULTS: While previous meta-analyses found small to moderate
improvements, the current results including the most recent research indicate
that the overall effect of DCS is very small and almost indistinguishable from
zero (g = -0.12, CI = [-0.27, 0.02]; SMCC = -0.10, CI = [-0.29, 0.07]). Slightly
larger effects were found for social anxious patients. Further, study quality and
year of publication were relevant moderators, with higher quality / more recent
studies reported smaller effects of DCS. CONCLUSIONS: These findings raise the
question of the usefulness of DCS as an augmentation of exposure therapy for
anxiety and obsessive-compulsive disorders. At least, it seems to be less
promising than initially thought. The fact that study quality was inversely
related to the reported effect sizes underlines the importance of high quality
primary research in order to avoid over-estimation of treatment effects in
clinical psychology.