Efficacy of D-cycloserine augmented brief intensive cognitive-behavioural therapy for paediatric obsessive-compulsive disorder: a randomised clinical trial

Lara J. Farrell*, Allison M. Waters, Evelin Tiralongo, Sharna Mathieu, Matthew McKenzie, Vinay Garbharran, Robert S. Ware, Melanie J. Zimmer-Gembeck, Harry McConnell, Cassie Lavell, Jacinda Cadman, Thomas H. Ollendick, Jennifer L. Hudson, Ronald M. Rapee, Brett McDermott, Daniel Geller, Eric A. Storch

*Corresponding author for this work

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Abstract

Objective: To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods: Youth (n = 100, 7–17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results: Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: −11.2 to −7.4, and estimate −10.7, 95% CI: −12.6 to −8.7), diagnostic severity (T1 to T2 estimate: −2.0, 95% CI: −2.4 to −1.5 and estimate −2.5, 95% CI: −3.0 to −2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions: DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample.

Original languageEnglish
Pages (from-to)461-473
Number of pages13
JournalDepression and Anxiety
Volume39
Issue number6
Early online date27 Jan 2022
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • cognitive‐behaviour therapy
  • D‐cycloserine
  • exposure therapy
  • OCD

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