From the Guidelines
Cycloserine is not recommended as a standard treatment for specific phobias. The most recent and highest quality study, 1, published in 2020, provides a clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders, including specific phobias. According to this guideline, cognitive-behavioral therapy (CBT) with exposure techniques is the first-line treatment for specific phobias, without medication augmentation. While cycloserine has been studied as a potential adjunct to exposure therapy for anxiety disorders, the evidence for its effectiveness in specific phobia treatment remains limited and inconsistent.
Some key points to consider when evaluating the use of cycloserine for specific phobias include:
- The primary treatment for specific phobias is CBT with exposure techniques, as recommended by 1 and 1.
- Cycloserine is primarily an antibiotic used to treat tuberculosis, but it also acts as an NMDA receptor partial agonist that may enhance learning and memory processes involved in fear extinction.
- Potential side effects of cycloserine include headache, dizziness, confusion, and in rare cases, seizures or psychosis.
- If medication is needed to facilitate treatment engagement, short-term benzodiazepines or beta-blockers may be considered for situational use, though these also have limitations.
It's also important to note that the diagnosis and treatment of specific phobias should be based on a comprehensive assessment of the individual's symptoms, medical history, and other factors, as outlined in 1. The use of cycloserine for specific phobias is not supported by the current evidence, and clinicians should exercise caution when considering its use in clinical practice.
From the Research
Use of Cycloserine in Specific Phobia
- The use of D-cycloserine (DCS) as an adjunct to exposure therapy for anxiety disorders, including specific phobia, has been investigated in several studies 2, 3, 4.
- A meta-analysis found that DCS enhances exposure therapy in the treatment of anxiety disorders, including specific phobia, by facilitating the extinction of fear 2.
- The efficacy of DCS in augmenting exposure therapy for specific phobia has been demonstrated in studies using a randomized, double-blind, placebo-controlled design 2, 4.
- The optimal dosing schedule for DCS in the treatment of specific phobia appears to be acute rather than chronic, with administration timed to coincide with exposure therapy sessions 4, 5.
- The use of DCS as an adjunct to cognitive behavioral therapy (CBT) for social anxiety disorder has also been investigated, with studies suggesting that tailored post-session DCS administration may be more effective than untailored administration 5.
- Clinical perspectives on the combination of DCS and CBT for the treatment of anxiety disorders, including specific phobia, suggest that this approach may offer advantages over traditional combination-treatment strategies 6.
Key Findings
- DCS enhances exposure therapy in the treatment of anxiety disorders, including specific phobia 2.
- Acute dosing of DCS is more effective than chronic dosing in augmenting exposure therapy for specific phobia 4.
- Tailored post-session DCS administration may be more effective than untailored administration in the treatment of social anxiety disorder 5.
- The use of DCS as an adjunct to CBT for anxiety disorders, including specific phobia, may offer advantages over traditional combination-treatment strategies 6.