More threads by David Baxter PhD

David Baxter PhD

Late Founder
A Pill That Helps Ease Grip of Irrational Fears
March 22, 2005
By ANAHAD O'CONNOR, New York Times

For many psychiatric disorders, drug therapy has become the norm. But phobias - irrational fears that can paralyze and disrupt people's lives - have been largely resistant to chemical intervention, and behavioral therapies have remained the treatment of choice.

Recently, however, a tuberculosis drug with surprising effects on the brain has given psychiatrists hope that a new approach to phobias and other severe anxiety disorders may be in the offing.

The drug, D-cycloserine, an antibiotic, does nothing to soothe panic or calm nerves. Instead, it increases learning and memory, and may help people overcome their fears faster in psychotherapy, which can be costly and take years.

In November, researchers at Emory found that people who combined the drug with behavioral treatment to conquer their fear of heights improved drastically after only two sessions, instead of the usual eight. Elsewhere, researchers are studying its effects on social phobia, panic disorder and obsessive-compulsive disorder. And a group at Columbia is exploring whether the drug may help people grappling with anorexia nervosa.

"Treating anxiety with Valium or antidepressants works on the symptoms, but doesn't really get rid of the fear except to cover it up in the moment," said Dr. Michael Davis, a psychiatrist at Emory who was involved in the study on heights, published in The Archives of General Psychiatry. "Psychotherapy is really the best way to treat these disorders, and this makes it better and faster."

For panic disorder, phobias and other severe anxiety disorders, psychiatrists often rely on a specific type of treatment called exposure therapy, in which patients gradually learn to feel comfortable in situations they dread.

Studies have shown that a glutamate receptor in the amygdala, a part of the brain that governs emotion, plays a role in learning to adjust to threatening stimuli. Since D-cycloserine is known to act on these receptors, Dr. Davis, who has applied for a patent on the concept of using the drug to enhance learning during psychotherapy, decided to test whether it might accelerate the breaking of people's fearful associations, a process called extinction.

For the study, his team assembled a group of 28 people so terrified of heights that they refused to park in multilevel garages or would go out of their way to book rooms on the lower floors of hotels.

They all took part in sessions involving a virtual reality program that simulates rides in a glass elevator. Some received a dose of D-cycloserine beforehand, others were given a placebo.

After two sessions, people who were given the medication had almost fully recovered and showed fewer symptoms of anxiety than those in the placebo group.

"The people who had the drug were also more likely to report crossing bridges and going to the tops of buildings in their daily lives," said Dr. Kerry Ressler, an assistant professor of psychiatry and behavioral sciences at Emory and an author of the study.

Early results were released in 2003. Since then, 10 other teams around the world have been testing the drug on a vast lineup of disorders treated with psychotherapy.

Anorexia nervosa, a disorder with high relapse rates and few medications, is one of them. Because D-cycloserine specifically affects learning, not anxiety per se, psychiatrists suspect it may help anorexic patients unlearn their negative perceptions of food.

"We're approaching some of the disturbed eating behavior as though it were phobic," said Dr. Timothy Walsh, a professor of psychiatry at Columbia and the director of eating disorders research at the New York State Psychiatric Institute.

Dr. Walsh is leading a study in which anorexic patients, aided by a therapist, are given D-cycloserine and trained to overcome their anxiety about food. He said the first results would be known in the summer.
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