Paroxetine , sertraline , citalopram , escitalopram , and clomipramine showed the most consistent results , while fluvoxamine , fluoxetine , and imipramine showed limited efficacy .
Preliminary results suggested the potential efficacy of inositol ; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy .
No studies have been specifically oriented toward evaluating the effect of drugs on AG ; in the available studies , the improvement of AG might have been the consequence of the reduction of panic attacks .
BACKGROUND Although there are controversial issues ( the " American view " and the " European view " ) regarding the construct and definition of agoraphobia ( AG ) , this syndrome is well recognized and it is a burden in the lives of millions of people worldwide .
To better clarify the role of drug therapy in AG , the authors summarized and discussed recent evidence on pharmacological treatments , based on clinical trials available from 2000 , with the aim of highlighting pharmacotherapies that may improve this complex syndrome .
Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear.
BACKGROUND Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities . However , some disorders , particularly the anxiety-related disorders exemplified by specific phobia , have an emotional learning component to them that can be facilitated with psychotherapy . OBJECTIVE To determine whether D-cycloserine ( DCS ) , a partial agonist at the N-methyl-d-aspartate receptor that has previously been shown to improve extinction of fear in rodents , will also improve extinction of fear in human phobic patients undergoing behavioral exposure therapy . DESIGN R and omized , double-blind , placebo-controlled trial examining DCS vs placebo treatment in combination with a precisely controlled exposure paradigm . SETTING Participants were recruited from the general community to a research clinic . PARTICIPANTS Twenty-eight subjects with acrophobia diagnosed by the Structured Clinical Interview for DSM-IV were enrolled . INTERVENTIONS After we obtained pretreatment measures of fear , subjects were treated with 2 sessions of behavioral exposure therapy using virtual reality exposure to heights within a virtual glass elevator . Single doses of placebo or DCS were taken prior to each of the 2 sessions of virtual reality exposure therapy . Subjects , therapists , and assessors were blind to the treatment condition . Subjects returned at 1 week and 3 months posttreatment for measures to determine the presence and severity of acrophobia symptoms . MAIN OUTCOME MEASURES Included were measures of acrophobia within the virtual environment , measures of acrophobia in the real world , and general measures of overall improvement . An objective measure of fear , electrodermal skin fluctuation , was also included during the virtual exposure to heights . Symptoms were assessed by self-report and by independent assessors at approximately 1 week and 3 months posttreatment . RESULTS Exposure therapy combined with DCS result ed in significantly larger reductions of acrophobia symptoms on all main outcome measures . Subjects receiving DCS had significantly more improvement compared with subjects receiving placebo within the virtual environment ( 1 week after treatment , P</=.001 ; 3 months later , P</=.05 ) . Subjects receiving DCS also showed significantly greater decreases in posttreatment skin conductance fluctuations during the virtual exposure ( P</=.05 ) . Additionally , subjects receiving DCS had significantly greater improvement compared with subjects receiving placebo on general measures of real-world acrophobia symptoms ( acrophobia avoidance [ P</=.02 ] , acrophobia anxiety [ P</=.01 ] , attitudes toward heights [ P</=.04 ] , clinical global improvement [ P</=.01 ] , and number of self-exposures to real-world heights [ P</=.01 ] ) ; the improvement was evident early in treatment and was maintained at 3 months . CONCLUSION These pilot data provide initial support for the use of acute dosing of DCS as an adjunct to exposure-based psychotherapy to accelerate the associative learning processes that contribute to correcting psychopathology
Paroxetine , sertraline , citalopram , escitalopram , and clomipramine showed the most consistent results , while fluvoxamine , fluoxetine , and imipramine showed limited efficacy .
Preliminary results suggested the potential efficacy of inositol ; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy .
No studies have been specifically oriented toward evaluating the effect of drugs on AG ; in the available studies , the improvement of AG might have been the consequence of the reduction of panic attacks .
BACKGROUND Although there are controversial issues ( the " American view " and the " European view " ) regarding the construct and definition of agoraphobia ( AG ) , this syndrome is well recognized and it is a burden in the lives of millions of people worldwide .
To better clarify the role of drug therapy in AG , the authors summarized and discussed recent evidence on pharmacological treatments , based on clinical trials available from 2000 , with the aim of highlighting pharmacotherapies that may improve this complex syndrome .