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Panic Attacks, Anxiety, and D-cycloserine: Thinking Outside of the Box

“Necessity is the mother of invention.” Always works for me. It seems as though it works for psychiatric research, as well. And that’s a good thing because I’ve become frustrated and puzzled by the lack of research and treatment attention panic disorder, all of the anxiety disorders for that matter, receives.

Panic, and the anxiety disorders, so often take a back seat, especially to the mood disorders. And that’s odd given the fact that the anxiety disorders are the most prevalent of the mind variances, and so many anxiety sufferers have a comorbid mood disorder.

Stepping off my soapbox, here’s some very creative thinking that gives me renewed confidence and hope. Using meds and psychotherapy as a punch combo to combat a mind variance isn’t anything new. For example, a panic disorder sufferer participating in cognitive behavioral therapy (CBT) gets referred to a psychiatrist and begins taking a selective serotonin reuptake inhibitor (SSRI). Happens all the time, though not always efficacious.

But, what if there was a more creative boxing strategy? What if instead of meds and therapy working as a jab/cross combo, they teamed to become one massive knockout punch? Well, tune-in because this is cool.

D-cycloserine is an antibiotic that’s best known as a back-up treatment for tuberculosis. But, go figure, it’s shown efficacy in the treatment of phobias. And it’s also provided relief when used in augmentation with psychotherapy in the treatment of depression, obsessive-compulsive disorder, and even schizophrenia. Well, it seems you may be able to add panic disorder to that list, especially within the context of exposure work in cognitive behavioral therapy (CBT).

So how does an antibiotic provide relief for panic? Well, one of the characteristics of D-cycloserine is that of a partial agonist of a receptor for glutamate. Glutamate is the most abundant excitatory neurotransmitter in mammals, and an agonist is a manufactured or naturally-occurring drug that triggers neural neuron. The impact of glutamate is thought to be based in sensory-related fear extinction in the amygdala. Of course, the amygdala is our emotion/fear headquarters.

So if you really think about it, the D-cycloserine work is really a matter of enhancing a learning process. And it would then make perfect sense that a dosage of D-cycloserine would be administered one-hour prior to a CBT session. Isn’t that wild? It’s like a pre-game warm-up for the brain.

Though, to my knowledge, use of D-cycloserine hasn’t gone beyond the lab, it’s really very exciting and offers a lot of hope for many reasons. First and foremost, there’s every reason to believe the treatment can provide relief. And, secondly, it’s proof that some very creative thinking is occurring in the world of psychiatric research. It’s like a football coach revising offensive and defensive strategy, as well as the game plan, because he knows his player talent level is low.

“Necessity is the mother of invention.” Thank goodness for thought outside of the box.