Is the antibiotic(Seromycin) usefull for social anxiety?

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13 Sep 2007, 10:22 am

A few people have mentioned treatment options for social
anxiety yesturday/today. So that inspired me to read a little
on it. I came across D-cycloserine. Its an antibiotic used
to treat tuberculosis. Sold under the brand name Seromycin®
in the US (in 250 mg capsules usually I think).

Some studies have shown it may aid in fear extinction. A
low dose is taken (50-100 mg) before one tries exposure
therapy (basically confronting the fear producing situation in a
slow but increasing intensity over time). Seems to help some people with social anxiety disorder. I seen a study in the works
that plans to test LFA's chronically with 100-500mg. My on personally observation is exposure therapy may not be
particularly effective for a person that has some major social cognitive problems (people on the autism spectrum perhaps).
If I can find an online sources for Seromycin I will experiment
with it and report my results.

Quote:

1: Arch Gen Psychiatry. 2006 Mar;63(3):298-304.
Links
Augmentation of exposure therapy with D-cycloserine for social anxiety disorder.
Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, Shiekh M, Otto MW.

Department of Psychology and Center for Anxiety and Related Disorders, Boston University, Boston, MA 02215, USA.

CONTEXT: Social anxiety disorder (SAD) is common and debilitating. Although exposure therapy is one of the most effective forms of psychotherapy for this disorder, many patients remain symptomatic. Fear reduction in exposure therapy is similar to extinction learning, and early clinical data with specific phobias suggest that the treatment effects of exposure therapy for SAD may be enhanced with d-cycloserine, an agonist at the glutamatergic N-methyl-d-aspartate receptor. OBJECTIVE: To determine whether short-term treatment with 50 mg of d-cycloserine enhances the efficacy of exposure therapy for SAD. DESIGN: Randomized, double-blind, placebo-controlled augmentation trial examining the combination of d-cycloserine or pill placebo with exposure therapy for SAD. SETTING: Patients were self-referred from the general community to 1 of 3 research clinics. PARTICIPANTS: Twenty-seven participants meeting DSM-IV criteria for SAD with significant public speaking anxiety. INTERVENTIONS: Following a diagnostic interview and pretreatment assessment, participants received 5 therapy sessions delivered in either an individual or group therapy format. The first session provided an introduction to the treatment model and was followed by 4 sessions emphasizing exposure to increasingly challenging public speech situations with videotaped feedback of performances. One hour prior to each session, participants received single doses of d-cycloserine or placebo. MAIN OUTCOME MEASURES: Symptoms were assessed by patient self-report and by clinicians blind to the randomization condition before treatment, after treatment, and 1 month after the last session. RESULTS: Participants receiving d-cycloserine in addition to exposure therapy reported significantly less social anxiety compared with patients receiving exposure therapy plus placebo. Controlled effect sizes were in the medium to large range. CONCLUSION: The pilot data provide preliminary support for the use of short-term dosing of d-cycloserine as an adjunctive intervention to exposure therapy for SAD.

PMID: 16520435 [PubMed - indexed for MEDLINE]

Quote:

1: CNS Drug Rev. 2006 Fall-Winter;12(3-4):208-17.
Links
Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine.
Hofmann SG, Pollack MH, Otto MW.

Department of Psychology, Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts 02215, USA. shofmann@bu.edu

Anxiety disorders are among the most common mental disorders. One of the most effective strategies to treat anxiety disorders is exposure therapy with or without cognitive intervention. Fear reduction in exposure therapy is similar to extinction learning. Preclinical studies suggest that extinction learning can be blocked by antagonists at the glutamatergic N-methyl-D-aspartate (NMDA) receptor, and facilitated with D-cycloserine (DCS), a partial agonist at the glycine recognition site of the NMDA receptor in the amygdala. DCS is an established antibiotic drug for the chronic treatment of tuberculosis in humans, but has only recently been investigated as an augmentation therapy for psychological treatment procedures. The review of the literature provides preliminary support for the use of acute dosing of DCS as an adjunctive intervention to exposure therapy for anxiety disorders, including specific phobia and social anxiety disorder. Negative results have recently been reported in the treatment of subclinical fears of animals. These studies suggest that DCS needs to be administered on an acute rather than a chronic dosing schedule, include sufficient time for memory consolidation, and be administered together with psychological treatment that leaves sufficient room for further improvement. It remains to be seen whether these highly promising findings represent reliable pharmacological strategies to enhance exposure therapy of anxiety disorders.

PMID: 17227287 [PubMed - indexed for MEDLINE

fresco
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13 Sep 2007, 10:30 am

Sounds interesting, yes I don't think exposure really works for AS I'm sure my fear response is hard wired. With an antibiotic would the body become resistant to it over time?

TheMachine1
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13 Sep 2007, 10:44 am

fresco wrote:

Sounds interesting, yes I don't think exposure really works for AS I'm sure my fear response is hard wired. With an antibiotic would the body become resistant to it over time?

Antibiotic resistances is an evolutionary adaptation a bacteria makes. For non-anti-microbial use the word "resistant" really
does not apply. Though certainly any drug can become less effective over time. The drug is used short term in the studies. Though presumably it has lasting effects. Its sort of a
non-drug treatment. A person takes it merely to improve their results to CBT and exposure therapy. Then they do not take it
after therapy. Plus its not a mind altering drug in the sense of a drug such as an antidepressant. It would be more like aspirin.

monty
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13 Sep 2007, 11:27 am

At first read, it looks like seromycin works on the NMDA/glutamate receptors - probably not limited to that, but lots of the recent studies seem to be checking on that. One substance with similar effects is theanine, an unusual amino acid from tea. Some studies show it can reduce anxiety somewhat, increasing alpha-wave activity in the brain.

Dunno if you've seen this one, but magnesium potentiates the activity of cycloserine.

Quote:

Pharmacol Biochem Behav. 2007 Aug 10; [Epub ahead of print]Click here to read Links
NMDA/glutamate mechanism of antidepressant-like action of magnesium in forced swim test in mice.
Poleszak E, Wlaź P, Kędzierska E, Nieoczym D, Wróbel A, Fidecka S, Pilc A, Nowak G.

Department of Pharmacology and Pharmacodynamics, Skubiszewski Medical University of Lublin, Staszica 4, PL 20-081 Lublin, Poland.

Antidepressant-like activity of magnesium in forced swim test (FST) was demonstrated previously. Also, enhancement of such activity by joint administration of magnesium and antidepressants was shown. However, the mechanism(s) involved in such activity remain to be established. In the present study we examined the involvement of NMDA/glutamate pathway in the magnesium activity in FST in mice. In the present study we investigated the effect of NMDA agonists on magnesium-induced activity in FST and the influence of NMDA antagonists with sub-effective doses of magnesium in this test. Magnesium-induced antidepressant-like activity was antagonized by N-methyl-d-aspartic acid (NMDA). Moreover, low, ineffective doses of NMDA antagonists (CGP 37849, L-701,324, d-cycloserine, and MK-801) administered together with low and ineffective doses of magnesium exhibit significant reduction of immobility time in FST. The active in FST doses of examined agents did not alter the locomotor activity (with an exception of increased activity induced by MK-801). The present study indicates the involvement of NMDA/glutamate pathway in the antidepressant-like activity of magnesium in mouse FST and further suggests antidepressant properties of magnesium.

Whatcha think of the amino acid GABA for anxiety?

TheMachine1
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13 Sep 2007, 11:39 am

monty wrote:

Whatcha think of the amino acid GABA for anxiety?

I took a formula that had it 10 years ago.

http://en.wikipedia.org/wiki/Ghb#Endogenous_production_by_the_body

According to wikipedia it can not cross the blood brain barrier. So presumably a small amount of GABA is converted to GHB in the body yeilding its limited anti-anxitey effect. Or an excess of
GABA might prevent the bodies own GHB production from being converetd to GABA.

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13 Sep 2007, 11:58 am

Can't most of the Mycin antibiotics cause high-frequency hearing loss when used long term though?

monty
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13 Sep 2007, 12:02 pm

I found GABA helped mostly with somatic symptoms (heart rate, blood pressure) which is consistent with the 'can't get into the brain' idea. But some claim that orally it can have effects on the brainwaves:

Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans.

monty
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13 Sep 2007, 12:05 pm

LostInSpace wrote:

Can't most of the Mycin antibiotics cause high-frequency hearing loss when used long term though?

Chemically, cycloserine does not look anything like the other "-mycins" - I think it is a name based on one activity that humans have discovered for it. The true mycins are aminoglycosides, I don't think seromycin is, but I am a bit rusty on some of my chemistry.

Here is Neomycin (if wikipedia allows image serving)

Here is Streptomycin

Here is cycloserine.

Some studies suggest that cycloserine works by being able to cross the BBB and then convert to serine, which modulates brain activity. Not sure what other amino acids might boost serine in the brain. I went back on 5-htp to boost my serotonin levels yesterday. Very nice.

Selective increase in the extracellular D-serine contents by D-cycloserine in the rat medial frontal cortex.

Last edited by monty on 13 Sep 2007, 12:27 pm, edited 3 times in total.

TheMachine1
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13 Sep 2007, 12:18 pm

monty wrote:

LostInSpace wrote:

Can't most of the Mycin antibiotics cause high-frequency hearing loss when used long term though?

Chemically, cycloserine does not look anything like the other "-mycins" - I think it is a name based on one activity that humans have discovered for it.

Here is Neomycin (if wikipedia allows image serving)

Here is cycloserine.

One of the studies underway with D-cycloserine did mention it would not allow any one with hearing loss in the study. But again its being used at 1/10 to 1/5 the dose it would be used at for TB. Plus its being used short term in the studies.

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13 Sep 2007, 3:56 pm

Keep us posted on this if you try it.

Sedaka
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13 Sep 2007, 4:03 pm

so is this the one case where it's recommended to take antibiotics for extended periods? indefinitely? i dont see how that's a good thing

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maccer
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13 Sep 2007, 6:26 pm

I think its ridiculous that they are trying to come up with drugs to treat or help aspies. First of all its not a disease, its a more or less condition. depending on how your see it and feeding an aspie with drugs isnt gonna stop them being an aspie, so its pointless. If it aint broke why fix it. My point is why do we have to fit in with the NTs, why cant the NTs fit in with us???

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13 Sep 2007, 6:57 pm

Sedaka wrote:

so is this the one case where it's recommended to take antibiotics for extended periods? indefinitely? i dont see how that's a good thing

No, there were some studies where cycloserine combined with cognitive behavioral therapy can improve the extinction of phobias. Using it when undergoing the therapy for a day or two led to long term reduction in the fears.

It is not just trying to zap AS - it is specifically for certain anxiety/phobia behaviours.

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13 Sep 2007, 7:55 pm

My NT husband participated in a study a few years ago involving this drug. They were looking at its effectiveness in quelling phobic reactions (possibly permanently) after just a few doses, and he was part of a fear-of-flying group that was referred for the study. Turns out he received the placebo, but those who received the drug said it worked great!

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13 Sep 2007, 9:02 pm

maccer wrote:

It's not a drug to cure AS. It's a drug to help excessive anxiety, which *is* a disorder.

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13 Sep 2007, 9:36 pm

maccer wrote:

Social anxiety is not part of the DSM-IV criteria for aspergers
either. So seeking treatment for it is no different than seeking treatment for a headache.

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