A readily available anti-tuberculosis drug could also cure man's deepest, darkest phobias. Jo Revill reports
Sunday November 30, 2003
The Observer
For some, the fear can drive them out of their own home. Others have to avoid feathers, subways, glass lifts or city squares that are filled with pigeons.
Phobias appear in many shapes and forms, affecting at least a quarter of the population. But doctors believe that a cure may soon be on hand from the most unlikely quarter.
They have discovered that a drug on the market for tuberculosis helps phobics to overcome their worst fears within a week. They believe it could be the anti-phobia pill which scientists have been searching for.
Early results from trials have been greeted with some excitement. The medication, D-cycloserine, works alongside traditional talking therapy and speeds up the process through which sufferers can learn how to beat their irrational panic.
The chemical causes changes to the amygdala, the part of the brain involved in learning and memory. It involves a protein that appears to kick-start a chain of neuro chemical events that enable people to relearn what makes them scared.
'These results are very exciting,' said Michael Otto, professor of psychiatry at Harvard Medical School. 'They represent a new direction for combining medication and cognitive-behavioural approaches to psychotherapy.'
So far, the pill has been trialled in a study by Michael Davis at Emory University School of Medicine in Atlanta, Georgia. Davis took 30 acrophobics - people who are scared of heights - and put them in simulated glass lifts that appeared to go up and down. Those who had received the pill had dramatically reduced levels of fear compared with those who took a placebo.
All of them had received two sessions of psychotherapy. A small dose of D-cycloserine - 50mg - appeared as effective as the 500mg usually given to combat TB.
People with strong phobias usually receive some form of exposure therapy, where they are exposed to whatever it is that they fear, so that they can learn not to be afraid. But normally they need at least eight sessions of therapy before improvements are made, and it doesn't work for everyone.
Davis believes it could work in almost any situation where a person is very nervous, according to Chemistry and Industry magazine. 'It should help you get over whatever it is you are afraid of, as long as you face up to your fear.' Apart from phobias, it could also help people overcome their natural nervousness when learning new skills, such as snowboarding or riding.
The Atlanta team is now beginning a study looking at people with a fear of public speaking, and the Harvard group, led by Otto, is to examine whether the drug could help people who have a panic disorder, a very debilitating form of anxiety.
Theories have abounded over what phobias represent, with some speculating that they are an evolutionary throwback to a time when man had to be instinctively wary of poisonous animals or falling from a cliff.
There are three specific forms: agoraphobia, a fear of open spaces; social phobia, which affects relationships with other people; and specific phobia, dealing with particular stimuli such as spiders or birds.
Freud speculated that agoraphobics suffered because, as young children, they had feared being abandoned by unloving mothers. But modern theories suggest that it often occurs in people who tend to avoid situations that are painful or embarrassing.
The avoidance of danger is a common thread in many phobias, yet phobias about cars, which cause more death and injury than anything else, are unheard of. But inherently disgusting creatures, such as slugs and cockroaches, may relate to an innate avoidance of creatures that would be dangerous to eat, or that might be harmful. Some research suggests there is a genetic predisposition to phobias: identical twins who live apart can independently develop fears such as claustrophobia.
One of the most common is arachnophobia, but sufferers don't all take it
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