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Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promise in decreasing fibromyalgia symptom severity. Emerging data suggest that adjunctive administration of the\n                    <jats:italic>N<\/jats:italic>\n                    -methyl-\n                    <jats:italic>D<\/jats:italic>\n                    -aspartate receptor partial agonist, D-Cycloserine, with rTMS can significantly improve clinical outcomes for other rTMS indications. Accordingly, this trial investigated adjunctive D-Cycloserine to intermittent Theta-Burst Stimulation (iTBS) of the dorsolateral prefrontal cortex (DLPFC) in adults with fibromyalgia. All participants received 20 daily (Monday-Friday) active iTBS treatments (600 pulses per session) delivered to the left DLPFC at 80% resting motor threshold, with double-blind, random assignment to adjunctive D-Cycloserine (100\u2009mg) or placebo, taken prior to each iTBS session. The primary outcome was change on the Fibromyalgia Impact Questionnaire \u2013 Revised (FIQR) from baseline to treatment end. Secondary outcomes included self-report and clinician-rated measures of fibromyalgia-associated symptoms and quantitative sensory testing. Following a planned interim analysis, the trial was terminated for futility at\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200947 participants. There was a very large overall treatment effect on the FIQR (Cohen\u2019s\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.41, 95% CI: 0.82\u20132.00) with no significant between-group difference. There was, however, a greater decrease in depressive symptoms in the iTBS+D-Cycloserine group compared to the iTBS+Placebo group. In conclusion, iTBS+\/-D-Cycloserine was associated with a large improvement in fibromyalgia symptom severity, while iTBS+D-Cycloserine was superior to iTBS+Placebo only for improvements in depressive symptoms. The large effect of iTBS on fibromyalgia symptoms may have masked specific effects of adjunctive D-Cycloserine. Trial Registration: NCT05395494.\n                  <\/jats:p>","DOI":"10.1038\/s41386-026-02441-y","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:08:18Z","timestamp":1779250098000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adjunctive D-cycloserine to intermittent theta-burst transcranial magnetic stimulation in fibromyalgia: a randomized placebo-controlled trial"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9722-6027","authenticated-orcid":false,"given":"Marilena M.","family":"DeMayo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandad","family":"Sharifi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald W.","family":"Zamponi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-9492","authenticated-orcid":false,"given":"Tuan","family":"Trang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-7075","authenticated-orcid":false,"given":"Ashley D.","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8425-3958","authenticated-orcid":false,"given":"Alexander","family":"McGirr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2441_CR1","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.amjmed.2009.09.006","volume":"122","author":"DJ Clauw","year":"2009","unstructured":"Clauw DJ. 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