In a clinical trial, veterans taking topiramate alongside prolonged exposure therapy experienced greater improvements in posttraumatic stress disorder (PTSD) symptoms than those receiving exposure therapy alone. However, adding topiramate—used off-label to treat alcohol use disorder (AUD)—did not reduce heavy drinking more than prolonged exposure did by itself.
The trial results were published in the American Journal of Psychiatry.
Sonya Norman, Ph.D., of the University of California, San Diego School of Medicine, and colleagues enrolled 100 veterans (84 male, average age 45) with full or sub-threshold PTSD and co-occurring AUD. The participants were randomized to receive daily topiramate (up to 250 mg) or placebo pills and asked to attend 12 prolonged exposure sessions across 16 weeks. PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
At 16 weeks, veterans in both groups dramatically reduced their number of heavy drinking days and improved their number of days abstinent, though there were no differences between the topiramate and placebo groups. Likewise, there were no differences between groups in secondary outcomes like depression symptoms and quality of life scores.
However, the average CAPS-5 score in the group receiving prolonged exposure and topiramate dropped from 36.72 to 20.83, compared with a drop from 38.60 to 29.87 in the group receiving prolonged exposure and placebo—a significant difference. Overall, 61% of veterans taking topiramate experienced a clinically meaningful change in their symptoms (defined as at least a 12-point improvement in CAPS-5 score), versus 28% of veterans in the placebo group.
At three- and six-month follow-up visits, there was no longer a difference in CAPS-5 scores between the treatment groups, though both groups were still well below baseline.
“While [prolonged exposure] can have lasting effects, with continued recovery up to 10 years following treatment, the actions of topiramate may be such that its efficacy is greatest when patients are actively taking the medication,” Norman and colleagues wrote. “Future studies should examine whether more prolonged topiramate treatment leads to continued greater benefit in PTSD symptoms and perhaps downstream benefits on alcohol use.”
For related information, see the Psychiatric News article “Virtual Exposure Therapy Found Effective for PTSD.”
(Image: Getty Images/iStock/SDI Productions)
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