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of distress and functional impairment. Diagnostic criteria for PTSD include a history of exposure to a traumatic event leading to intense fear and symptoms from each of 3 symptom clusters: intrusive recollections (cluster B), avoidance/numbing (cluster C), and hyperarousal (cluster D). 1 Recent data estimate lifetime PTSD prevalence to be 10.9%, 2 with up to 40% having a chronic form that is prolonged, may be unremitting, and is subject to reactivation upon exposure to stressors. 3 Treatment of PTSD is often complicated by the presence of comorbid anxiety, mood, and substance use disorders as well as somatic diseases. 4,5 Recent scientific advances have elucidated the neurobiology of PTSD, which includes a complex, multifaceted interplay of changes or differences in neuroendocrine systems, brain structure and function, and physiologic reactivity. 5 Pharmacotherapeutic treatment of PTSD has been substantiated by few placebo-controlled trials, with open

Background: Topiramate can improve drinking outcomes via a hypothesized mechanism of facilitating ␥aminobutyric acid function and inhibiting glutaminergic pathways in the corticomesolimbic system. We sought to determine whether topiramate's antidrinking effects are bolstered by improvements in physical and psychosocial well-being.Methods: In a 17-site, 14-week, double-blind, randomized controlled trial, we compared the effects of topiramate (up to 300 mg/d) vs placebo on physical health, obsessional thoughts and compulsions about using alcohol, and psychosocial well-being among 371 alcoholdependent subjects who received weekly adherence enhancement therapy.Results: Topiramate was more efficacious than placebo in reducing body mass index (calculated as weight in kilograms divided by height in meters squared) (mean difference, 1.08; 95% confidence interval [CI], 0.81-1.34; PϽ.001), all liver enzyme levels (PϽ.01 for all comparisons), plasma cholesterol level (mean difference, 13.30 mg/dL; 95% CI, 5.09-21.44 mg/dL; P = .002), and sys-Author Affiliations are listed at the end of this article. Group Information: The members of the Topiramate for Alcoholism Advisory Board and the Topiramate for Alcoholism Study Group are listed on page 1198.

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