Topiramate as Monotherapy or Adjunctive Treatment for Posttraumatic Stress Disorder: A Meta‐Analysis

Abstract

Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition for which clinicians sometimes turn to anticonvulsants as a treatment for symptoms. This study was a systematic review and meta-analysis of randomized controlled trials (RCT) that have assessed the efficacy of topiramate as monotherapy or adjunctive therapy, compared to placebo, for the treatment of PTSD in adults. Prescribers may be reluctant to turn to topiramate, given the commonly reported side effects of impaired cognition, sedation, fatigue, and headache. We searched PubMed, PsycInfo, and Cochrane Central databases for relevant trials. Five studies were identified as RCTs and thus met inclusion criteria; one additional nonpublished study was identified via phone contact with its authors. Of these six studies, one was excluded from the statistical meta-analysis due to its high dropout rate (16 of 40 participants). One of these studies was excluded from a stratified analysis of symptom types because this subscale data were unavailable. For overall symptomatology, topiramate showed a medium, but not significant effect, standardized mean difference (SMD) = 0.55, p = .082. Topiramate showed a small and significant reduction of hyperarousal symptoms, SMD = 0.35, 95% CI [0.029, 0.689], p = .033. Topiramate did not significantly reduce reexperiencing symptoms, SMD = 0.29, 95% CI [-0.019, 0.597], p = .067, or avoidance symptoms, SMD = 0.20, 95% CI [-0.105, 0.509], p = .198. Results did not differ significantly between veteran and nonveteran subjects, or between topiramate as monotherapy and adjunctive therapy. Further studies on topiramate will clarify its role in PTSD treatment.

Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review

“…The drugs evaluated in this systematic review are as follows: atypical antipsychotics [11], bupropion [12], cannabinoids [13], divalproex [14], fluoxetine [15], ganaxolone [16], ketamine [17], paroxetine [18], prazosin [19], pregabalin [20], propranolol [21], quetiapine [22], rivastigmine [23], sertraline [24 -26], tiagabine [27], topiramate [28] and venlafaxine [29,30].…”

Topiramate for Posttraumatic Symptoms in an Obese Adolescent Girl

“…Trauma in early life has been associated with long-term consequences, such as the development of PTSD, disability, and premature mortality, including increased risk for death by suicide (de Moraes Costa et al 2020). Although selective serotonin reuptake inhibitors are Food and Drug Administration (FDA)-approved for treatment of trauma-and stressorrelated disorder, their questionable efficacy and known adverse effect of weight gain did not make them ideal options for D. (Varma et al 2018). The risk of activation is also well known, and youth with significant impulsivity, aggression, and irritability may be at risk for worsening impairment when treated with them (Luft et al 2018).…”

“…In the most recent meta-analysis comparing medications for adults with PTSD, topiramate was found to be the most effective treatment, and the authors highlighted its beneficial effect of weight loss and lack of abuse potential (de Moraes Costa et al 2020). Most importantly, it has been found to have a significant specific effect in reducing hyperarousal symptoms in PTSD (Varma et al 2018).…”

Post-Traumatic Stress Disorder as Pressing Issues of Our Time

“…Однак клінічне застосування антиконвульсантів (ламотриджин, вальпроат, топірамат) при ПТСР показало суперечливі результати. Зокрема топірамат зменшував вираженість симптомів занурення та уникнення [52], у 40% пацієнтів препарат викликав побічні ефекти, що призводять до його скасування [53]. Вальпроат краще діяв на симптоми емоційної нестабільності, збудливості, дисфорії, агресивності та імпульсивності [54], проте у ветеранів воєн різниці із застосуванням плацебо виявлено не було [55].…”