Topiramate in Combat-Related Posttraumatic Stress Disorder

Alderman, Christopher P; McCarthy, Linda; Condon, John T.; Marwood, Anita C; Fuller, Judith R

doi:10.1345/aph.1l578

Cited by 45 publications

(24 citation statements)

References 23 publications

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“…While case series suggested that adjunctive topiramate [1026,1027,1029] may be effective in treatment-resistant PTSD, a RCT failed to show superiority over placebo [1028] (Level 2, negative).…”

Section: Posttraumatic Stress Disordermentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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Section: Posttraumatic Stress Disordermentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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“…Topiramate has shown partial effectiveness in reducing PTSD symptoms in patients without AUD in three open trials (Berlant and van Kammen, 2002, Berlant, 2004, Alderman et al, 2009) and three small-to-medium sized controlled trials (Lindley et al, 2007, Tucker et al, 2007, Yeh et al, 2011). In a placebo-controlled trial in veterans, topiramate treatment was associated with greater improvement in PTSD re-experiencing symptoms when used to augment standard PTSD pharmacotherapy, although with more adverse effects and higher dropout (Lindley et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…There have been no controlled trials of topiramate to examine its effects in reducing alcohol consumption and PTSD symptom severity in patients with co-occurring AUD and PTSD, although a small open trial of topiramate in male combat veterans with PTSD showed a reduction in PTSD symptoms and a decrease in the proportion of patients with high-risk drinking (defined as >43 drinks/week) (Alderman et al, 2009). We therefore conducted a randomized, placebo-controlled pilot trial to provide a preliminary assessment of the efficacy, and safety of topiramate during a 12-week course of treatment in 30 veterans with PTSD and AUD whose treatment goals were to reduce and possibly stop alcohol consumption.…”

Section: Introductionmentioning

confidence: 99%

Topiramate Treatment of Alcohol Use Disorder in Veterans with Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial

Batki

Pennington

Lasher

et al. 2014

Alcoholism Clin & Exp Res

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Background The course of posttraumatic stress disorder (PTSD) is frequently and severely complicated by co-occurring alcohol use disorder (AUD), yet there are few reports of pharmacologic treatments for these co-morbid conditions. The objective of this pilot study was to obtain a preliminary assessment of the efficacy and safety of topiramate in reducing alcohol use and PTSD symptoms in veterans with both disorders. Methods This was a prospective 12-week, randomized, double-blind, placebo-controlled pilot trial of flexible-dose topiramate up to 300mg/day in 30 veterans with PTSD and AUD. The primary outcome measure was frequency of drinking. Secondary outcomes consisted of other measures of alcohol use and PTSD symptom severity. Results Within-group analyses showed that topiramate treatment was associated with significant reductions in frequency and amount of alcohol use and alcohol craving from baseline through week 12. Between-group analyses showed that topiramate reduced frequency of alcohol use and alcohol craving significantly more than placebo and tended to reduce drinking amount. Topiramate treatment was also associated with decreased PTSD symptom severity and tended to reduce hyperarousal symptoms compared to placebo. Topiramate transiently impaired learning and memory, with significant recovery by the end of treatment. Conclusions These preliminary results indicate that in veterans with co-occurring PTSD and AUD, topiramate may be effective in reducing alcohol consumption, alcohol craving, and PTSD symptom severity – particularly hyperarousal symptoms.. Topiramate was associated with transient cognitive impairment but was otherwise well tolerated.

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“…Other promising pharmacotherapies of comorbid PTSD and SUD include, for instance, quetiapine, an antipsychotic medication (Monnelly et al 2004) and topiramate, an antiseizure medication (Alderman et al 2009), but the safety and efficacy of these medications for the treatment of posttraumatic stress disorders and SUD need to be tested in controlled clinical trials.…”

Section: Pharmacotherapymentioning

confidence: 99%

Posttraumatic Stress Disorders and Addiction

Schäfer

Langeland²

2014

Co-Occurring Addictive and Psychiatric Disorders

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Topiramate in Combat-Related Posttraumatic Stress Disorder

Abstract: When used in addition to other empiric therapy, topiramate may be effective at reducing general symptoms of combat-related PTSD and reducing high-risk alcohol intake and nightmares. Further randomized controlled trials of topiramate for the treatment of combat-related PTSD are warranted.

Cited by 45 publications

References 23 publications

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Topiramate Treatment of Alcohol Use Disorder in Veterans with Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial

Posttraumatic Stress Disorders and Addiction

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