Topiramate (Topamax) is a medication that, while originally intended for use as a seizure treatment, now sometimes plays a role in the treatment of alcohol use disorder (alcoholism and/or alcohol abuse). Significant numbers of the people affected by this disorder also have diagnosable cases of the mental health condition PTSD (post-traumatic stress disorder). In a study published in August 2014 in the journal Alcoholism: Clinical & Experimental Research, an American research team used a small-scale project to evaluate the effectiveness of topiramate in individuals simultaneously impacted by alcohol use disorder and PTSD.
Topiramate is an anticonvulsant or anti-seizure medication that first saw use as a treatment for some of the problems associated with the seizure disorder epilepsy. The medication has also been previously used as a preventive measure in people affected by recurring migraine headaches. When used in both of these contexts, topiramate apparently produces its benefits by reducing excessive or unusual patterns of electrical activity inside the brain. The U.S. Food and Drug Administration has not approved the medication as a treatment for people dealing with alcohol use disorder. However, research and real-world clinical experience have shown that topiramate can help at least some affected individuals by rebalancing the levels of two key brain chemicals, reducing the urge to drink and reducing the amount of alcohol consumed.
PTSD and Alcohol Problems
Post-traumatic stress disorder appears in substantial minorities of men and women who get exposed to situations that threaten their lives, threaten the lives of others or appear to present a genuine deadly threat. Symptoms of the condition include an inability to stop mentally/emotionally reliving a traumatic event, a compelling urge to stay away from circumstances that trigger memories of a traumatic event, an increase in negative states of mind and loss of control over the body’s “fight-or-flight” response. By definition, these symptoms must first arise or continue to produce their effects 30 days or longer after the original traumatic episode.
Even before their trauma exposure, people who eventually develop PTSD are unusually likely to feel the effects of alcohol abuse or alcoholism, the National Center for PTSD reports. In addition, individuals not previously affected by alcohol problems are substantially more likely to develop such problems after they develop the symptoms of PTSD. Alcohol abuse, alcoholism and other substance-related issues appear relatively frequently in people whose PTSD trauma exposure involved acts of sexual abuse. Acts of violence also frequently function as the underlying traumatic event for PTSD-affected individuals who develop alcohol use disorder.
Can Topiramate Help?
In the study published in Alcoholism: Clinical & Experimental Research, researchers from the Department of Veterans Affairs, the Northern California Institute for Research and Education and UC San Francisco used a pilot project involving 30 adults to gauge the usefulness of topiramate in people simultaneously affected by alcohol use disorder and PTSD. All of these individuals were military veterans who had previously received a diagnosis for both conditions. Half of them received adjusted doses of topiramate every day for three months; the remaining study participants received a placebo. The researchers assessed the effectiveness of the two treatment approaches through four outcomes: the amount of alcohol consumed by treated individuals, the frequency of alcohol use, the level of craving for continued drinking and the relative intensity of each individual’s PTSD symptoms.
The researchers concluded that the three-month course of topiramate substantially reduced the treated participants’ frequency of drinking, level of alcohol intake and severity of continued alcohol cravings. They also concluded that the same basic set of benefits still applied when they directly compared the results of the medication recipients to the results of the participants who received a placebo instead of topiramate. In addition, the researchers concluded that, compared to placebo treatment, treatment with topiramate led to a meaningful reduction in the severity of PTSD symptoms, especially symptoms related to the overactivation of the body’s fight-or-flight response.
The study’s authors note that the topiramate recipients experienced short-term problems with their memory and learning functions that typically improved considerably before the three-month treatment period came to an end. Overall, they believe the findings of their pilot project indicate that use of topiramate may provide unique benefits for people simultaneously affected by alcohol use disorder and post-traumatic stress disorder. Like the results of all pilot projects, these findings require further verification in larger population groups.