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A Controlled Trial of Topiramate Treatment for Alcohol Dependence in Veterans with PTSD

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Technical Report

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Northern California Institute for Research and Education San Francisco United States

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Alcohol use disorders AUDs and PTSD commonly co-occur, complicate assessment and treatment, and worsen clinical outcomes in veterans with both conditions. AUDs are potential consequences of PTSD, as many veterans may use alcohol in an attempt to self-medicate or ameliorate PTSD symptoms such as hyperarousal or emotional numbing. AUDs may also be a risk factor for the development of PTSD and may exacerbate PTSD symptom severity and impairment. Treatment for co-occurring PTSD and alcohol dependence among veterans is challenging. To date there has been little research to develop pharmacotherapies that would, ideally, reduce both alcohol use and PTSD symptom severity in patients with both of these conditions. Topiramate is one of the few medications for alcohol dependence that has also been separately tested as a potential medication to treat PTSD. Topiramates efficacy in alcohol dependence in patients without PTSD has been shown in two recent large controlled trials. Open trials have suggested that topiramate may be effective in reducing PTSD symptoms in patients without AUDs, and a number of small controlled trials have also produced promising results. The PI recently completed the first pilot clinical trial of topiramate treatment in veterans with both alcohol dependence and PTSD, and preliminary analyses demonstrate feasibility, safety, tolerability, and efficacy in reducing alcohol use. Results also provide support for testing topiramates potential efficacy in reducing PTSD symptoms.

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