Prolonged exposure plus topiramate helps lower PTSD symptoms

A prolonged exposure (PE) therapy with topiramate may significantly reduce symptoms of post-traumatic stress disorder (PTSD) compared with placebo, suggests a study.

“The addition of topiramate led to more rapid and pronounced PTSD symptom reduction, which may be of benefit to patients,” the authors said.

A double-blind, placebo-controlled outpatient clinical trial was conducted to compare 12 sessions of PE plus either topiramate or placebo in 100 US veterans (mean age 45 years, 84 percent men) with PTSD and alcohol use disorder (AUD).

The authors randomly allocated the participants to 16 weeks of treatment with PE plus topiramate (up to 250 mg) or PE plus placebo. They then analysed the effects on alcohol use and PTSD severity at post-treatment assessment and at 3- and 6-month follow-up.

Significant reductions were observed in percent heavy drinking days for both conditions, but there were no differences seen between treatment groups. PTSD scores at post-treatment assessment were lower in the PE plus topiramate group than in the PE plus placebo group, but not at follow-up.

These patterns were consistent for loss of PTSD diagnosis and meaningful PTSD symptom change. In addition, no significant difference was noted in change in secondary outcomes (ie, depression and quality of life) between conditions.

“Because [the] effects of topiramate were not maintained at longer-term follow-up, extending time on topiramate or additional strategies to prolong such effects may be useful,” the authors said. “Topiramate did not show added benefit to PE for percent heavy drinking days or secondary outcomes.”