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Early Results Show Topiramate May Be Effective in Posttraumatic Stress Disorder: Presented at ADAA

By Bonnie Darves

SEATTLE, WA -- March 22, 2005 -- Topiramate might emerge as a viable therapeutic option for patients with posttraumatic stress disorder (PTSD), according to findings from the first randomised double-blind trial of topiramate in the treatment of this condition.

During presentation of the preliminary findings at the Anxiety Disorders Association of America 25^th Annual Conference here March 19^th, the study's chief author noted that the drug's broad-spectrum effects may ameliorate some of the more difficult-to-treat symptoms of PTSD.

"Topiramate may be a good treatment option for some patients, as it appears to prevent some of the sensitization that occurs -- and the re-experiencing symptoms improved as well," said Phebe Tucker, MD, professor, Department of Psychiatry and Behavioral Sciences, Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.

Dr. Tucker noted that few placebo-controlled trials to date have looked at pharmacotherapeutic treatment of the disorder, and that only sertraline and paroxetine are currently approved by the U.S. Food and Drug Administration for use in PSTD. Topiramate may prove efficacious in these patients because it reduces neuronal hyperexcitability through several mechanisms.

The placebo-controlled trial included 38 civilian patients, predominantly women, with non-military combat-related PSTD, whose mean age was 42 years. The median topiramate dose was 150 mg daily, and the mean treatment duration was 76 days. Patients were started on 25 mg daily and titrated weekly over eight weeks, to a maximum dose of 400 mg/day.

Baseline total Clinician Administered PSTD Scale (CAPS) score was 88.3 in the drug group and 91.1 in the placebo group.

Patients who took the drug experienced a mean decrease in CAPS score of 59.5% by the end of the study, compared to a 45.5% in the placebo group. Re-experiencing symptoms declined 74.9% in the topiramate group, compared to 50.2% in the placebo patients.

The CAPS changes did not reach statistical significance, Dr. Tucker noted, possibly because the study was inadequately powered. Nonetheless, she said that the positive preliminary findings "warrant further studies" of the drug and are a valuable literature addition in an area that has been little studied.


[Presentation title: Efficacy and Safety of Topiramate in the Treatment of Civilian Posttraumatic Stress Disorder: A Randomized, Double-blind, Placebo-controlled Study. Abstract 23]

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