Topiramate Hints At Potential To Treat Civilian PTSD

The news keeps getting better for those struggling with a life lived under the specter of post-traumatic stress disorder (PTSD).

Recent data points to a new alternative for treating civilian PTSD – thanks to topiramate, an anticonvulsant that scientists originally developed to treat epilepsy.

Methodology

Researchers ran this double-blind, placebo-controlled study between 2001 and 2004 among several U.S. outpatient clinics. The team enrolled 72 adults from 19 to 64 years of age who’d received a PTSD diagnosis. The researchers randomly assigned the study participants into two groups. One group received topiramate while the team administered a placebo to the control group. Treatment lasted 12 weeks. The researchers started with topiramate doses of 25 mg and ramped them up gradually to a max of 400 mg daily.

The study measured success by tracking reductions in PTSD symptom severity with the Clinician-Administered PTSD Scale (CAPS), which gauges symptoms across three areas:

• Reexperiencing.
• Avoidance/numbing.
• And hyperarousal.

The team relied on the Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS) as secondary metrics used to chart shifts in anxiety and depression.

Promising Results for PTSD

The results uncovered a 39.5 percent drop in CAPS scores among the topiramate group, which the researchers saw as an improvement in symptoms. Nevertheless, it didn’t appear notably significant when the team compared it to the placebo group’s 29.5 percent decrease. 

The study’s authors observed that while both groups admitted to symptom relief, the placebo group’s improvement rate narrowed the gap, limiting the statistical impact of topiramate’s results.

These results echo earlier research showing inflated placebo response rates. Some theories suggest that psychological factors like hope and expectancy could drive it.

That being, the research also revealed symptom-specific improvements in the topiramate group. The topiramate recipients reported fewer recurring symptoms – such as flashbacks –  and better sleep quality.

Even so, high attrition rates undermined the study. Nearly 60 percent – 58.8 percent – of topiramate participants and 48.6 percent of placebo participants dropped out of the study. The topiramate group also reported side effects such as paresthesia, headache, fatigue, and insomnia. These adverse effects seemed to be severe enough to drive 18 percent of the test group participants to walk away.

A Postscript

While topiramate showed some promise, the study’s authors concede that its effects failed to meet the statistical threshold necessary to conclusively establish efficacy over placebo. They added that perhaps longer trials – along with larger sample sizes – might produce more definitive results.

Nonetheless, the numbers shore up some of the admittedly limited research data that academics have collected on pharmacologic treatments for civilian PTSD.

Despite these mixed results, the study offers valuable insights into PTSD treatment, especially with so few pharmacologic options available, with only two FDA-approved SSRIs — sertraline and paroxetine.

For PTSD patients who might not respond to SSRIs or psychotherapy alone, topiramate’s supplemental role could justify further investigation, especially since some of them did experience meaningful symptom relief.

While the researchers discovered that topiramate appeared to be safe, while showing (admittedly limited) positive effects on PTSD symptoms, its overall efficacy remains shrouded in doubt.

Ultimately, the study further reinforces PTSD’s complex nature and the power of the placebo in mental health research. 

Further Reading

Post-2020 Election Partisan Hostility Left Americans Traumatized

Trauma Appears To Alter How We Process Memories

Researchers Identify Variables Driving PTSD in Traumatized Youth