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PSYCHIATRY

Topiramate in Combat-Related Posttraumatic Stress Disorder

Director, Pharmacy Department, Repatriation General Hospital, Adelaide, South Australia; Associate Professor, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia

Linda C McCarthy, MBBS FRANZCP

Director, Post Traumatic Stress Disorder Unit, Repatriation General Hospital

John T Condon, MBBS FRANZCP

Senior Consultant Psychiatrist, Repatriation General Hospital

Anita C Marwood, B Pharm M Clin Pharm CGP

Senior Clinical Pharmacist, Repatriation General Hospital

Judith R Fuller, BN, PTSD Nurse

Post Traumatic Stress Disorder Unit, Repatriation General Hospital

Reprints: Mr. Alderman, Pharmacy Department, Repatriation General Hospital, Adelaide, South Australia 5042, fax 618 83790225, chris.alderman{at}health.sa.gov.au

BACKGROUND: Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that is common among combat veterans and may lead to very poor sleep and disturbing nightmares.

OBJECTIVE: To examine the safety and effectiveness of topiramate as add-on therapy for the management of combat-related PTSD and to examine the effects of topiramate on sleep and alcohol consumption.

METHODS: We conducted an 8-week open-label pilot study of topiramate for male combat veterans (N = 43) with PTSD, with analysis of veterans who completed the protocol. Psychometric, sleep, and alcohol consumption assessments were conducted at baseline and at week 8.

RESULTS: Twenty-nine subjects completed the 8-week study. Significant reductions in Clinician Administered PTSD Scale scores were observed at the 8-week endpoint (from 86.3 ± 21.1 to 67.1 ± 25.1; p < 0.01). Decreases were seen in both Stanford Sleepiness Scale scores (from 10.5 ± 0.72 to 9.0 ± 0.58; p = 0.08) and Mississippi PTSD scores (from 120.4 ± 6.5 to 111.5 ± 20.9; p = 0.08), but the extent of the changes did not attain statistical significance for either scale. There was a significant reduction in the proportion of patients with nightmares (from 100% to 62%; p < 0.001) and patients who experienced anxiety that interfered with falling asleep (from 90% to 62%; p < 0.05). The proportion of patients with high-risk drinking patterns also decreased (from 31% to 14%). Two serious adverse events were reported during the study: an increase in low back pain and an episode of acute confusion.

CONCLUSIONS: When used in addition to other empiric therapy, topiramate may be effective at reducing general symptoms of combat-related PTSD and reducing high-risk alcohol intake and nightmares. Further randomized controlled trials of topiramate for the treatment of combat-related PTSD are warranted.

Key Words: nightmares, posttraumatic stress disorder, sleep disorders, topiramate

Published Online, March 31, 2009. www.theannals.com, DOI 10.1345/aph.1L578