Photo Credit: bsd studio

The following is a summary of “A Randomized Clinical Trial of Prolonged Exposure Therapy With and Without Topiramate for Comorbid PTSD and Alcohol Use Disorder,” published in the March 2025 issue of American Journal of Psychiatry by Norman et al. 

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur, limiting prolonged exposure (PE) effectiveness. Topiramate may help reduce PTSD symptoms and alcohol use. 

Researchers conducted a retrospective study on PE with topiramate or placebo for PTSD and AUD. 

They randomly assigned 100 U.S. veterans (mean age 45 [SD=12], 84% men) with PTSD+AUD to 16 weeks of PE+topiramate (up to 250 mg) or PE+placebo to assess alcohol use and PTSD severity at posttreatment, 3-month, and 6-month follow-ups. 

The results showed percent heavy drinking days decreased in both groups with no difference. PTSD scores were lower in PE+topiramate at posttreatment but not at follow-ups. Similar patterns were seen for PTSD diagnosis loss and symptom change. Secondary outcomes (depression, quality of life) showed no difference. 

Investigators found that PE+topiramate led to greater PTSD symptom reduction during treatment but showed no long-term benefits. Topiramate did not improve heavy drinking days or secondary outcomes. 

Source: psychiatryonline.org/doi/10.1176/appi.ajp.20240470