A 12-Week Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Topiramate for the Treatment of Compulsive Buying Disorder

Abstract

Background Topiramate is an anticonvulsant that has shown promise as a pharmacological agent for the treatment of addictive disorders, including compulsive buying disorder (CBD). The aim of the present study was to examine the efficacy of topiramate in the treatment of CBD and its associated characteristics using a 12-week randomized, double-blind, placebo-controlled design. Methods Fifty patients seeking treatment of CBD who met the inclusion criteria were randomly assigned to either the experimental group (n = 25) or the control group (n = 25). Both groups received 4 sessions of psychoeducation. Results Forty-four participants completed the follow-up with no differences in the rate of dropout between groups. There were no differences between participants who received topiramate or placebo in reducing CBD symptoms assessed by the primary outcome scale (Yale-Brown Obsessive-Compulsive Scale – Shopping Version). However, participants who received topiramate were significantly more likely to show clinical improvement when assessed by a secondary outcome measure, the Compulsive Buying Follow-Up Scale. In addition, there was a trend among participants who received topiramate to report improvements in aspects of hoarding and impulsivity compared with the control group. There were significant improvements in comorbid depression and social adjustments over time, but no group × time interaction was found. Conclusions The results do not provide support for the use of topiramate in the treatment of CBD. Future investigation with larger and representative samples and longer follow-up period are needed.

Therapeutic management of buying/shopping disorder: A systematic literature review and evidence-based recommendations

“…The superiority of topiramate vs. placebo was not confirmed by the main outcome measure (YBOCS-SV), and only clinical variables (hoarding, impulsivity) and Compulsive Buying Follow-Up Scale (CB-FUS) scores confirmed the efficacy of topiramate vs. placebo ( 56 ). However, the follow-up analysis suggested that topiramate may begin to distinguish itself from placebo after 10 weeks, which indicates the need for a longer duration of monitoring ( 56 ).…”

“…A randomized, double-blind, controlled trial evaluated the efficacy of topiramate (up to 300 mg/day in the ninth week, if tolerated) vs. placebo for 12 weeks in 50 patients with B/SD ( 56 ). The superiority of topiramate vs. placebo was not confirmed by the main outcome measure (YBOCS-SV), and only clinical variables (hoarding, impulsivity) and Compulsive Buying Follow-Up Scale (CB-FUS) scores confirmed the efficacy of topiramate vs. placebo ( 56 ). However, the follow-up analysis suggested that topiramate may begin to distinguish itself from placebo after 10 weeks, which indicates the need for a longer duration of monitoring ( 56 ).…”

Update on treatment studies for compulsive buying-shopping disorder: A systematic review

“…We identified six psychotherapy studies, two of those were open trials ( Filomensky & Tavares, 2009 ; Granero et al., 2017 ) and four were randomized controlled studies ( Benson, Eisenach, Abrams, & van Stolk-Cooke, 2014 ; Mitchell, Burgard, Faber, Crosby, & de Zwaan, 2006 ; Müller, Arikian, de Zwaan, & Mitchell, 2013 ; Müller, Mueller, et al., 2008 ). In terms of the seven included pharmacological studies, two were open studies ( Grant, Odlaug, Mooney, O'Brien, & Kim, 2012 ; Koran, Bullock, Hartston, Elliott, & D'Andrea, 2002 ), another two started with an open-label phase that was followed by a double-blind discontinuation phase ( Koran, Aboujaoude, Solvason, Gamel, & Smith, 2007 ; Koran, Chuong, Bullock, & Smith, 2003 ), and three studies had a clear placebo-controlled design ( Black, Gabel, Hansen, & Schlosser, 2000 ; Nicoli de Mattos et al., 2020 ; Ninan et al., 2000 ).…”

“…Most of the 13 identified studies were conducted in the United States ( Benson et al., 2014 ; Black et al., 2000 ; Grant et al., 2012 ; Koran et al., 2002 , 2003 , 2007 ; Mitchell et al., 2006 ; Müller et al., 2013 ; Ninan et al., 2000 ). Two studies were performed in Brazil ( Filomensky & Tavares, 2009 ; Nicoli de Mattos et al., 2020 ) and one study each in Germany ( Müller, Mueller, et al., 2008 ) and Spain ( Granero et al., 2017 ). Within all studies, mean ages of participants ranged between 24.0 and 46.55 years, and the vast majority of participants were women (range 72–100%).…”

Criteria for the establishment of a new behavioural addiction •

“…There is no compelling evidence that addiction treatments are effective for compulsive buying (Criterion 4). Cognitive-behaviour therapy, naltrexone and topiramate are not more effective than placebo, nor are tricyclic and SSRI antidepressants; although they are effective for mood symptoms (Hague, Hall, & Kellett, 2016;Kellett, Oxborough, & Gaskell, 2021;Nicoli de Mattos et al, 2020). However, existing studies tend to be of low methodological quality.…”