The Potential Interest of Topiramate in Addictions

Abstract

Topiramate is one of the currently most promising compounds in the field of addiction medicine. This paper discusses its potential utility related to a phase model of addiction development, focusing on the assumption that addiction is a continuous process involving different neurobiological pathways, depending on the stage of addiction. A specific emphasis will be made on the development of dysfunctional automatic behaviors in late stage of addiction and the central role of glutamate and AMPA receptors. The aim is to propose that if a too broad effect of anti-addiction medication is expected (such as anti-craving, anti-relapse and preventive effects), the results might be disappointing. The speculative specific efficacy of topiramate in addiction is described.

Topiramate reduces basal anxiety and relieves ethanol withdrawal-induced anxious behaviors in male rats.

“…A growing number of preclinical studies investigated the therapeutic potential (Breslin, Johnson, & Lynch, 2010; Cagetti et al, 2004; Chen & Holmes, 2009; Farook, Morrell, Lewis, Littleton, & Barron, 2007; Hargreaves & McGregor, 2007; Lynch, Bond, Breslin, & Johnson, 2011; Moore, Protzuk, Johnson, & Lynch, 2014) and pitfalls (Arenas et al, 2016) of topiramate as innovative treatment for drug abuse. A range of clinical studies focusing on various addictive drugs suggest that topiramate not only reduces mean consumption levels, but also reduces heavy consumption days and promotes and maintains abstinence (for a review see Thorens et al, 2011). Ultimately, the anxiolytic effects of topiramate could contribute to the treatment of drug addiction by reducing withdrawal-induced anxiety, a symptom associated with an increased risk of relapse, and then prolonging the abstinence time.…”

Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review

“…Another possible mechanism of action for topiramate is based on the theoretical framework that addiction is a learned automatic behavior that gets established by forced memorization through neuronal synaptic plasticity involving both long-term potentiation (LTP) and long-term depression (LTD) (Thorens et al, 2011). Topiramate has been suggested to inhibit the expression of addiction-related automatic behavior through glutamatergic receptor inhibition.…”