Topiramate-Induced Psychosis in an Individual With Alcohol Dependence: A Case Report

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Sir: Topiramate, an antiepileptic drug, has been shown to reduce alcohol craving and heavy drinking and to improve abstinence among alcohol-dependent individuals.1 By potentiating the inhibitory effects of γ-aminobutyric acid (GABA)2 and depressing the excitatory action of kainate on α-amino-3-hydroxy- 5-methylisoxazole-4-propionic acid (AMPA) glutamate receptors,3 topiramate reduces mesocorticolimbic dopamine activity, which is a crucial pathway by which alcohol exerts its rewarding effects.4–6 Doses of up to 300 mg per day have been effective in reducing craving in alcohol-dependent patients.

Prim Care Companion J Clin Psychiatry 2007;9(4):317-318 [letter]