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 reducealcohol craving and heavy drinking and to improve abstinenceamong alcohol-dependent individuals.¹ By potentiatingthe inhibitory effects of γ-aminobutyric acid (GABA)² and depressingthe excitatory action of kainate on α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) glutamatereceptors,³ topiramate reduces mesocorticolimbic dopamine activity,which is a crucial pathway by which alcohol exerts its rewardingeffects.4-6 Doses of up to 300 mg per day have beeneffective in reducing craving in alcohol-dependent patients.