Topamax, or topiramate, is a drug mainly used to treat seizure disorders, migraines, and weight loss. It is currently being studied for its effectiveness in treating addiction to alcohol and cocaine, but it has not yet been approved by the FDA for that purpose.
Topiramate is thought to help treat addiction in three ways: it increases GABA, decreases glutamate, and reduces the dopamine response to alcohol. GABA is an inhibitory neurotransmitter, meaning it reduces activity in the neurons. Glutamate is an excitatory neurotransmitter, which does the opposite. Dopamine is what creates the pleasant feeling in when you drink.
Alcohol enhances the effect of GABA and inhibits the effect of glutamate. Normally, the production of these neurotransmitters in your brain doesn’t change and you feel normal again once the alcohol is out of your system. Regular heavy drinking eventually changes the concentrations of these neurotransmitters so that you have very little GABA and too much glutamate. Your brain is suddenly all gas and no brakes. This is why you feel so tense and irritable during withdrawal and why seizures sometimes happen during detox.
Topiramate corrects this imbalance, reducing withdrawal symptoms and making seizures less likely. This is especially helpful in the early stages of treatment when withdrawal symptoms and cravings are most intense.
There are two other alcohol addiction drugs already in common use–disulfiram and naltrexone, or Antabuse and Vivitrol, respectively. In studies, topiramate has performed better than naltrexone in reducing cravings and promoting abstinence. However, disulfiram is better than both at promoting abstinence, probably because drinking while on disulfiram makes you violently ill.
There are some drawbacks to topiramate. When you reduce activity in the neurons, you can’t function optimally. Side effects include drowsiness, tingling in the extremities, shaking and uncontrollable muscle movements, trouble focusing and speaking clearly. Also, neurotransmitter production can’t return to normal if it is still propped up artificially by a drug. Eventually, you have to quit topiramate for your brain chemistry to properly balance itself.
Despite these limitations, topiramate might prove to be a useful option in treating addiction. It may artificially change neurotransmitter levels, but it lacks the addictive and destructive effects of alcohol, so it’s certainly an improvement. People respond differently to different treatments and the more options there are, the more people may recover from addiction.