Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Nov 18;60(1):agae078.
doi: 10.1093/alcalc/agae078.

Comparative effects of topiramate and naltrexone on neural activity during anticipatory anxiety in individuals with alcohol use disorder

Gezelle Dali  1   2 , Warren Logge  1   2 , Henry R Kranzler  3 , Tristan Hurzeler  1 , Hugh Gallagher  1 , Paul S Haber  1   2 , Kirsten C Morley  1   2
Affiliations
Randomized Controlled Trial

Comparative effects of topiramate and naltrexone on neural activity during anticipatory anxiety in individuals with alcohol use disorder

Gezelle Dali et al. Alcohol Alcohol. .

Abstract

Topiramate has been found to be effective in reducing alcohol use and may also attenuate anxiety severity in patients with alcohol use disorder (AUD). This study compared the neural response of treatment-seeking patients with AUD on either topiramate or naltrexone during an anticipatory anxiety task. Participants were 42 patients with AUD who were randomized to receive either topiramate (n = 23; titrated dose up to 200 mg/day) or naltrexone (n = 19; 50 mg/day) for 12-weeks as part of a larger randomized controlled trial. Following 6 weeks of treatment, participants completed an anticipatory anxiety task during a functional magnetic resonance imaging (fMRI) session. The task presented a series of high-threat and low-threat stimuli followed by an unpleasant or pleasant image, respectively. Primary whole-brain analyses revealed no significant differences in neural activation between the topiramate and naltrexone groups. Deactivation for safe cues relative to threat cues was observed within the precuneus, inferior parietal lobule and the cingulate gyrus. In the precentral and middle frontal gyri, threat cues elicited greater activation. Exploratory analyses revealed an effect of change in anxiety from baseline to week 6, with a greater reduction associated with a reduced response to threat cues relative to safe cues in the cuneus and lingual gyrus. The current study is the first to examine and compare neural activation during anticipatory anxiety in treatment-seeking individuals on topiramate and naltrexone. This preliminary research contributes to our understanding of the therapeutic mechanisms of these alcohol pharmacotherapies.

Keywords: alcohol use disorder; anxiety; fMRI; naltrexone; topiramate.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Anticipatory anxiety task.
Figure 2
Figure 2
Clusters demonstrating significantly different activation for threat versus safe cues. Brighter colours represent greater activation in response to threat cues. Activation maps presented at P < .001 corrected, with the colour bar representing T-scores.
Figure 3
Figure 3
(A) Cluster of activation encompassing the left and right cuneus and lingual gyrus for interaction between the threat versus safe contrast and change in anxiety from baseline to week 6. Activation maps presented at P < .001 corrected, with the colour bar representing T-scores. (B) Scatterplot of beta weights for threat versus safe contrast against change in anxiety from baseline to week 6 (positive scores indicate a reduction in anxiety from baseline to week 6). Beta values derived from the highest extent threshold of cluster spanning cuneus and lingual gyrus at MNI coordinates (x, y, z) = −20, −76, 4. Positive beta weights indicate greater activation for threat cues versus safe cues.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association, 2013. 10.1176/appi.books.9780890425596. - DOI
    1. Ängehagen M, Rönnbäck L, Hansson E. et al. . Topiramate reduces AMPA-induced Ca2+ transients and inhibits GluR1 subunit phosphorylation in astrocytes from primary cultures. J Neurochem. 2005;94:1124–30. 10.1111/j.1471-4159.2005.03259.x. - DOI - PubMed
    1. Baltieri DA, Daró FR, Ribeiro PL. et al. . Comparing topiramate with naltrexone in the treatment of alcohol dependence*. Addiction. 2008;103:2035–44. 10.1111/j.1360-0443.2008.02355.x. - DOI - PubMed
    1. Blodgett JC, Del Re AC, Maisel NC. et al. . A meta-analysis of Topiramate's effects for individuals with alcohol use disorders. Alc: Clin Experimen Res. 2014;38:1481–8. 10.1111/acer.12411. - DOI - PMC - PubMed
    1. Carlson JM, Reinke KS, Habib R. A left amygdala mediated network for rapid orienting to masked fearful faces. Neuropsychologia. 2009;47:1386–9. 10.1016/j.neuropsychologia.2009.01.026. - DOI - PubMed

Publication types

MeSH terms