Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia.
Edith Collins Centre for Translational Research (Alcohol, Drugs & Toxicology), Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW 2050, Australia.
Alcohol Alcohol. 2024 Nov 18;60(1). doi: 10.1093/alcalc/agae078.
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.
托吡酯已被证明能有效减少饮酒量，并可能减轻酒精使用障碍（AUD）患者的焦虑严重程度。本研究比较了接受托吡酯或纳曲酮治疗的 AUD 患者在预期焦虑任务中的神经反应。参与者为 42 名 AUD 患者，他们被随机分为托吡酯组（n = 23；滴定剂量高达 200mg/天）或纳曲酮组（n = 19；50mg/天），作为更大规模随机对照试验的一部分，接受为期 12 周的治疗。在治疗 6 周后，参与者在功能磁共振成像（fMRI）期间完成了预期焦虑任务。任务呈现了一系列高威胁和低威胁刺激，随后分别呈现不愉快或愉快的图像。主要的全脑分析显示，托吡酯组和纳曲酮组之间的神经激活没有显著差异。在楔前叶、下顶叶和扣带回中观察到相对于威胁线索的安全线索去激活。在中央前回和额中回，威胁线索引起更大的激活。探索性分析显示，焦虑从基线到第 6 周的变化有影响，与威胁线索相对于安全线索的反应减少与楔叶和舌回的减少有关。目前的研究首次检查并比较了接受托吡酯和纳曲酮治疗的寻求治疗的个体在预期焦虑期间的神经激活。这项初步研究有助于我们理解这些酒精药物治疗的治疗机制。
