Patil Thayjas A, Espiridion Eduardo D, Napalinga Katherine M
Psychiatry, Drexel University College of Medicine, Philadelphia, USA.
Psychiatry, Reading Hospital Tower Health, West Reading, USA.
Cureus. 2025 Jul 14;17(7):e87935. doi: 10.7759/cureus.87935. eCollection 2025 Jul.
Introduction Cocaine use disorder is a chronic substance use disorder characterized by persistent use of cocaine despite substantial harm and adverse consequences, often developing from patterns of recreational or episodic cocaine use. The pathophysiology of cocaine use is complex, involving the addictive effects on the brain's limbic system, which affects the region of the brain that regulates pleasure and motivation. In this study, we aimed to examine whether topiramate exposure is associated with the incidence of psychiatric comorbidities in patients with cocaine use. Methods This study involved data from 7,325 patients pulled from 66 large healthcare organizations in the TriNetX global health research network and investigated the associations between topiramate exposure and the development of psychiatric comorbidities among patients with cocaine use. The analysis compared patients treated with psychotherapy alone to those treated with psychotherapy and who had topiramate exposure. Results Analysis revealed an increased likelihood of developing a depressive episode [odds Ratio (OR) 1.321, risk ratio (RR) 1.145, p<0.0001] and anxiety-related disorders (OR: 1.317, RR: 1.124, p<0.0001) in the topiramate group compared to the group with psychotherapy alone. Although there was a slight increase in suicidal ideation (OR: 1.109, RR: 1.08, p=0.14) and alcohol abuse (OR: 1.005, RR: 1.003, p=0.948) in the topiramate group, these differences were not statistically significant. Conclusions These findings suggest that while topiramate may offer some benefits, its exposure is associated with a higher observed incidence of developing depressive and anxiety disorders in patients with cocaine use. On the other hand, topiramate exposure was not significantly associated with increased incidence of developing suicidal ideation or alcohol abuse in this population. Treatment plans should carefully weigh the potential physiological and psychiatric risks when considering topiramate for managing cocaine use, especially in populations already vulnerable to mental health issues.
引言 可卡因使用障碍是一种慢性物质使用障碍，其特征是尽管存在严重危害和不良后果，但仍持续使用可卡因，通常由娱乐性或间歇性使用可卡因的模式发展而来。可卡因使用的病理生理学很复杂，涉及对大脑边缘系统的成瘾作用，该系统会影响大脑中调节愉悦和动机的区域。在本研究中，我们旨在探讨托吡酯暴露是否与可卡因使用者精神疾病共病的发生率相关。
方法 本研究涉及从TriNetX全球健康研究网络的66个大型医疗保健机构中抽取的7325名患者的数据，并调查了托吡酯暴露与可卡因使用者精神疾病共病发生之间的关联。该分析将仅接受心理治疗的患者与接受心理治疗且接触过托吡酯的患者进行了比较。
结果 分析显示，与仅接受心理治疗的组相比，托吡酯组发生抑郁发作的可能性增加[优势比（OR）1.321，风险比（RR）1.145，p<0.0001]，以及发生焦虑相关障碍的可能性增加（OR：1.317，RR：1.124，p<0.0001）。尽管托吡酯组的自杀意念（OR：1.109，RR：1.08，p=0.14）和酒精滥用（OR：1.005，RR：1.003，p=0.948）略有增加，但这些差异无统计学意义。
结论 这些发现表明，虽然托吡酯可能有一些益处，但其暴露与可卡因使用者中观察到的更高的抑郁和焦虑障碍发生率相关。另一方面，在该人群中，托吡酯暴露与自杀意念或酒精滥用发生率增加无显著关联。在考虑使用托吡酯来管理可卡因使用时，治疗计划应仔细权衡潜在的生理和精神风险，尤其是在已经易患心理健康问题人群中。
