Is Topiramate Helpful in the Management of Cocaine Use-Related Psychiatric Comorbidities?

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.