Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial.

Brito, Antonio; Almeida Pinto, Moema; Bronstein, Gabriel; Carneiro, Elizabeth; Faertes, Daniela; Fukugawa, Viviane; Duque, Angela; Vasconcellos, Fatima; Tavares, Hermano; de Brito, Antonio Marcelo Cabrita; de Almeida Pinto, Moema Galindo

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.

COMPULSIVE gambling; TOPIRAMATE; COGNITIVE restructuring therapy; IMPULSIVE personality; CLINICAL trials; THERAPEUTICS; GAMBLING & psychology; ANTICONVULSANTS; RESEARCH; RESEARCH methodology; FRUCTOSE; COGNITION; EVALUATION research; MEDICAL cooperation; GAMBLING; TREATMENT effectiveness; COMPARATIVE studies; RANDOMIZED controlled trials; DOSE-effect relationship in pharmacology; BLIND experiment; COMBINED modality therapy

Journal of Gambling Studies, 2017, Vol 33, Issue 1, p249

1050-5350

Academic Journal

10.1007/s10899-016-9620-z