Topiramate is an increasingly popular option for substance and alcohol use disorder treatment. Since 1997, this medication that has been used to treat epilepsy and, in 2004, the Food and Drug Administration (FDA) approved it for preventing migraine headaches. It has helped quite a few people with these two conditions.
No FDA Approval
Using topiramate to treat substance use disorder is considered off-label because it is not a use that has received FDA approval. Although it hasn’t received governmental approval, topiramate has been used to help reduce cravings for disordered use of alcohol and other substances. Health care providers have prescribed it, and their patients have experienced reduced cravings for substances of disordered use.
How Topiramate Works
Topiramate is approved to treat two conditions that occur in the brain, epilepsy and migraine headaches. It is a medication that works directly on the brain chemistry, so you must understand a little about brain chemistry to fully appreciate what topiramate can do to combat substance use disorder in the brain.
One Word You Need to Know
Everything your brain does is fueled by chemistry. The chemicals that fuel the brain are called neurotransmitters. In your quest to understand brain chemistry basics, you really need to know about one neurotransmitter. That neurotransmitter is dopamine.
Dopamine might sound a bit like the word “dope,” and that may or may not be entirely coincidental. What this neurochemical does, though, is no accident. Dopamine helps send pleasure signals throughout your brain and body. These signals intensify the enjoyment you get from whatever experience you’re having when dopamine is released.
The Pleasure Principle
When you enjoy the scent of roses or someone’s smile, your brain releases dopamine. This neurotransmitter targets the portions of the brain that understands an experience as rewarding. It enhances learning, memory, and the competitive spirit. It also increases your heart rate, reduces your experience of physical pain, and enhances your coordination.
Dopamine’s Secret
Dopamine might sound nearly perfect. After all, who doesn’t want a better memory or coordination? Unfortunately, dopamine levels rise relatively quickly when alcohol and other substances prone to disordered use are ingested. In fact, disordered substance use releases much more dopamine than the amount of dopamine released through healthier means such as music or social interaction.
While dopamine can help you feel pleasure during disordered use, it does more than boost the pleasure associated with disordered substance use. It creates a dependency on the extra dopamine. As a result, your brain feels it is getting a double reward for disordered substance use and intensely craves this experience.
Research has shown that your brain becomes accustomed to such large releases of dopamine. After repeated bursts of this powerful neurotransmitter, your brain finds cocaine, alcohol, or any other substance of disordered use synonymous with pleasure. In other words, your brain has learned that it needs the substance.
If this wasn’t bad enough news, there’s more. Since no one lives in isolation, your dopamine-steeped system also connects these pleasurable rewards with people, places, and activities surrounding disordered substance use. This association is so powerful that such triggers create the feeling that you must have more of the substance and the dopamine surge that has become connected to it.
One Tool for Taking Back the System
Topiramate is one tool that can be used to fight substance use disorders. In addition to quelling seizures and preventing migraines, the medication reduces dopamine levels. Without as much dopamine in the system, cravings are diminished because the pleasurable reward feelings are gone or substantially reduced.
More specifically, researchers have found that topiramate helps reduce cravings for alcohol. Other studies have demonstrated that those who were taking topiramate did not use cocaine for more weeks than those who were not on the medication.
Substance Treats Substance Use Disorder
There are many people who have switched or added additional substances to their list of substances they use in a disordered manner. In this light, using one substance to treat substance use disorder might sound counterproductive. Topiramate-assisted treatment is supervised by a medical professional who can plan, monitor, and discontinue the medication for optimal use.
Beyond Dopamine
Topiramate does more than reduce the amount of dopamine in your system. It increases the levels of another neurotransmitter, GABA. GABA is an acronym that stands for gamma-aminobutyric acid. This neurotransmitter reduces anxiety and stressful feelings.
How GABA Can Help
Recovery, like disordered alcohol or substance use, is stressful. While the stressors may be different, or sometimes even positive, they still cause at least some anxiety for most people. Reducing these stressful feelings with GABA will improve the quality of your life.
More on GABA
GABA improves sleep. This can give you more energy for meeting your goals. Another benefit of GABA is improved mood. Lifting low feelings can give you an additional boost toward tackling your substance use disorder.
Why Not to Buy a Bottle of GABA Supplements
Commercially sold GABA supplements might seem to be an easy way to reap the benefits of GABA. Unfortunately, such supplements are regulated as a food by the FDA. As a result, they don’t undergo the stringent testing required of medications, including potency and effectiveness.
Why Your Family Doctor Isn’t Your Best Option, Either
While your family health care provider would be glad to answer your questions about topiramate, it’s not the kind of medication doctors will prescribe during a fifteen-minute visit. It has such a powerful effect on the body that you need a complete evaluation before, during, and after taking it.
You may choose to use your visit to your family doctor for a referral to a psychiatrist or neurologist. While those are wonderful specialists to consult, an office visit will not provide you with the level of comprehensive care you need, even if it’s from a specialist.
Side Effects
One of the main reasons for a higher level of care is the side effects. Here are some of the possible side effects of topiramate:
- Reduced alertness
- Kidney stones
- Lack of appetite
- Loss of muscle coordination
- Depression
Of course, conquering your substance use disorder is about so much more than avoiding a list of side effects. During the early stages, these side effects can have subtle symptoms. If you were at home, you might not notice you have a problem until it has damaged your body.
Getting Help
At Granite Recovery Centers, we’ve helped many conquer their substance and alcohol use disorders at our residential programs. While this option provides complete treatment, some people benefit from our specialized Medication-Assisted Treatment program. This multi-pronged approach includes medical support, 12-step philosophy, and many other tools to bolster your resources for your recovery journey.
An Excellent Beginning
Your triumph over substance use disorder is our mission. Therefore, we want you to have access to proven rehabilitative techniques under our close supervision. Such closely monitored care is particularly critical at the beginning of treatment, as many of the more severe topiramate side effects occur or begin to appear within the first 48 hours of taking it.
Our trained clinicians can spot issues early in your treatment. They can prescribe treatment to support you through minor side effects. Discontinuing topiramate is also an option if the side effects are likely to lead to complications.
Progress Monitoring
When you’re at one of our facilities, we monitor your progress every step of the way. While careful supervision during the first 48 hours on topiramate is crucial to your success, our close care of you doesn’t end there. We assess you before you even take a dose, while you’re using it for treatment, and after you’ve completed your topiramate course.
Changing Course
We know that topiramate is not going to work for every person. At Granite Recovery Centers, we apply a scientific approach to your treatment, so we have data to determine if this medication works for you or if you need a change. We also have an array of other options and research-based knowledge of them, so you have many options if topiramate’s side effects are too significant or treatment effect is not appropriate for you.
Discontinuation Day
Topiramate is a tool for treating substance use disorder, not a medication you must take for the rest of your life. There will be a day when you can stop taking it, but it must first be tapered off under the guidance of a medical professional. If you suddenly stop taking it, you can develop seizures even if you’ve never had them before.
You’re Not Alone
At our centers, we walk with you and know you’re far from alone. In 2019, 14.1 million adults reported they had alcohol use disorder, according to the National Survey on Drug Use and Health. Substance use disorders can break up a promising engagement, end a career, and even, tragically, lead to loss of life. Much of this profound impact stems from the social nature of these disorders.
We Connect You With Community
There are many people who are leveraging the power of topiramate to conquer their alcohol and substance use disorders. Why not harness the power of this community? We do it using the 12-step framework because we’ve found it supports healthy relationships that promote recovery.
Easing your transition from our residential program to long-term success is something we consider from the moment you arrive, and community support will be crucial for your success in the extended community. Twelve-step support groups are one way to find help in your neighborhood. We also offer family counseling sessions to help you create an even more supportive environment.
One More Surprise From the Researchers
If you’re considering topiramate, you may be pleased with some research related to its use during the long-term or maintenance phase of recovery. Researchers have found that topiramate helps to extend the time between cocaine-use episodes for those in the maintenance or later phase of recovery. Similarly, topiramate is also useful for reducing alcohol cravings while managing recovery beyond withdrawal. It is now considered one of the first-line medications for that purpose.
Harness the Power of Research-Based Treatment
If you or a loved one is ready to improve your life using scientific research, we encourage you to do some research of your own. Government resources such as the National Institute of Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse provide a wealth of information on what we know about substance use disorder and how we can treat it. At Granite Recovery Centers, we specialize in helping individuals make sense of the latest research and finding treatment options that work for them. We’d be glad to do the same for you.
