Topiramate in the treatment of compulsive sexual behavior: case report.
BACKGROUND
Among the multiple mechanisms of action of topiramate, AMPA/kainate antagonism may be particularly interesting for the treatment of disorders characterized by conditioned cognitive and behavioral cue reactivity.


METHODS
We report the case of a patient consulting primarily for obesity and cue triggered snacking, who responded well on topiramate at doses up to 50 mg. Coincidentally he reported on an improvement of compulsive nonparaphilic sexual behaviors (consumption of prostitution), which was also strongly triggered by environmental cues. Both addictive behaviors (snacking and consumption of prostitution) reoccurred after discontinuation of topiramate and again responded reintroduction of the drug.


CONCLUSIONS
The present case report of topiramate's effect on comorbid obesity and nonparaphilic addiction could be interpreted as a further indication that topiramate acts on the common pathway underlying conditioned behaviors and seems to be a treatment of behavioral disorders associated with environmental cues.
Khazaal
Yasser
Y
Department of Psychiatry, Mood and Anxiety Disorders Unit, Echallens 9, 1004 Lausanne, Switzerland. yasser.khazaal@chuv.ch
Zullino
Daniele Fabio
DF
D000328:Adult; D019440:Anti-Obesity Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003192:Compulsive Behavior / Q000188:drug therapy* / Q000523:psychology; D003213:Conditioning, Psychological / Q000187:drug effects / Q000502:physiology; D003463:Cues; D004435:Eating / Q000187:drug effects / Q000523:psychology; D005632:Fructose / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009765:Obesity / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D018091:Receptors, AMPA / Q000502:physiology; D018092:Kainic Acid Receptors / Q000187:drug effects / Q000502:physiology; D012008:Recurrence; D011477:Sex Work / Q000523:psychology; D012725:Sexual Behavior / Q000187:drug effects* / Q000523:psychology; D000077236:Topiramate; D016896:Treatment Outcome
D019440:Anti-Obesity Agents; D005632:Fructose; D018091:Receptors, AMPA; D018092:Kainic Acid Receptors; D000077236:Topiramate