title: Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial.
abstract: 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.
authors.affiliation: Outpatient Clinic for Impulse Control Disorders, Institute and Department of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 785, Jardim Paulista, São Paulo, SP, CEP 05403-010, Brazil. antoniomarcelo@usp.br.
authors.forename: Antonio Marcelo Cabrita
authors.initials: AM
authors.lastname: de Brito
authors.affiliation: Outpatient Clinic for Impulse Control Disorders, Institute and Department of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 785, Jardim Paulista, São Paulo, SP, CEP 05403-010, Brazil.
authors.forename: Moema Galindo
authors.initials: MG
authors.lastname: de Almeida Pinto
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bronstein
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carneiro
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Faertes
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Viviane
authors.initials: V
authors.lastname: Fukugawa
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Angela
authors.initials: A
authors.lastname: Duque
authors.affiliation: Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
authors.forename: Fatima
authors.initials: F
authors.lastname: Vasconcellos
authors.affiliation: Outpatient Clinic for Impulse Control Disorders, Institute and Department of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 785, Jardim Paulista, São Paulo, SP, CEP 05403-010, Brazil.
authors.forename: Hermano
authors.initials: H
authors.lastname: Tavares
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005715:Gambling / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose
keywords: Cognitive therapy; Craving; Gambling; Randomized controlled trial; Social adjustment; Topiramate