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January 30, 2008

Topiramate as Treatment for Alcohol Dependence

JAMA. 2008;299(4):405-407. doi:10.1001/jama.299.4.405-b

To the Editor: In the clinical trial by Dr Johnson and colleagues,1 topiramate reduced the percentage of heavy drinking days in selected alcohol-dependent individuals. However, there was an important exclusion criterion that was not addressed in the discussion.

The study methods note that participants were excluded who “had a current Axis I psychiatric diagnosis on the DSM-IV other than alcohol, nicotine, or caffeine dependence,” so that patients with current Axis I mood or anxiety disorders were not included in this trial. This may represent a large percentage of persons with alcohol dependence. In a community-based national survey of 43 093 respondents representative of a noninstitutionalized population (the National Epidemiologic Survey on Alcohol and Related Conditions), the 12-month prevalence of any mood disorder among persons with alcohol dependence was 28%, and the prevalence of any anxiety disorder was 23%.2 Among those with any alcohol use disorder who sought treatment in the past 12 months, the prevalence was 41% for any mood disorder and 33% for any anxiety disorder. Although prevalence was not provided specifically for those with alcohol dependence who sought treatment in the past 12 months, in general mood and anxiety disorders were more prevalent in this group than in those with any alcohol use disorder.