Evaluating cognitive effects of topiramate in trauma-focused treatment: Findings from a randomized double-blind clinical trial of veterans with PTSD and alcohol use disorder.

While minor declines in some cognitive domains were observed in both the topiramate and placebo groups, these changes were nonsignificant and not clinically meaningful (<1 standard deviation change). These findings suggest that topiramate does not produce clinically significant cognitive impairment when combined with prolonged exposure and may enhance treatment response. Future research should examine the long-term cognitive and therapeutic effects of topiramate to guide shared decision making and optimize integrated treatment for veterans with PTSD and AUD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).