What is the neuropharmacological pathway through which topiramate exerts its effects in alcohol use disorder?

• A. Enhancing dopamine release in reward pathways
• B. Antagonising glutamate and suppressing alcohol-induced dopamine release
• C. Inhibiting GABA synthesis
• D. Blocking serotonin reuptake

Answer: (B)

Topiramate works by dampening excitatory signaling while boosting inhibitory signaling in brain circuits tied to addiction. It blocks glutamate receptors, which reduces the excitatory drive that can fuel craving and drinking. At the same time, it enhances GABAergic inhibition. In the brain’s reward pathway, alcohol normally increases dopamine release, reinforcing drinking. By reducing glutamatergic activity and lowering the alcohol-induced dopamine surge, topiramate diminishes the rewarding effects of alcohol, helping to curb cravings and consumption. This differs from options that would increase dopamine, suppress GABA synthesis, or block serotonin reuptake, which don’t reflect its actual pharmacology.