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Research
News . . . .
Topiramate in Bipolar
Disorder (cont.)
In 2002, McIntyre et al.6
performed a randomized open study on 36 depressed bipolar patients, who
received either adjunctive topiramate (50-300 mg/day) or adjunctive
bupropion SR (100-400 mg/day) for 8 weeks. Response rates were very similar
and substantial (56% for topiramate vs. 59% for bupropion SR),
although more patients lost weight on topiramate than on bupropion. Patients in the topiramate group lost an average of 5.8
kg (about 12.8 lbs).
In 2003, an open-label,
12-week study of adjunctive topiramate in patients with bipolar II
disorder, Vieta et al.7 found that topiramate was effective
in both hypomania (53% response) and depression (50% response).
IV. Topiramate in
Alcoholism
Johnson et al (2003)8
reported striking efficacy of topiramate in a 12-week,
placebo-controlled trial in 150 patients with alcohol dependence.
Essentially on every measure, treatment with topiramate (up to 300
mg/day) substantially exceeded placebo, including number of drinking
days and percentage of days abstinent, and even the subjective report of
alcohol craving.
Given the high incidence
of alcohol dependence comorbidity in bipolar disorder, this property of
topiramate or its proclivity to cause weight loss may be therapeutically
important, even if topiramate is not a primary antimanic treatment in
monotherapy.
V. Side Effects
Many of the other mood stabilizers commonly
used in bipolar illness often increase weight, sometimes leading to
drug discontinuation. The potentially positive side effect of topiramate,
as noted in the table, is significant weight loss.
There have been several reports of cognitive
difficulties with topiramate in mood disorder, including word-finding
difficulties, confusion, and decreased attention; these could be related
to the blocking of AMPA receptors. Paresthesias (abnormal tingling sensations)
are seen in the hands and
peri-oral regions in patients receiving topiramate (due to its inhibition of carbonic anhydrase). A very small
percentage of epilepsy patients (1-2%) report the occurrence of renal stones
with topiramate, also related to carbonic anhydrase inhibition.
Other adverse side effects of topiramate in
affective disorder patients noted in the literature include inducing
depression (3 cases), inducing mania (1 case), and inducing bilateral
acute angle-closure glaucoma** (1 case).
** Note: If you are taking
topiramate and experience difficulty with vision, eye pain, or eye
discomfort you should see your physician immediately. **
6
McIntyre RS, Mancini DA, McCann S, Srinivasan J,
Sagman D, Kennedy SH (2002). Topiramate versus bupropion SR when added to
mood stabilizer therapy for the depressive phase of bipolar disorder: a
preliminary single-blind study. Bipolar Disorders 4: 207-213.
7 Vieta E, Sanchez-Moreno J, Goikolea
JM, Torrent C, Benabarre A, Colom F, Martinez-Aran A, Reinares M, Comes M,
Corbella B (2003). Adjunctive topiramate in bipolar II disorder. World J Biol
Psychiatry 4: 172-176.
8 Johnson BA, Ait-Daoud N, Bowden CL,
DiClemente CC, Roache JD, Lawson K, Javors MA, Ma JZ (2003). Oral topiramate
for treatment of alcohol dependence: a randomised controlled trial. Lancet
361: 1677-1685.
Click here to go to
Ortho-McNeil Pharmaceutical Topiramate website
Click here to see table of
topiramate studies in mood disorders
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