Bipolar Beat

Bipolar Medication Spotlight: Topamax (Topiramate)

By Candida Fink MD
October 10, 2008

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Topamax (topiramate) – an anti-seizure medication primarily used to help prevent the onset of migraines and epileptic seizures. It has also been found useful in curbing the weight gain commonly associated with other medications used to treat bipolar symptoms.

In other posts in the Bipolar Medication Spotlight series, we include a list of potential pros and cons the medication offers in the treatment of bipolar disorder, but Topamax really has a very short list of pros in relation to its use in treating other conditions that may play a role:

  • Potential weight loss without the often mood-stimulating effects of many weight loss medications. Some retrospective studies support the use of Topamax for weight reduction in people on psychiatric medications, but no well designed, placebo-controlled studies provide solid support for this practice. Even so, psychiatrists do use Topamax frequently in this manner and have found it to be helpful in this way.
  • Results from a recent study indicate that Topamax may provide a number of benefits to people who are heavy alcohol drinkers, including reducing the cravings and the actual consumption of alcohol, as well as improvement on a number of physical and psychosocial health measures.

For a period of time, there was hope that Topamax would reduce mood symptoms and/or cycles, but studies haven’t supported Topamax’s usefulness in reducing cycling or symptoms of depression or mania. Doctors rarely prescribe it as a sole treatment for mania or depression.

Although most people tolerate Topamax, it does have some drawbacks and potential negative side effects:

  • More common side effects, including tingling in arms and legs, loss of appetite, tiredness, nausea, diarrhea, taste change, weight loss, and clumsiness or unsteadiness.
  • Cognitive-related problems, including impaired memory, concentration, or attention, and language problems. This family of side effects is one of the most common reasons for patients stopping Topamax.
  • A potentially serious problem with increased pressure in the eyes is a rare side effect of Topamax. Call your doctor immediately if you experience eye pain or vision problems, which could lead to blindness if not treated soon.
  • Reduced sweating is also rare but potentially quite dangerous – especially in hot weather. Always keep well hydrated and dress lightly in hot weather, but contact your prescriber if you believe that your sweat production has decreased.
  • Kidney stones are a potentially painful and serious side effect. Back pain, pain on urination, and difficulty urinating should be reported immediately to the prescriber.
  • Metabolic acidosis – increased acidity in the blood that can quickly become a medical emergency – is rare, but possible, in someone taking Topamax. Symptoms of acidosis may include fatigue, hyperventilation, loss of appetite, irregular heartbeat, or changes in the level of alertness. Call your doctor immediately if you experience these symptoms. Medications called carbonic anhydrase inhibitors – which are used in certain respiratory, eye, and kidney diseases, can increase the risk of this outcome. Baseline and periodic blood tests to monitor this are suggested when you are taking this medication.
  • Recently the FDA has released warnings about the possibility of the development of suicidal ideation on a number of anti-seizure medications, including Topamax. This was more common in people taking the medication for epilepsy, rather than other conditions, but it should still be mentioned in thinking about Topamax.
  • Topamax can have negative mood effects such as agitation and anxiety.
  • A severe metabolic problem called hyperammonemia is possible in people taking both Depakote and Topamax and can be monitored through blood tests.
  • Possible reduction in the effectiveness of oral contraceptives.

Caution: Make sure you’re receiving the correct medication from your pharmacy. Some cases have been reported in which Topamax has been confused with Toprol-xl (metoprolol succinate extended-release tablets), a heart and blood pressure medication.
If you’re pregnant or planning on becoming pregnant, tell your doctor and discuss the possible risks of taking Topamax when pregnant or breastfeeding.

For additional information on the potential benefits of using Topamax, visit the Ortho-McNeil-Janssen Pharmaceuticals, Inc. Topamax site.

Caution: Never stop taking any medication cold turkey, especially an anti-seizure medication. Withdrawing an anti-seizure medication too quickly can actually cause seizures. Always consult your doctor before you stop or decrease your medication.

If you’ve taken Topamax for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.


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Links to This Article

From Psych Central's :
Mood Stabilizers for Bipolar Disorder - Psych Central (January 14, 2009)

18 Comments to
“Bipolar Medication Spotlight: Topamax (Topiramate)”

I have started on Topamax & am trying to decrease Abilify as that seems to be the culprit in my weight gain (I KNOW; I KNOW–”weight neutral”–just ask around my support group & see how “weight neutral” Abilify is).

It is a wonderful medication in that it stopped my delusional thinking, paranoia & allowed me to finally participate fully in therapy & “get somewhere.” But after gaining 50 lbs. in 10 years on Abilify the benefits did not outweigh the negatives: Now on meds for high blood pressure & cholesterol; just testing in the range for diabetes so will have to see if I have to go on medication for that & worst of all is the impact on my marriage.

My husband announced he no longer finds me sexually attractive & (lots of low self-esteem here) I overdosed when I heard that remark so decreasing Abilify & adding Topamax to try to promote weight loss. But the emotional devastation of an overdose after being stable for 5 years & the already in the gutter self-esteem (how can it get any lower? Well, it can) is really doing a trick on me.

Been dxed “mixed-moderate” for the 2 years since the overdose. Meds being adjusted. Adding Topamax, trying to get off Abilify. Can’t quite seem to do it. Paranoia sets in & I have to increase the Abilify for 2 weeks to knock it out.

So I don’t know yet if the Topamax has been given a “chance” to work on decreasing the eating or appetite. As far as the memory problems, etc. I got that from other meds before & I just have kissed spelling, math skills, memory, creativity good-bye.

Hope to eventually get off the Abilify or stay on the low dose of 5 mg & let the Topamax do its “wonder.”

I am a retired physician who have had problems similar to yours.. TOPAMAX, however, is not the answer. It caused severe paranoia, delusional thinking, psychosis and more than I can share. Smith Kline has had multiple reports but have NOT reported them to the FDA. I know because I have spoken to them.

I was on Topamax for about 6 months. 150mg. I had sleepiness (which slowly went away, severe tingling in my left leg and foot! But I have nerve damage from a blown disc soooo.
I really liked it though. It seem to really help and the side effects where barably. The tingling was the only irrating one. It did curb my eating and seem to help my mood swings.
The only reason I went off of it was the PRICE! Even with insurance it still ran me 150 bucks a month! without insurance it would have been $450! I am on a budget and just couldn’t keep paying for it. IF they come out with a generic I will defiantly go back on it!

I was untreated bi-polar and I was spinning out of control. I am 15 and I was going downhill. Topamax in the first few days made me less anxious, less confrontational, more rational, happier, I’m losing weight. I’m not nervously eating. The only problem I have is I need to eat on a schedual because I forget to eat. I’m understanding my schoolwork more. I’m considering this my drug of choice. I was prescribed Topamax because I was experiancing headaches of drastic measures and handtremors. I was an insomniac. And I was chronically depressed. I’m much happier now. =] I’ve heard it isn’t for everyone. I take 25mg in the morning and 50mg at night. And it works rather well.

I have been taking Topamax for 10 months and it has done a great job of keeping me out of depression but not so great at keeping me out of mania. When we added 300mg of Lithium ER to the 300mg of Topamax the mania leveled out. I have not felt any side effects except weight loss; I really cannot tell I take it except for the weight loss. I’m down 35 pounds this year but adding the Lithium stopped the weight loss and began a bit of a gain.

Oh man, I LOVE Topamax! I was originally put on it for migraines, but it not only helped my migraines but masked my mania… a little too well. I went to a psychiatrist because I was depressed, and she gave me an antidepressant… which erm, triggered a crazy manic episode. Anyways. We’ll see how it goes with my *new* bipolar meds, which is why I’m looking up all of this info on its bipolar uses as well. Anyways. SO! But I love topamax. I don’t care that the side effects are horrible because it cures migraines and the side effects go away eventually. Oh, and you lose your appetite. But that whole psychosis inducing thing is crap. I’ve about looked on every forum, comment, community thing on the web and not seen a single thing about anything like that. O.o That’s what I wanted to say.

I was prescribed topomax a few years ago. I took it for two years. I, too, previously suffered from very regularly migraine headaches prior to taking topomax. In addition, I lost over 120 lbs of weight over that two year period. I do believe that it helped with mood stabilization and anxiety though I can’t be one hundred percent sure because I was also prescribed so many combinations of different drugs. I stopped taking all of my medication over three years ago and have managed the illness fairly well. I am, however, now seeking a doctor to help. I am not advising or condoning self management. However, I do believe the success I’ve experienced in the past three years demonstrates that medication is not the end all, be all.

I just started Topiramate again for alcohol abuse. I began using it last year and started with 25mgs. But now my doctor started me with 50mgs and I am experiencing more of the side effects than I remember. I’m getting the dizziness, tingly feelings, and slight depression (although I have suffered from depression for over 15 years so it could just be an episode). I was just wondering if this side effects go away after some time. The dizziness and tingly feelings are not that big of a deal but the depression concerns me. And being only at 50mg, I’m concerned about dosing up to 300mg which is supposedly where I am supposed to get to.

When I first started Topomax, I felt like I had been ‘plugged in’ to a wall jack the intensity of the tingling was enormous. For a week or two afterwards, I experienced numb and tingling hands, my lips would ‘vibrate’ and I even felt the tingling in my face.

Those symptoms lightened up significantly but the memory problems were terrible. I actually had to ask my stepson when my birthday was while filling out paperwork at the doctors office. That was the final straw, so I requested the pdoc take me off of it. I’m now on Seroquel and Prozac and am stable for the most part.

When I first started Topomax, I felt like I had been ‘plugged in’ to a wall jack because of the intensity of the tingling–it flooded my whole body. For a week or two afterwards, I experienced numb and tingling hands, my lips would ‘vibrate’ and I even felt the tingling in parts of my face.

Those symptoms lightened up significantly but the memory problems were terrible. I actually had to ask my stepson when my birthday was while filling out paperwork at the doctors office. That was the final straw, so I requested my pdoc take me off of it. I’m now on Seroquel and Prozac and am stable for the most part.

I was on topamax for 7yrs it damaged my teeth but it really worked for me.I was taken off it and i haven’t been the same i can a reck

Sorry,I am a wreck

I have been on topamax for over a month now and already lost 15 lbs. It was perscribed to me for migranes and has somewhat helped with those for the most part but the weight loss has been the best part of all! I hate all the other side effects though! Sometimes I wonder if the medicine itself isn’t making me crazy! I felt drunk all the time at first and now i just feel hung ove all the time. I am forgetful and snappy and I vairly remember what to do day to day. I have a lot of stress going on around me so its hard to determine if it’s the medication or just other things! But it did help lower the number of days and the severness of the migranes and help with extreme weight loss! Goooo Topamax!…..Oh and You can get topamax for $5 a month now if you visit Topamax.com until December 31, 2009…you can print out a coupon..I ran across the coupon the other day for those of you who do now have health insurance!

I have been on Topamax for over 6 years and am stable. After researching Topamax while in my Masters program for social work, I asked my doc to put me on the drug. We had previously tried every other mood stabilizer, which did little to stop the mania/depression symptoms of my Bipolar II Dx.

As with any medication, each one works differently for each individual and you must take it at the same time each day. You must also ensure you are eating healthy, as well as exercising as much as you can (when you have the energy), and getting enough rest. I still find that when I deprive myself of sleep due to stressful events in my life, I tend to get overly anxious or crash into a depression.

There are still those who believe Topamax does not work for BP affected individuals, but if you are like me and take care of yourself, you will indeed see positive results. You do need to advocate for yourself though. Because as my doctor tells me again and again, “patients make the best doctors.” Why? Because we know our bodies better than anyone else. So listen to what your’s is telling you.

P.s. As of June 2009, there is a generic (Topiramate) available.

Candice-
I have had bipolar for 12 yrs and have taken Topomax not so much as a mood stabalizer but to curb appetite. In looking back I think it did help curb appetite, but did nothing for mood. But, I have diff
diagnosis than you do. Good to know there is generic now, may just push dr to prescribe. He is very stubborn though, wish me luck!

I am 33 and have suffered from severe mood issues for as long as I can remember. Diagnosed with severe depression at age 16, started taking antidepressants and have struggled my entire life to find stability. Last year, my excellent Dr. diagnosed me bipolar, prescribed me topamax and I am a whole new woman. It has made an incredible difference in my life. I am stable for the first time in my life. I can be a mom, a wife, a professional and not be stuck in my head or freaking out all the time. I sleep through the night. I don’t have panic attacks. I can have professional disagreements without freaking out. It has REALLY helped me…then my work switched insurance companies and the new company denied covering Topamax or the generic for mood stabilization because it is not FDA approved for this yet…it is a nightmare. I would love to visit the insurance company after being off the meds. for a week or two…

Topamax is a miracle drug for my bipolar. I have only taken for a couple of months and have lost 14 pounds. My moods have levelled out. I am no longer a nervous wreck all the time and have to pop benzos all day. My headaches have also gone away mysteriously, but I thought that was just a sinus thing. The side effects are: I can’t drink anything carbonated, it tastes flat and salty (which is weird), I can’t concentrate, I have become as dumb as a box of rocks, my dr has me on strattera for that now. The strattera hasn’t started working yet. I can’t eat, I feel nauseous all the time and I get dizzy a lot. But these are all worth being mentally and emotionally stable and the weight loss is awesome especially since I also have hypothyroidism.

I have been on Topamax for 2.5 years. I am bipolar. The side effects either went away or I just got used to them. I lost about 20lbs. My weight now stablizes. My life was not manageable before Topamax. I now have a career, family, friends, I have gone back to school and so on. I do have my “bad days” but I can get through them now. Topama is my life saver, my miracle drug.

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Candida Fink, M.D. and Joe Kraynak are authors of Bipolar Disorder for Dummies. Pick up the book today!
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