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Bipolar Medication Spotlight: Topamax (Topiramate)

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.

Bipolar Medication Spotlight: Topamax (Topiramate)

Candida Fink, MD

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APA Reference
Fink, C. (2008). Bipolar Medication Spotlight: Topamax (Topiramate). Psych Central. Retrieved on November 29, 2020, from


Last updated: 10 Oct 2008
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