And a JAMA meta-analysis and review of several drugs that could cause weight loss found that Topamax led obese patients to lose at least 5 percent of their body weight after taking it for a year. And, again, there are those side effects, which every study seems to warn about. Another thing you should know: It would take some solid time to lose weight with this drug.
Would It Be A Horrible Idea To Still Be Interested In Taking It?
A lot of patients gain the weight back after they stop taking it. Potential side effects are the biggie here. While plenty of people take Topamax for its intended purpose and have no issues, others have pretty major ones. Weight Loss. This side effect is known with other mood-stabilizers such as valproate. If true, it is likely to be quite rare, as it has not been mentioned in previous papers, or listed as a side effect.
We submitted a report for a suspected adverse drug reaction to the Committee on Safety of Medicines in the UK.
One patient N 10 complained of paraesthesia, sore tongue and bad taste in her mouth and stopped topiramate during an earlier treatment on Figure 1 this coincides with an earlier short period of weight loss. She restarted it 7 months later as her weight had increased again by 5. This second start of treatment with topiramate is taken as day 0 for the purposes of this report, as it was of a longer duration and is still on-going. One patient N 2 complained of paraesthesia, later developed unsteadiness of gait and finally severe Parkinsonism, therefore most of her medications, including topiramate were stopped.
This patient was taking a number of psychotropic and cardiovascular drugs a total of nine! She recovered completely around 4 months later and no cause for her condition was identified, despite numerous investigations and consultations. We cannot exclude the possibility that topiramate was at least partially responsible, alone, or in combination with several other drugs, therefore we report this event here. Two patients complained of memory and concentration problems but preferred to continue with the medication despite this.
These side effects are also well recognised. One patient did not like the appetite suppressing effect of topiramate and stopped it after only one month, so his data is not analysed in the study. We do not perform regular formal ratings of the mood of our patients.
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However we regularly record their condition and changes since the previous appointment. Clear improvement of the course of illness was noticed only in one patient N 3 , while eight patients continued to display a similar pattern of illness, as they had done before the treatment. None of them was judged to have deteriorated.
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The patients in remission remained well. One patient N 12 whose carbamazepine was changed to topiramate developed a manic episode, therefore we stopped his topiramate after 6 months and asked him to resume carbamazepine. This is a naturalistic case-series and the absence of a placebo control group could have influenced the results. On the other hand, these patients had already made unsuccessful efforts to lose weight and, as can be seen on Figure 1 , their pre-topiramate weight had been either stable, or in most cases had increased steadily during the period of observation.
The weight-reducing potential of topiramate was impressive in 10 of the 12 patients and the effect was maintained for the duration of the observation, in most cases for more than one year.
Topiramate
These results are in keeping with a large body of evidence supporting the weight-losing potential of topiramate, as presented in the Background. In fact, we could not find a single study that reported a mean weight gain with topiramate. Only one patient N 10 had a weight gain or 0. Obesity is a very common problem in developed countries. Its prevalence in the USA is rising and has been estimated at Weight gain is even more prevalent in bipolar disorder patients [ 2 ]. The increased weight in this population is due to a number of factors, including life-style and diet, but a major cause is the side effect profile of the medications that are prescribed long-term for their illness.
If deaths due to suicide and accidents are excluded, there is still a substantially increased mortality in patients with mood disorders, which is due mostly to circulatory disorders [ 39 , 40 ]. Increased weight, high levels of smoking and reduced exercise are likely to be the main factors leading to such an increased mortality.
Health professionals cannot just give advice on diet and exercise to overweight patients, because the weight gain is to a large extent caused by the more sedentary life imposed by the illness, combined with the side effects of the majority of drugs they are prescribed. Psychiatrists should have a responsibility in managing obesity in their patients by choosing more appropriate drugs in patients prone to weight gain. This will bring several benefits: 1 It will improve the quality of life of their patients, as weight gain is among the most distressing side effects of psychotropic drugs [ 41 ].
Several studies, including this one, show that topiramate has a strong potential to induce weight loss which is sustained for at least one year. Despite the side effects reported in this and other studies, topiramate is generally well tolerated. Most of the patients in our series who complained of side effects, still preferred to continue the treatment, as they liked its overall effect. In our experience it is very unusual to have such a high rate of patients who continue to take a new medication.
The effect on memory and concentration should however receive closer examination in future studies. The main unanswered question is whether topiramate has any mood-stabilizing properties, like other anticonvulsants such as carbamazepine, valproate and lamotrigine. Open studies for maintenance treatment in bipolar disorder and in the acute treatment of mania have so far been encouraging as reviewed in the Background.
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However, four large unpublished placebo-controlled monotherapy trials failed to confirm the efficacy of topiramate in the treatment of acute mania cited in [ 35 ] , indicating a poor antimanic effect, at least in monotherapy. Our work was not designed to examine any mood-stabilizing properties of topiramate, as we did not use regular mood charts, the period of 12 months is too short to evaluate long-term benefits on the pattern of episodes, and there was no comparison group. In addition, many of our patients were already talking a combination of mood stabilizers without complete treatment effect, having failed to achieve a long-term stability on a variety of treatments that had been tried over the years.
In view of that, we did not expect any clear improvements in the mood or course of illness of this patient population. All we can conclude so far is that topiramate does not appear to be superior to other mood stabilizers in the long-term treatment of patients with treatment resistant affective disorders. One of our patients had a manic relapse after we changed his carbamazepine with topiramate he was also receiving regular lithium prophylaxis.
These two patients had refused to take other mood-stabilizing drugs for fear of weight gain and only agreed to take topiramate as monotherapy, having heard that it will not cause weight gain. Both of them suffered relapses of mania, which necessitated the addition of atypical antipsychotics and admission to hospital. Although these three observations are anecdotal, they strengthen the impression that topiramate monotherapy does not have antimanic effect.
Whether topiramate has any effect on the depressive side of bipolar illness is not yet know. Topiramate appears a very useful drug for weight reduction in patients with bipolar disorders. The mood stabilizing effect of topiramate is however questionable. The very different results obtained from the controlled monotherapy trials of topiramate in mania and the open add-on trials summarised in the Background indicate that topiramate should not be prescribed as monotherapy in bipolar disorders as it has no acute antimanic effect.
In our opinion the current place of topiramate in the treatment of affective disorders is as an add-on treatment for patients who experience clinically significant weight gain, which could either compromise their physical health, or influence them to stop taking established mood stabilizers. Topiramate should not be used in monotherapy and unless new research shows otherwise, psychiatrists should assume that it has no mood-stabilizing properties. Topiramate is known to cause neurocognitive side effects.
Psychiatrists should monitor their patients carefully for the emergence of such side effects. As with most other mood-stabilizers anticonvulsants and lithium , women who may become pregnant should be warned of the possible consequences of taking such drugs during pregnancy [ 37 ]. Patients should be advised to ensure adequate hydration, especially if they are predisposed to nephrolithiasis [ 37 ].
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J Clin Psychiatry. Nemeroff CB: Safety of available agents used to treat bipolar disorder: Focus on weight gain. Am J Psychiatry. Silverstone T, Romans S: Long term treatment of bipolar disorder. Fava M: Weight gain and antidepressants. Jallon P, Picard F: Body weight gain and anticonvulsants: a comparative review. Drug Safety. Google Scholar. Suppes T: Review of the use of topiramate for treatment of bipolar disorders. J Clin Psychopharmacol. Obes Res. Marcotte D: Use of topiramate, a new anti-epileptic as a mood stabilizer.
J Affect Disord. Biol Psychiatry. Guille C, Sachs G: Clinical outcome of adjunctive topiramate treatment in a sample of refractory bipolar patinets with comorbid conditions. Prog Neuropsychopharmacol Biol Psychiatry. Clin Ther. Bipolar Disord. Prog Neuropsychopharmacol Biol Psychaitry. Ann ClinPsychiatry. It works by decreasing appetite. Topiramate is in a class of medications called anticonvulsants.
It works by decreasing appetite and by causing feelings of fullness to last longer after eating. Phentermine and topiramate come as extended-release capsules to take by mouth. The medication is usually taken with or without food once a day in the morning. This medication may cause difficulty falling asleep or staying asleep if it is taken in the evening.
Take phentermine and topiramate at around the same time every day.