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Adjunctive topiramate treatment in refractory obese bipolar patients: A descriptive open label study

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Abstract

OBJECTIVES: To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refractory bipolar patients. METHOD: Patients (n=30) with Bipolar I or II, were provided with an open label treatment with topiramate as an add-on therapy. All patients deemed refractory to at least one mood stabilizer, were overweight, and were treated with topiramate as an adjuvant to existing medication for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression Scale (CGI). Other scales included the Young’s Mania Rating Scale (YMRS), and the Hamilton Depression scale (HAMD21). Measures prior to adding topiramate were compared to those repeated at 4, 8 and 12 weeks. Tolerance, and weight changes were monitored. RESULTS: There was significant reduction in both depressive and manic symptoms with adjunctive treatment. The mean BMI at 12 weeks of topiramate treatment dropped by 2 points (p<0.0001). CONCLUSION: Topiramate is an effective adjunctive treatment in bipolar refractory patients and the significant weight reduction effects may result in important medical risk reductions, and make topiramate attractive for some obese bipolar patients.

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References

  1. Bowden C.L., Calabrese J.R., McElroy S.L., Gyulai L., Wassef A., Petty F., Pope H.G. Jr, Chou J.C., Keck P.E. Jr, Rhodes L.J., Swann A.C., Hirschfeld R.M., Wozniak P.J.: A randomised placebo-controlled 12 months trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch. Gen. Psychiatry, 57, 481–489, 2000.

    Article  PubMed  CAS  Google Scholar 

  2. Chengappa R.K.N., Gershon S., Levine J.: The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder. Bipolar Disorders, 3, 215–232, 2001.

    Article  PubMed  CAS  Google Scholar 

  3. Thase M.E., Sachs G.S.: Bipolar depression, pharmacotherapy and related therapeutic strategies. Biol. Psychiatry, 48, 558–572, 2000.

    Article  PubMed  CAS  Google Scholar 

  4. Dunn R.T., Frye M.S., Kimbrell T.A., Denicoff K.D., Leverich G.S., Post R.M.: The efficacy and use of anticonvulsants in mood disorders. Clin. Neuropharmacol., 21, 215–235, 1998.

    PubMed  CAS  Google Scholar 

  5. Dubovsky S.L., Buzan R.D.: Novel alternatives and supplements to lithium and anticonvulsants for Bipolar Affective Disorder. J. Clin. Psychiatry, 58, 224–242, 1997.

    Article  PubMed  CAS  Google Scholar 

  6. Nemeroff C.B.: An ever-increasing pharmacopoeia for the management of patients with bipolar disorder. J. Clin. Psychiatry, 13 (Suppl. 61), 19–25, 2000.

    Google Scholar 

  7. Vieta E., Sanchez-Moreno J., Goikolea J.M., Colom F., Martinez-Aran A., Benabarre A., Corbella B., Torrent C., Comes M., Reinares M., Brugue E.: Effects on weight and outcome of long-term olanzapine-topiramate combination treatment in bipolar disorder. J. Clin. Psychopharmacol., 24, 374–378, 2004.

    Article  PubMed  CAS  Google Scholar 

  8. Ketter T.A., Wang P.W., Tate D.L., Rennicke C.M., Hier A.M., Strong C.M.: Low dose adjunctive topiramate attenuates weight gain in bipolar disorder patients. The international J. Neuropsychopharmacol., 3 (Suppl. 1), S344, 2000.

    Google Scholar 

  9. Garonna F., Stifani L.: Topiramate in the treatment of overweight/obese binge eaters. Int. J. Neuropsychopharmacol., 3, S299, 2000.

    Google Scholar 

  10. Bahk W.M., Shin Y.C., Woo J.M., Yoon B.H., Lee J.S., Jon D.I., Chung S.K., Choi S.K., Paik I.H., Pae C.U.: Topiramate and divalproex in combination with risperidone for acute mania: a randomized open-label study. Prog. Neuropsychopharmacol. Biol. Psychiatry, 29, 115–121, 2005.

    Article  PubMed  CAS  Google Scholar 

  11. Marken P.A., Pies R.W.: Emerging treatments for bipolar disorder: safety and adverse effect profiles. Ann. Pharmacother., 40, 276–285, 2006, Epub 2006 Jan.

    Article  PubMed  CAS  Google Scholar 

  12. Calabrese J.R., Keck P.E. Jr, McElroy S.L., Shelton M.D.: A pilot study of topiramate as monotherapy in the treatment of acute mania. J. Clin. Psychopharmacol., 21, 340–342, 2001.

    Article  PubMed  CAS  Google Scholar 

  13. Bozikas V.P., Petrikis P., Kourtis A., Youlis P., Karavatos A.: Treatment of acute mania with topiramate in hospitalized patients. Prog. Neuro-Psychopharmacol. Biol. Psychiatry, 26, 1203–1206, 2002.

    Article  CAS  Google Scholar 

  14. Arnone D.: Review of the use of Topiramate for treatment of psychiatric disorders. Ann. Gen. Psychiatry, 4, 5, 2005.

    Article  PubMed  Google Scholar 

  15. Kushner S.F., Khan A., Lane R., Olson W.H.: Topiramate monotherapy in the management of acute mania: Results of four double-blind placebo controlled trials. Bipolar Disord., 8, 15–27, 2006.

    Article  PubMed  CAS  Google Scholar 

  16. Delbello N.R., Kushner S., Wang D., Olson W.H., Capece J.A., Fazzio L., Rosenthal N.R.: A pilot controlled trial of topiramate in mania in children and adolescents with bipolar disorder. J. Am. Acad. Child Psychiatry, 44, 259–547, 2005.

    Article  Google Scholar 

  17. Vasudev K., Macritchie K., Geddes J., Watson S., Young A.: Topiramate for acute affective episodes in bipolar disorder. Cochrane Database Syst. Rev., 25, CD003384, 2006.

    Google Scholar 

  18. Kusumakar V., Lakshmi N., Yatham M.B., O’Donovan C.A., Kutcher S.P.: Topiramate in rapid cycling bipolar women. In: 152nd Annual Meeting of the American Psychiatric Association, Washington, DC, 1999.

    Google Scholar 

  19. Marcotte D.: Use of Topiramate, a new anti-epileptic as a mood stabiliser. J. Affect. Disord., 50, 245–251, 1998.

    Article  PubMed  CAS  Google Scholar 

  20. McIntyre R.S., Riccardelli R., Bender C., Kusumakar V.: Open-label adjunctive topiramate in the treatment of unstable bipolar disorder. Can. J. Psychiatry, 50, 415–422, 2005.

    PubMed  Google Scholar 

  21. Vieta E., Torrent C., Garcia-Ribas G., Gilabert A., Garcia-Pares G., Rodriguez A., Cadevall J., Garcia- Castrillon J., Lusilla P., Arrufat F.: Use of topiramate in treatment-resistant bipolar spectrum disorders. J. Clin. Psychopharmacol., 22, 431–435, 2002.

    Article  PubMed  CAS  Google Scholar 

  22. Chengappa R.K.N., Rathore D., Levine J., Atzert R., Solai L., Parepally H., Levin H., Moffa N., Delaney J., Brar J.S.: Topiramate as add-on treatment for patients with bipolar mania. Bipolar Disord., 1, 42–53, 1999.

    Article  PubMed  CAS  Google Scholar 

  23. Grunze H.C., Normann C., Langosch J., Schaefer M., Amann B., Sterr A., Schloesser S., Kleindienst N., Walden J.: Antimanic efficacy of topiramate in 11 patients in an open trial with an on-off design. J. Clin. Psychiatry, 62, 464–468, 2001.

    Article  PubMed  CAS  Google Scholar 

  24. McIntyre R.S., Konarski J.Z., Wilkins K., Soczynska J.K., Kennedy S.H.: Obesity in bipolar disorder and major depressive disorder: Results from a national community health survey on mental health and wellbeing. Can. J. Psychiatry, 51, 274–280, 2006.

    PubMed  Google Scholar 

  25. Cassidy F., Ahearn E., Carroll B.J.: Elevated frequency of diabetes mellitus in hospitalized manic depressive patients. Am. J. Psychiatry, 156, 1417–1420, 1999.

    PubMed  CAS  Google Scholar 

  26. Bray G.A., Hollander P., Klein S., Kushner R., Levy B., Fitchet M., Perry B.H.: A 6-month randomized, placebo- controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes. Res. 11, 722–733, 2003.

    Article  PubMed  CAS  Google Scholar 

  27. M.I.N.I. SCREEN 5.0.0 / English version / DSM-IV 1/1/05 ″ 2001–2005 Sheehan DV & Lecrubier Y. All rights reserved. D. Sheehan, J. Janavs, R. Baker, (University of South Florida-Tampa, USA): Y. Lecrubier, T. Hergueta, E. Weiller, (INSERM-Paris, France). T. Proeschel.

  28. National Institute of Mental Health. CGI: Clinica Global Impression. In: Guy W., Bonato R.R., (eds.), Manual for the ECDEU Assessment battery. 2.Rev ed. Chevy Chase, MD, National Institute of Mental health, 1970, 12–1–12–6

    Google Scholar 

  29. Young R.C., Biggs J.T., Ziegler V.E., Meyer D.A.: A rating scale for mania: reliability, validity, and sensitivity. Br. J. Psychiatry, 133, 429–435, 1978.

    Article  PubMed  CAS  Google Scholar 

  30. Hamilton M.: A rating scale for depression. J. Neurol. Neurosurg. Psychiatry, 23, 56–62, 1960.

    Article  PubMed  CAS  Google Scholar 

  31. Goldberg J.F., Burdick K.E.: Cognitive side effects of anticonvulsants. J. Clin. Psychiatry 62 (Suppl. 14), 27–33, 2001.

    PubMed  CAS  Google Scholar 

  32. McIntyre R.S., Mancini D.A., MCann S., Srinivasan J., Sagman D., Kennedy S.H.: Topiramate versus bupropion SR, when added to a mood stabilizer therapy for depressive phases of bipolar disorder: a preliminary single-blind study. Bipolar Disord., 4, 207–213, 2002.

    Article  PubMed  CAS  Google Scholar 

  33. Carpenter L.L., Leon Z., Yasmin S., Price L.H.: Do obese depressed patients respond to topiramate? A retrospective chart review. J. Affect. Disord., 69, 251–255, 2002.

    Article  PubMed  CAS  Google Scholar 

  34. Colditz G.A., Willett W.C., Rotnitzky A., Manson J.E.: Weight gain as a risk factor for clinical diabetes in women. Ann. Intern. Med., 122, 122–486, 1995.

    Article  Google Scholar 

  35. Hussain M.Z., Chaudhry Z.A., Hussain S.: Topiramate in treatment of refractory bipolar depression. Bipolar Disord. 3, 43, 2001.

    Google Scholar 

  36. Hoopes S.P., Reimherr F.W., Hedges D.W., Rosenthal N.R., Karim M., Karim R., Capece J.A., Karvois D.: treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 1:improvement in binge and purge measures. J. Clin. Psychiatry, 64, 1335–1341, 2003.

    Article  PubMed  CAS  Google Scholar 

  37. McElroy S.L., Arnold L.M., Shapira N.A., Keck P.E., Rosenthal N.R., Karim M.R., KArim M., Hudson J.I.: Topiramate in the treatment of binge eating disorder associated with obesity: a randomized placebo-controlled trial. Am. J. Psychiatry, 160, 255–261, 2003.

    Article  PubMed  Google Scholar 

  38. Bray G.A., Hollander P., Klein S., Kushner R., Levy B., Fitchet M., Perry B.H.: A 6 month randomized, placebo- controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes. Res., 11, 722–733, 2003.

    Article  PubMed  CAS  Google Scholar 

  39. Johnson B.A., Anita-Daoud N., Bowden C.L., DiClemente C.C., Roache J.D., Lawson K., Javors M.A., Ma J.Z.: Oral treatment for alcohol dependence: a randomized controlled trial. Lancet, 361, 1677–1685, 2003.

    Article  PubMed  CAS  Google Scholar 

  40. Brandes J.L., Saper J.R., Diamond M., Couch J.R., Lewis D.W., Schmitt J., Neto W., Schwabe S., Jacobs D.: Topiramate for migraine prevention: A randomized- controlled trial. JAMA, 29, 965–973, 2004.

    Article  Google Scholar 

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  1. Airport Business Center, University of Calgary, 2000 Pegasus Road NE, Calgary, AB, T2E 8K7, Canada

    Adel Gabriel MD, FRCPC, DPM, DPIP (Clinical Assistant Professor & Consultant Psychiatrist)

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Correspondence to Adel Gabriel MD, FRCPC, DPM, DPIP.

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Gabriel, A. Adjunctive topiramate treatment in refractory obese bipolar patients: A descriptive open label study. Eat Weight Disord 12, 48–53 (2007). https://doi.org/10.1007/BF03327772

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