Psychopharmacology

, Volume 179, Issue 4, pp 838–845 | Cite as

Differential effects of topiramate in patients with traumatic brain injury and obesity—a case series

  • Ornah T. Dolberg
  • Gaby Barkai
  • Yigal Gross
  • Shaul Schreiber
Original Investigation

Abstract

Rationale

Topiramate is an antiepileptic drug known to have effects on weight. In order to use this as a tool to treat eating disorders, it is useful to examine whether these effects can be predicted in certain patients.

Objectives

To report the effects of topiramate, initiated for the treatment of epilepsy, on top of ongoing treatment, on eating patterns and weight of 17 patients with traumatic brain injury (TBI) with post-traumatic epilepsy and weight gain of various etiologies.

Methods

Patients were followed up according to their usual treatment plan. Topiramate was added on top of current and stable treatment. Dose was titrated based on the patients’ neurological status. Patients were asked to report side effects. No other changes were made.

Results

Of the 17 patients included, one patient dropped out. Six patients with binge eating disorder (BED) demonstrated the most pronounced effects, with marked attenuation of binges and normalizing body mass index. Less noticeable were the effects in patients with mood disorders. Topiramate was ineffective in patients whose overweight was a side effect of their medication. Side effects were rated as mild and included somnolence, paresthesias, mild cognitive disturbances and some gastrointestinal disturbances.

Conclusions

In this report of the actual effects of topiramate in a clinical setting on weight and eating habits of 17 patients with TBI and obesity of various etiologies, topiramate seemed to be a safe intervention. Topiramate appeared to be differentially effective, with particular effects on primary pathological eating patterns.

Keywords

Binge eating disorder Obesity PTSD Post Traumatic Stress Disorder Topiramate Traumatic brain injury TBI Weight gain Epilepsy Side effects 

References

  1. Appolinario JC, Fontenelle LF, Papelbaum M, Bueno JR, Coutinho W (2002) Topiramate use in obese patients with binge eating disorder: an open study. Can J Psychiatry 47:271–273Google Scholar
  2. Birt, J (2003) Management of weight gain associated with antipsychotics. Ann Clin Psychiatry 15:49–58CrossRefGoogle Scholar
  3. Bray GA, Hollander P, Klein S, Kushner R, Levy B, Fitchet M, Perry BH (2003) A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes Res 11:722–733Google Scholar
  4. Calabrese JR, Keck PE, McElroy SL, Shelton MD (2001) A pilot study of topiramate as monotherapy in the treatment of acute mania. J Clin Psychopharmacol 21:340–342CrossRefGoogle Scholar
  5. Carpenter LL, Leon Z, Yasmin S, Price LH (2002) Do obese depressed patients respond to topiramate? A retrospective chart review. J Affect Disorder 69:251–255CrossRefGoogle Scholar
  6. Chengappa KNR, Gershon S, Levine J (2001a) The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder. Bipolar Disord 3:215–232Google Scholar
  7. Chengappa KNR, Levine J, Rathore D, Parepally H, Atzert R (2001b) Long-term effects of topiramate on bipolar mood instability, weight change and glycemic control: a case-series. Eur Psychiatry 16:186–190CrossRefGoogle Scholar
  8. Colom F, Vieta E, Benabarre A, Reinares M, Corbella B, Gasto C (2001) Topiramate abuse in a bipolar patient with an eating disorder. J Clin Psychiatry 62:475–476Google Scholar
  9. Dursun SM, Devarajan S (2000) Clozapine weight gain, plus topiramate weight loss. Can J Psychiatry 45:198Google Scholar
  10. Dursun, SM, Devarajan S (2001) Accelerated weight loss after treating refractory depression with fluoxetine plus topiramate: possible mechanism of action? Can J Psychiatry 46:50–51Google Scholar
  11. Erfurth A, Kuhn G (2000) Topiramate monotherapy in the maintenance treatment of bipolar I disorder: effects on mood, weight and serum lipids. Neuropsychobiology 42:50–51CrossRefGoogle Scholar
  12. Gordon A, Price LH (1999) Mood stabilization and weight loss with topiramate. Am J Psychiatry 156:968–969Google Scholar
  13. Lessig MC, Shapira NA, Murphy TK (2001) Topiramate for reversing atypical antipsychotic weight gain. J Am Acad Child Adolesc Psych 40:1364CrossRefGoogle Scholar
  14. McElroy, SL, Arnold LM, Shapira NA (2003) Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry 160:255–261CrossRefGoogle Scholar
  15. National Heart, Lung and Blood Institute (NHLBI) Obesity Task Force (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6:51–209Google Scholar
  16. Shapira NA, Goldsmith TD, McElroy SL (2000) Treatment of binge-eating disorder with topiramate: a clinical case series. J Clin Psychiatry 61:368–372Google Scholar
  17. Van Ameringen M, Mancini C, Pipe B, Campbell M, Oakman J (2002) Topiramate treatment for SSRI-induced weight gain in anxiety disorders. J Clin Psychiatry 63:981–984Google Scholar
  18. Wallace SJ (2001) Newer antiepileptic drugs: advantages and disadvantages. Brain Dev 23:277–283CrossRefGoogle Scholar
  19. Weiden PJ, MacKell JA, McDonnell DD (2003) Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res 66:51–57CrossRefGoogle Scholar
  20. Werneke U, Taylor D, Sanders TAB (2002) Options for pharmacological management of obesity in patients treated with atypical antipsychotics. Int Clin Psychopharmacol 17:145–160PubMedGoogle Scholar
  21. Young WB, Hopkins MM, Shechter AL, Silberstein SD (2002) Topiramate: a case series in migraine prophylaxis. Cephalalgia 22:659–663CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Ornah T. Dolberg
    • 1
    • 4
  • Gaby Barkai
    • 1
    • 2
  • Yigal Gross
    • 2
    • 3
  • Shaul Schreiber
    • 1
  1. 1.Department of Psychiatry, Tel Aviv Sourasky Medical Center and The Department of Psychiatry, Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.The Neuropsychiatric Unit for Treatment and RehabilitationTel AvivIsrael
  3. 3.Department of PsychologyBar Ilan UniversityGivat ShemuelIsrael
  4. 4.Lundbeck Israel Ltd.Petach TikvaIsrael

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