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Sanjay Gupta, M.D., Prakash S. Masand, M.D., Bradford L. Frank, M.D., M.P.H., Kari L. Lockwood, R.N., and Peggy L. Keller, R.N., C., M.S.

You are watching: Do bipolar meds make you gain weight


From the room of Psychiatry, Olean basic Hospital, Olean (Dr. Gupta); the room of Psychiatry, SUNY Upstate clinical University at Syracuse, Syracuse (Drs. Gupta and Masand); the department of Psychiatry, college of Buffalo, Buffalo (Dr. Gupta); the department of Psychiatry, WCA Hospital, jamestown (Dr. Frank); the Research and also Education Division, Psychiatric Network, Olean (Ms. Lockwood); and also Cattaraugus County continuing Day treatment Program, Olean, N.Y. (Ms. Keller).
Reprint requests to: Sanjay Gupta, M.D., Research and Education division of Psychiatric Network, 2221 W. State St., Olean, NY 14760.

Background: Although beneficial in bipolar disorder, mood stabilizers, such together lithium, divalproex sodium, and also carbamazepine, can cause significant weight gain.

Method: We conducted a retreat chart review of 5 patients with DSM-IV bipolar disorder or schizoaffective disorder that were treated v topiramate together adjunctive treatment or monotherapy.

Results: every 5 patients had a an excellent response to therapy at a typical topiramate sheep of 195 mg/day (range, 100–375 mg/day). All patients shed a an extensive amount of load on topiramate treatment. The mean weight loss was 22 lb (10 kg; range, 8–56 lb [4–25 kg]). Nobody of the patients discontinued topiramate because of side effects.

Conclusion: Topiramate might represent a beneficial alternative to existing the atmosphere stabilizers, either as an adjunct or as monotherapy in patients v bipolar disorder or schizoaffective disorder.


Weight get is a common and also important side impact of numerous psychotropic drugs. Weight acquire puts the patience at risk for hypertension, coronary love disease, form 2 diabetes mellitus, dyslipidemia, and also cancer. Boosted weight deserve to lead to noncompliance v an raised risk that relapse and subsequent rehospitalization.1 atmosphere stabilizers, consisting of lithium and valproic acid, can lead to load gain. In a double-blind, regulated study that valproic mountain for the maintenance treatment of bipolar disorder, weight acquire of more than 7% to be reported in 4% that patients taking placebo, 16% of patients treated v lithium, and also 23% treated with valproic acid.2 atypical antipsychotics, specifically clozapine and also olanzapine, are associated with far-reaching weight gain.3,4 In a recent meta-analysis by Allison et al.,5 after 10 main of treatment, the typical weight gain with clozapine to be 4.45 kg and also with olanzapine, 4.1 kg. Nemeroff6 reported the the mean weight get after 1 year the treatment through olanzapine was 11.8 kg.

Topiramate is a more recent antiepileptic drug that blocks sodium channels, similar to carbamazepine and valproate, and also potentiates γ-aminobutyric acid (GABA) neuroinhibition, comparable to valproate. Topiramate also antagonizes the glutamate results at non–N-methyl-d-aspartate (non-NMDA) receptors and inhibits particular isoenzymes of carbonic anhydrase.7 peak topiramate levels are reached within 1.75 to 4.3 hrs after oral administration. The relative bioavailability that the medicine from the tablet form is 80% compared with a solution. Food decreases the rate however not the degree of absorption of topiramate. The drug has actually linear pharmacokinetics and has just 9% to 17% plasma protein binding. Topiramate extensively binds to red blood cells. The typical elimination half-life is 18.7 come 23 hours. Seventy percent of one administered sheep is excreted in the to pee unchanged. Topiramate is metabolized via hydroxylation, hydrolysis, and also glucuronidation. No correlation with plasma levels is known, and also hence over there is no clinical point out to measure them.

Common side results of topiramate encompass sedation, fatigue, diplopia, dizziness, ataxia, psychomotor slowing, an obstacle with concentration, anorexia, headache, decided problems, memory problems, nystagmus, and paresthesias. Topiramate is classified as a pregnancy classification C drug. It may lead to diminished effectiveness of some dental contraceptives. The full daily dosage suggested in epilepsy is 400 mg/day in separated dosages; however, no clear recommendations have actually yet been offered for bipolar disorder. In patients with renal impairment, half the usual adult dosage is suggested.8

Several studies have demonstrated the efficacy the topiramate in the treatment of bipolar disorder, including refractory populations, and in the therapy of posttraumatic tension disorder.7,9–12 Topiramate led to considerable weight ns in patients with bipolar disorders in this studies. The efficacy the topiramate as an adjunct therapy in patients through mood disorders has been demonstrated. Marcotte7 uncovered that 11 the 18 patients with refractory bipolar disorder (types I and II) comment to a median dose that 200 mg/day the topiramate after 8.5 weeks of treatment. Chengappa et al.10 treated 20 patients with bipolar ns disorder or schizoaffective disorder v adjunctive topiramate (mean sheep = 210.5 mg/day) over a 5-week period. Twelve patient (60%) responded to topiramate, and also the time to response ranged native 2 come 4 weeks. Disadvantage events included paresthesias, anorexia, slowed thinking, fatigue, sedation, and word-finding difficulty. Fifty-five percent of patient reported no disadvantage effects. Only 1 patient discontinued the study prematurely since of “acute confusional states.” Wooten and Kramer11 provided high-dose topiramate come treat 8 patients v bipolar disorder, schizoaffective disorder, or schizophrenia. The median dosage to be 868 mg/day in split doses (range, 50–2000 mg/day). Sixty percent of patients responded come topiramate. One patient competent mild paresthesia, and also 2 patients proficient transient delirium at high sheep (1600 and also 2000 mg/day).

Kusumakar et al.9 cure 27 mrs patients with a DSM-IV diagnosis of bipolar I and also bipolar II disorder who had been refractory come at the very least 2 the atmosphere stabilizers and who had actually a weight get of more than 20% end the vault 24 months with topiramate (100–150 mg/day). Fifteen of the 27 patient showed far-ranging improvement, and only 4 patients discontinued due to the fact that of adverse events. Fourteen patients lost weight during the 16-week study. Nine patients experienced a load loss of much more than 5%.

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We define a case collection of 5 patients that were treated with topiramate either together an adjunct or as monotherapy who experienced innovation in mood symptoms as well as comprehensive weight loss.