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You are watching: Bipolar medication that causes weight loss

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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., as well as Peggy L. Keller, R.N., C., M.S.
From the Division of Psychiatry, Olean General Medical Facility, Olean (Dr. Gupta); the Division of Psychiatry, SUNY Upstate Medical College at Syracuse, Syracuse (Drs. Gupta as well as Masand); the Division of Psychiatry, College of Buffalo, Buffalo (Dr. Gupta); the Division of Psychiatry, WCA Medical Facility, Jamestown (Dr. Frank); the Research Study as well as Education And Learning Department, Psychiatric Network, Olean (Ms. Lockwood); as well as Cattaraugus Area Continuing Day Therapy Program, Olean, N.Y. (Ms. Keller).
Reprint demands to: Sanjay Gupta, M.D., Research Study and also Education And Learning Department of Psychiatric Network, 2221 W. State St., Olean, NY 14760.


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History: Although beneficial in bipolar affective disorder, state of mind stabilizers, such as lithium, divalproex salt, and also carbamazepine, can trigger substantial weight gain.

Approach: We carried out a retrospective graph evaluation of 5 people with DSM-IV bipolar illness or schizoaffective problem that were treated with topiramate as adjunctive treatment or monotherapy.

Outcomes: All 5 clients had a great feedback to therapy at a mean topiramate dosage of 195 mg & #x 0002f; day (variety, 100 & #x 02013; 375 mg & #x 0002f; day). All people shed a considerable quantity of weight on topiramate therapy. The ordinary weight management was 22 pound (10 kg; array, 8 & #x 02013; 56 pound & #x 0005b; 4 & #x 02013; 25 kg & #x 0005d;-RRB-. Since of side impacts, none of the individuals stopped topiramate.

Final thought: Topiramate might stand for an important choice to existing state of mind stabilizers, either as a complement or as monotherapy in people with bipolar illness or schizoaffective condition.


Weight gain is a vital as well as typical adverse effects of numerous psychotropic medicines. Weight gain places the client in danger for high blood pressure, coronary cardiovascular disease, kind 2 diabetic issues dyslipidemia, cancer cells, as well as mellitus. Raised weight can cause disobedience with a boosted danger of regression and also succeeding rehospitalization.1 State of mind stabilizers, consisting of lithium as well as valproic acid, can cause weight gain. In a double-blind, regulated research study of valproic acid for the upkeep therapy of bipolar illness, weight gain of greater than 7 & #x 00025; was reported in 4 & #x 00025; of individuals taking sugar pill, 16 & #x 00025; of individuals treated with lithium, and also 23 & #x 00025; treated with valproic acid.2 Irregular antipsychotics, specifically clozapine and also olanzapine, are related to substantial weight gain.3,4 In a current meta-analysis by Allison et al.,5 after 10 weeks of therapy, the mean weight gain with clozapine was 4.45 kg and also with olanzapine, 4.1 kg. Nemeroff6 reported that the mean weight gain after 1 year of therapy with olanzapine was 11.8 kg.

Topiramate is a more recent antiepileptic medicine that obstructs salt networks, comparable to carbamazepine as well as valproate, as well as additionally potentiates & #x 003b3;-aminobutyric acid (GABA) neuroinhibition, comparable to valproate. Topiramate additionally annoys the glutamate impacts at non & #x 02013; N -methyl-d-aspartate (non-NMDA) receptors as well as hinders particular isoenzymes of carbonic anhydrase.7 Peak topiramate degrees are gotten to within 1.75 to 4.3 hrs after dental management. The loved one bioavailability of the medication from the tablet type is 80 & #x 00025; compared to an option. Food lowers the price however not the degree of absorption of topiramate. The medication has straight pharmacokinetics as well as has just 9 & #x 00025; to 17 & #x 00025; plasma healthy protein binding. Topiramate thoroughly binds to red cell. The typical removal half-life is 18.7 to 23 hrs. Seventy percent of a provided dosage is secreted in the pee the same. Topiramate is metabolized through hydrolysis, hydroxylation, and also glucuronidation. No connection with plasma degrees is recognized, as well as for this reason there is no scientific indicator to gauge them.

Usual adverse effects of topiramate consist of sedation, exhaustion, diplopia, lightheadedness, ataxia, psychomotor slowing down, trouble with focus, anorexia nervosa, migraine, speech issues, memory issues, nystagmus, as well as paresthesias. Topiramate is categorized as a maternity classification C medication. It might bring about reduced efficiency of some oral contraceptive pills. The overall day-to-day dose recommended in epilepsy is 400 mg & #x 0002f; day in split does; nonetheless, no clear suggestions have actually yet been provided for bipolar illness. In individuals with kidney disability, half the normal grown-up dose is recommended.8

Numerous research studies have actually shown the efficiency of topiramate in the therapy of bipolar illness, consisting of refractory populaces, as well as in the therapy of posttraumatic tension condition.7,9 & #x 02013; 12 Topiramate resulted in significant weight-loss in individuals with bipolar affective disorders in these research studies. The efficiency of topiramate as an accessory therapy in individuals with state of mind conditions has actually been shown. Marcotte7 located that 11 of 18 clients with refractory bipolar illness (kinds I and also II) replied to a mean dosage of 200 mg & #x 0002f; day of topiramate after 8.5 weeks of therapy. Chengappa et al. 10 cured 20 individuals with bipolar I condition or schizoaffective condition with adjunctive topiramate (mean dosage & #x 0003d; 210.5 mg & #x 0002f; day) over a 5-week duration. Twelve people (60 & #x 00025;-RRB- reacted to topiramate, as well as the moment to action varied from 2 to 4 weeks. Negative occasions consisted of paresthesias, anorexia nervosa, reduced reasoning, word-finding, sedation, as well as exhaustion problem. Fifty-five percent of people reported no damaging results. Due to the fact that of & #x 0201c; severe confusional states, just 1 individual terminated the research study too soon. & #x 0201d; Wooten as well as Kramer11 made use of high-dose topiramate to deal with 8 clients with bipolar affective disorder, schizoaffective problem, or schizophrenia. The mean dose was 868 mg & #x 0002f; day in separated dosages (variety, 50 & #x 02013; 2000 mg & #x 0002f; day). Sixty percent of clients reacted to topiramate. One individual experienced moderate paresthesia, as well as 2 individuals experienced short-term ecstasy at high dosages (1600 and also 2000 mg & #x 0002f; day).

Kusumakar et al. 9 dealt with 27 women people with a DSM-IV medical diagnosis of bipolar I as well as bipolar II condition that had actually been refractory to a minimum of 2 state of mind stabilizers as well as that had a weight gain of greater than 20 & #x 00025; over the previous 24 months with topiramate (100 & #x 02013; 150 mg & #x 0002f; day). Fifteen of the 27 individuals revealed substantial enhancement, and also just 4 people stopped as a result of unfavorable occasions. Fourteen individuals dropped weight throughout the 16-week research. 9 people experienced a weight management of greater than 5 & #x 00025;.

We explain an instance collection of 5 individuals that were treated with topiramate either as a complement or as monotherapy that experienced enhancement in state of mind signs in addition to considerable weight management.