
- Vol 37, Issue 8
- Volume 37
- Issue 8
Topiramate in Bipolar Disorder and Comorbidities: The Myths and the Evidence
There are some off-label proposed uses for topiramate in comorbidities that are common in patients with bipolar disorder. What does the evidence say?
BIPOLAR UPDATE
There appears to be some confusion regarding the efficacy of topiramate in bipolar disorder. Some prescribers think it is effective for mania, depression, or simply for “mood.” The
There are some off-label proposed uses for topiramate in comorbidities that are common in patients with
Some patients with bipolar disorder who experience weight gain also have binge eating disorder (BED). There is only one FDA-approved medication for this: lisdexamfetamine. However, patients with bipolar disorder not currently on a good dose of a mood stabilizer and who have comorbid BED would likely not benefit from lisdexamfetamine or any other stimulant (nor with any antidepressant, some of which also have
Some substance abuse disorders (SUDs) may benefit from topiramate for prevention of relapse. There may be mild benefit in alcohol use disorder,5 and there are 2 positive studies of patients with
Several trials have examined the effect of topiramate on posttraumatic stress disorder (PTSD). In 2 studies, there was no difference from placebo, but 1 study conducted in Brazil on 70 civilian patients found a good effect size. The reduction in the Clinician-Administered PTSD scale was 58 on topiramate and 32 on placebo, p = 0.008.7
Three small placebo-controlled trials of topiramate at up to 200 mg daily in patients with borderline personality disorder (BPD) are all from the same research group in Germany/Austria.
Dr Osser is Associate Professor of Psychiatry, Harvard Medical School, and Consulting Psychiatrist, US Department of Veterans Affairs, National Telemental Health Center, Bipolar Disorders Telehealth Program, Brockton, MA. The author reports no conflicts of interest concerning the subject matter of this article.
References
1. Pigott K, Galizia I, Vasudev K, et al.
2. Dell’Oro VG, Belotti EA, Simonetti BG, et al. Metabolic disturbances and renal stone promotion on topiramate: a systematic review. Br J Clin Pharmacol. 2013;70(6):958-964
3. Narula PK, Rehan HS, Unni KES, Gupta N. Topiramate for the prevention of olanzapine associated weight gain and metabolic dysfunction in schizophrenia: a double-blind, placebo-controlled trial. Schizophr Res. 2010:118:218-223.
4. McElroy S, Hudson JI, Capece JA, et al.
5. Palpacuer C, Duprez R, Huneau A, et al. Pharmacologically Controlled Drinking in the Treatment of Alcohol Dependence or Alcohol Use Disorders: A Systematic Review with Direct and Network Meta-Analyses on Nalmefene, Naltrexone, Acamprosate, Baclofen and Topiramate. Addiction. 2018;113(2):220-237.
6. Singh M, Keer D, Klimas J, et al.
7. Yeh MSL, Mari JJ, Costa MCP, et al. A double-blind, randomized controlled trial to study the efficacy of topiramate in a civilian sample of PTSD. CNS Neurosci Ther. 2010;175:305-310.
8. Loew TH, Nickel MK, Muehlbacher M, et al.
9. National Institute for Clinical Excellence (NICE). Borderline Personality Disorder: Treatment and Management. January 28, 2009. Accessed July 13, 2020. www.
Articles in this issue
over 4 years ago
Suicidal Ideation and Behaviors in Oncology Patientsabout 5 years ago
Looking to the Future and Improving Patient Careabout 5 years ago
Case-Based Clinical Approaches for Cliniciansabout 5 years ago
Finding Meaning in the Face of Sufferingabout 5 years ago
To Scan or Not to Scan: Brain Imaging in First-Episode Psychosisabout 5 years ago
Cytochrome P450: You've Come a Long Wayabout 5 years ago
A Challenging Psychotherapeutic Journeyabout 5 years ago
A Double Whammy: Psychosis and Huntington DiseaseNewsletter
Receive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.