We do not perform regular formal ratings of the mood of our patients. However we regularly record their condition and changes since the previous appointment. Clear improvement of the course of illness was noticed only in one patient N 3 , while eight patients continued to display a similar pattern of illness, as they had done before the treatment. None of them was judged to have deteriorated. The patients in remission remained well. One patient N 12 whose carbamazepine was changed to topiramate developed a manic episode, therefore we stopped his topiramate after 6 months and asked him to resume carbamazepine.
This is a naturalistic case-series and the absence of a placebo control group could have influenced the results. On the other hand, these patients had already made unsuccessful efforts to lose weight and, as can be seen on Figure 1 , their pre-topiramate weight had been either stable, or in most cases had increased steadily during the period of observation.
The weight-reducing potential of topiramate was impressive in 10 of the 12 patients and the effect was maintained for the duration of the observation, in most cases for more than one year. These results are in keeping with a large body of evidence supporting the weight-losing potential of topiramate, as presented in the Background. In fact, we could not find a single study that reported a mean weight gain with topiramate. Only one patient N 10 had a weight gain or 0. Obesity is a very common problem in developed countries.
Its prevalence in the USA is rising and has been estimated at Weight gain is even more prevalent in bipolar disorder patients [ 2 ]. The increased weight in this population is due to a number of factors, including life-style and diet, but a major cause is the side effect profile of the medications that are prescribed long-term for their illness.
If deaths due to suicide and accidents are excluded, there is still a substantially increased mortality in patients with mood disorders, which is due mostly to circulatory disorders [ 39 , 40 ]. Increased weight, high levels of smoking and reduced exercise are likely to be the main factors leading to such an increased mortality. Health professionals cannot just give advice on diet and exercise to overweight patients, because the weight gain is to a large extent caused by the more sedentary life imposed by the illness, combined with the side effects of the majority of drugs they are prescribed.
Psychiatrists should have a responsibility in managing obesity in their patients by choosing more appropriate drugs in patients prone to weight gain. This will bring several benefits: 1 It will improve the quality of life of their patients, as weight gain is among the most distressing side effects of psychotropic drugs [ 41 ]. Several studies, including this one, show that topiramate has a strong potential to induce weight loss which is sustained for at least one year. Despite the side effects reported in this and other studies, topiramate is generally well tolerated.
Most of the patients in our series who complained of side effects, still preferred to continue the treatment, as they liked its overall effect. In our experience it is very unusual to have such a high rate of patients who continue to take a new medication. The effect on memory and concentration should however receive closer examination in future studies.
The main unanswered question is whether topiramate has any mood-stabilizing properties, like other anticonvulsants such as carbamazepine, valproate and lamotrigine. Open studies for maintenance treatment in bipolar disorder and in the acute treatment of mania have so far been encouraging as reviewed in the Background. However, four large unpublished placebo-controlled monotherapy trials failed to confirm the efficacy of topiramate in the treatment of acute mania cited in [ 35 ] , indicating a poor antimanic effect, at least in monotherapy.
Our work was not designed to examine any mood-stabilizing properties of topiramate, as we did not use regular mood charts, the period of 12 months is too short to evaluate long-term benefits on the pattern of episodes, and there was no comparison group. In addition, many of our patients were already talking a combination of mood stabilizers without complete treatment effect, having failed to achieve a long-term stability on a variety of treatments that had been tried over the years.
In view of that, we did not expect any clear improvements in the mood or course of illness of this patient population. All we can conclude so far is that topiramate does not appear to be superior to other mood stabilizers in the long-term treatment of patients with treatment resistant affective disorders. One of our patients had a manic relapse after we changed his carbamazepine with topiramate he was also receiving regular lithium prophylaxis.
These two patients had refused to take other mood-stabilizing drugs for fear of weight gain and only agreed to take topiramate as monotherapy, having heard that it will not cause weight gain. Both of them suffered relapses of mania, which necessitated the addition of atypical antipsychotics and admission to hospital.
Although these three observations are anecdotal, they strengthen the impression that topiramate monotherapy does not have antimanic effect. Whether topiramate has any effect on the depressive side of bipolar illness is not yet know. Topiramate appears a very useful drug for weight reduction in patients with bipolar disorders. The mood stabilizing effect of topiramate is however questionable.
The very different results obtained from the controlled monotherapy trials of topiramate in mania and the open add-on trials summarised in the Background indicate that topiramate should not be prescribed as monotherapy in bipolar disorders as it has no acute antimanic effect.
In our opinion the current place of topiramate in the treatment of affective disorders is as an add-on treatment for patients who experience clinically significant weight gain, which could either compromise their physical health, or influence them to stop taking established mood stabilizers.
Topiramate should not be used in monotherapy and unless new research shows otherwise, psychiatrists should assume that it has no mood-stabilizing properties. Topiramate is known to cause neurocognitive side effects.
Psychiatrists should monitor their patients carefully for the emergence of such side effects. As with most other mood-stabilizers anticonvulsants and lithium , women who may become pregnant should be warned of the possible consequences of taking such drugs during pregnancy [ 37 ].
Patients should be advised to ensure adequate hydration, especially if they are predisposed to nephrolithiasis [ 37 ]. J Clin Psychiatry. Article PubMed Google Scholar. Nemeroff CB: Safety of available agents used to treat bipolar disorder: Focus on weight gain. Am J Psychiatry. Silverstone T, Romans S: Long term treatment of bipolar disorder. Fava M: Weight gain and antidepressants. Jallon P, Picard F: Body weight gain and anticonvulsants: a comparative review.
Drug Safety. PubMed Google Scholar. Google Scholar. Suppes T: Review of the use of topiramate for treatment of bipolar disorders. J Clin Psychopharmacol. Obes Res. Marcotte D: Use of topiramate, a new anti-epileptic as a mood stabilizer. J Affect Disord.
Biol Psychiatry. The mechanisms underlying the effect of topiramate on lowering HbA1c and FBS of diabetic patients are not clear yet. Several studies have demonstrated whole-body insulin sensitivity following topiramate treatment although this would have been expected considering the over-all effect on glucose control. The most common adverse responses to topiramate were paresthesia and amnesia: Side effects that were realized early on in the study.
Most of the patients stated that these effects are not much a problem and tried to comply with the study. These results were unique and have not been seen in any studies.
The main limitations of this study were its short duration and the small sample size due to the non-co-operation state of some subjects. We recommend more studies with narrower inclusion criteria and larger sample size with different conditions with a long duration of follow-up in Iran and other middle to low income counties. Topiramate may be effective in improving metabolic parameters associated with obesity and glycemic control in diabetes type two patients.
Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Res Med Sci. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Abstract Background: Obesity has been associated with several co-morbidities such as diabetes and increased mortality. Materials and Methods: This was a week randomized clinical trial study of 69 subjects during Conclusion: Topiramate induced weight loss and improved glycemic control in obese, diabetic patients. Keywords: Obesity, topiramate, type 2 diabetes. Open in a separate window. Ethics Before including any individual in our study, all subjects signed a consent form stating that they willing to participate in our study.
Efficacy end points The primary efficacy end point was the percent change in BMI at the end of the study. Assesments Weight, height and blood pressure measurements for each patient were taken according to the appropriate scales Richter Inc. RESULT Baseline characteristics At the end of the study, 69 patients 21 male and 48 female were assessed as intention to treat ITT population; 39 in the topiramate group and 30 in the placebo group. Figure 1. Figure 2. Other diabetes markers Systolic and diastolic blood pressure and hemoglobin A1C HgA1C levels were evaluated in all patients.
Table 2 Blood pressure and hemoglobin A1C in ITT subjects, a comparison between drug and placebo groups; bolded P values are significant. Table 3 Lipid profile in ITT subjects, a comparison between drug and placebo groups. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. Obesity, diabetes, and exercise associated with sleep-related complaints in the American population. Z Gesundh Wiss. Read next. July 18, Receive an email when new articles are posted on.
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Perspective Back to Top Steven R. Processed foods, refined carbohydrates, sugar, and alcohol are all examples of foods that can cause weight gain. Fresh fruits, vegetables, and high-quality proteins like salmon, beans, and eggs are all great examples of foods that the body can easily process and get vital nutrients from. According to the Centers for Disease Control and Prevention CDC , exercise not only helps control weight, but it reduces high blood pressure, reduces the risk of Type 2 diabetes, and can even reduce the symptoms of depression and anxiety.
Some great exercises for weight loss include walking, biking, swimming, and weight training. Stress is linked to many health problems such as anxiety and depression.
Feeling stressed can lead to emotional eating, which can lead to weight gain over time. Finding ways to reduce stress may help you lose weight. You might try meditating, yoga, going for walks, or calling a friend or family member. You can also ask your doctor or a counselor for proven ways to reduce stress that will fit into your lifestyle.
According to the Sleep Foundation , a lack of sleep may increase the appetite and lead to metabolic problems. Getting enough sleep can help your body function properly and give you more energy to do things like exercise, which will help you lose weight.
Getting enough sleep can also reduce your stress levels, which will help you control any urges you might get to overeat. Singh says. The mindset is the most important thing. Medications cannot serve as a substitute for proper eating and exercising habits.
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