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Topamax for a mood disorder?

Discussion in 'Therapy and Medication' started by playdeaddear, Apr 28, 2008.

  1. playdeaddear

    playdeaddear Member

    My family has a history of mental illness and I was recently hospitalized in a behavioral health center for substance abuse, depression, anger and suicidal thoughts. I have ADHD, a mood and anxiety disorder as well as insomnia and weekly "sleep paralysis". I was put on Wellbutril XL a few years ago but it made me extremely angry so stopped taking it. They put me on 200 mg of Topamax a day at the hospital. Got out today. Been taking it for 2 weeks and still haven't felt any change, just a bunch of tingling in my hands and feet. I'm giving it time though.

    Anyone else take it for a mood disorder or anything else? Whats your thoughts on it?
  2. ~PinkElephants~

    ~PinkElephants~ Senior member

    umm i was given topamax years ago for headaches not for mood disorders.are you sure they are giving you the right stuff? :blink:
  3. nedflanders

    nedflanders Well-Known Member

    Topamax is a bit of an oddball prescription for depression or ADHD. It's an anticonvulsant, developed initially to treat epilepsy. It has been found to be a fairly effective preventive medication for migraine. It's a bit of an oddball drug in general, and like a lot of older drugs, its mechanism of action isn't terribly well understood.

    However, it has been used off-label to treat bipolar disorder, and I wouldn't be surprised if that's what the pshrinks at the hospital were thinking in your case.

    About a quarter of topamax patients experience the numbness or tingling that you describe. It has a happy side effect of inducing weight loss in 10-15% of the population. But about 5% of patients drop topamax treatment because it makes them feel spacey.

    What surprises me is that your pshrinks had you go immediately to 200mg/day. Topamax is generally ramped up slowly over 4-6 weeks. Going faster is more likely to leave you feeling loopy.

    Let us know how you progress. I, for one, am curious.
  4. playdeaddear

    playdeaddear Member

    my mother takes it for migraines as well, but its also used in high doses as a mood stabilizer.

    NOTE: Topiramate is only approved for the
    treatment of people with seizures. There are
    few systematic studies that establish the safety
    or efficacy of topiramate as a treatment
    for people with mood disorders, PTSD, or eating
    disorders While such studies are underway, what
    is currently known about the use of topiramate
    for the control of mood disorders, PTSD and eating
    disorders comes mostly from uncontrolled case reports.


    1. What is topiramate (Topamax)?

    Topiramate is an anticonvulsant that is chemically unrelated to any other anticonvulsant or mood regulating medication. The mechanism of action is unknown.


    2. When was topiramate approved for marketing in the USA and for what indications may it be promoted?

    topiramate received final approval for marketing in the USDA on 24 December 1996 and is labeled for use as an anticonvulsant.


    3. Is a generic version of topiramate available?

    There is no generic topiramate as the manufacturer has patent protection.


    4. How does topiramate differ from other mood stabilizing drugs?

    Topiramate differs from other mood stabilizing drugs in two major ways:

    1. topiramate's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;

    2. topiramate's unique side-effect profile.


    5. What, if anything, uniquely distinguishes topiramate from carbamazepine and valproate?

    Topiramate has been successful in controlling rapid cycling and mixed bipolar states in people who have not received adequate relief from carbamazepine and/or valproate.


    6. People with what sorts of disorders are candidates for treatment with topiramate?

    It is too early to be very specific about which mood disorders are most likely to respond to treatment with topiramate. There are just about no published reports on topiramate's use in psychiatry. Patients with hard-to-treat bipolar syndromes have been treated more often than patients with "treatment-resistant" unipolar disorders.

    Topiramate seems especially useful when it comes to treating people who have become manic as the result treatment with lamotrigine.

    There has recently been a report regarding the control of the symptoms of PTSD by topiramate.

    Topiramate has also been successfully used to decrease binge eating and overeating that is caused by other psychiatric medications.


    7. Is topiramate useful for the treatment of acute depressed, manic and mixed states, and can it also be used to prevent future episodes of mania and/or depression?

    The initial use of topiramate was to treat people with depressed, manic rapid-cycling, and mixed states that did not respond to existing medications. Some patients are now being maintained on topiramate on a long term basis in an attempt to prevent future episodes. The effectiveness of topiramate as a long-term prophylactic agent is currently being established.


    8. Are there any laboratory tests that should precede the start of topiramate therapy?

    Before topiramate is prescribed the patient should have a thorough medical evaluation, including blood and urine tests, to rule out any medical condition, such as thyroid disorders, that may cause or exacerbate a mood disorder.


    9. How is treatment with topiramate initiated?

    Topiramate is usually initially prescribed at an initial dose of 12.5 -25 mg once or twice a day and the total daily dose is increased by 12.5 - 25 mg every week. When prescribed in addition to other anticonvulsants being used as mood stabilizers, the final dose is often between 100 and 200 mg per day. Some patient with Bipolar Disorder do well on as little as a total daily dose of 50 mg/day. When used for the control of the symptoms of PTSD the average final dose is about 175 mg/day (with a range of 25 - 500 mg/day).


    10. Are there any special problems prescribing topiramate for people taking lithium, carbamazepine (Tegretol), or valproate (Depakene, Depakote)?

    An interaction between lithium and topiramate has not been reported.

    Carbamazepine and valproate both have the ability to lower plasma levels of topiramate . . . carbamazepine by about 50% and valproate by about 15%. Topiramate has no effect on the plasma level of carbamazepine but can reduce the plasma level of valproate by about 10%. Pharmacokinetic interactions between topiramate and either lamotrigine (Lamictal) or gabapentin (Neurontin) have not been reported.


    11. What is the usual final dose of topiramate?

    When used as a mood-stabilizing agent the final dose of topiramate is most often between 50 and 200 mg/day. Some people require doses as high as 400 mg/day to achieve a good mood stabilizing effect . . . especially when topiramate is being used as a monotherapy . . . while others do fine on 25 mg/day.


    12. How long does it take for topiramate to 'kick-in?'

    While some people notice the antimanic and antidepressant effects early in treatment, others have to take a therapeutic amount of topiramate for up to a month before being aware of a significant amount of improvement.


    13. What are the side-effects of topiramate?

    Here is a listing of topiramate's side effects that affected 10% or more of the 711 people taking the drug during clinical trials and the frequency of those side effects in the 419 people treated with placebo in those trials:

    Common Adverse Reactions (%)
    (Topiramate = 200 mg/day)

    Adverse Reaction Topiramate Placebo

    Somnolence 30 10
    Dizziness 28 14
    Vision problems 28 9
    Unsteadiness 21 7
    Speech problems 17 3
    Psychomotor slowing 17 2
    "Pins and needles" 15 3
    Nervousness 16 8
    Nausea 12 6
    Memory problems 12 3
    Tremor 11 6
    Confusion 10 6
  5. bobo

    bobo Member

    I was on it for 6 months for bipolar disorder. Was taking 600 mg a day. Honestly, all I got from it was the tingling feet and sometimes hands. I have been told that using Topamax for mood disorders is called "off label prescribing". It means the original purpose of the drug is not being used. I wouldn't give it more than 6-8 weeks. If no real effect, ask for a change. Good luck.
  6. playdeaddear

    playdeaddear Member

    Yea, I walked around the hospital(it has carpet hallways) once barefooted and the nurse yelled "girl you're gonna get a foot fungus!!". About 30 minutes later my foot got a sharp tingling feeling in the heel of it and I thought I got a foot fungus. Later I found out it was a side effect. Lol.

    I feel no effect. My depression and manic episodes are actually worse =/
  7. rwillson

    rwillson Well-Known Member

    made me loose weight, but otherwise i was a zombie...

  8. ggg456

    ggg456 Guest

    best zombie medicine out there. i thought i was dustin hoffman in the graduate it was that bad :laugh: it wasn't nice.