Open-label adjunctive topiramate in the treatment of bipolar disorders

McElroy, Susan L.; Suppes, Trisha; Keck, Paul E.; Frye, Mark A.; Denicoff, Kirk D.; Altshuler, Lori L.; Brown, E. Sherwood; Nolen, Willem A.; Kupka, Ralph; Rochussen, Jennifer; Leverich, Gabriele S.; Post, Robert M.

doi:10.1016/s0006-3223(99)00316-9

Cited by 185 publications

(105 citation statements)

References 24 publications

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“…[63][64][65][66] Rigorously performed, controlled trials, however, failed to find any benefit from use of this drug in bipolar disorder. 67 Topiramate has been commonly prescribed for patients with bipolar disorder, not only because of the expectation that it will prove to be efficacious, but also because of its weight-reducing effects, which are felt to be particularly desirable to counteract the weight gain induced by some other mood stabilizing agents (e.g., valproic acid).…”

Section: Topiramatementioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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Summary: Antiepileptic drugs (AEDs) are commonly utilized for nonepileptic conditions, including various psychiatric disorders and pain syndromes. Evidence for their benefit in these nonepileptic conditions varies widely among different drugs, but there is, in general, a paucity of published multicenter randomized double-blind trials. Variable levels of evidence suggest that lamotrigine and the vagal nerve stimulator have antidepressant properties. Carbamazepine, valproate, lamotrigine, and oxcarbazepine appear to have mood stabilizing properties while gabapentin, pregabalin, and tiagabine have anxiolytic benefits. Barbiturates, topiramate, and possibly phenytoin may precipitate or exacerbate depression. Underlying depression and anxiety symptoms may be exacerbated by levetiracetam, while psychotic symptoms have rarely been reported with topiramate, levetiracetam, and zonisamide. Pregabalin, gabapentin, carbamazepine, and oxcarbazepine have been used to treat neuropathic pain such as postherpetic neuralgia, and diabetic polyneuropathy. Topiramate and divalproex sodium have utility in the prophylaxis or acute treatment of migraine. Further rigorous studies are needed to clarify the utility of AEDs in nonepileptic conditions.

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Section: Topiramatementioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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“…In one study, CRH was observed to block NPYinduced feeding in rats, suggesting that CRH overrides the effect of NPY in this behavioral aspect (Heinrichs et al, 1993). Consequently, it is possible that the observed increase in CRH-LI may be of significance to the long-term appetite-suppressive effects of topiramate reported to humans (McElroy et al, 2000).…”

Section: Discussionmentioning

confidence: 98%

“…In addition to anticonvulsant efficacy, other major clinical observations have been made. Specifically, topiramate has antimanic and anticycling effects in bipolar patients (Calabrese et al, 2001;McElroy et al, 2000). In addition, topiramate treatment has been associated with appetite suppression and weight loss in patients, in particular in overweight individuals (McElroy et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, topiramate has antimanic and anticycling effects in bipolar patients (Calabrese et al, 2001;McElroy et al, 2000). In addition, topiramate treatment has been associated with appetite suppression and weight loss in patients, in particular in overweight individuals (McElroy et al, 2000). The mechanisms of action underlying these phenomena are not known, and thus animal models may provide means for investigating these questions.…”

Section: Introductionmentioning

confidence: 99%

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Topiramate Normalizes Hippocampal NPY-LI in Flinders Sensitive Line ‘Depressed’ Rats and Upregulates NPY, Galanin, and CRH-LI in the Hypothalamus: Implications for Mood-Stabilizing and Weight Loss-Inducing Effects

Husum

Kammen

Termeer

et al. 2003

Neuropsychopharmacol

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Topiramate is currently used in the treatment of epilepsy, but this anticonvulsant drug has also been reported to exert mood-stabilizing effects and induce weight loss in patients. Neuropeptide Y (NPY) is abundantly and widely distributed in the mammalian central nervous system and centrally administered NPY markedly reduces pharmacologically induced seizures and induces antidepressant-like activity as well as feeding behavior. Two other peptides, galanin and corticotropin-releasing hormone (CRH), have also been proposed to play a modulatory role in mood, appetite, and seizure regulation. Consequently, we investigated the effects of single and repeated topiramate (10 days, once daily: 40 mg/kg i.p.) or vehicle treatment in 'depressed' flinders sensitive line (FSL) and control Flinders resistant line (FRL) rats on brain regional peptide concentrations of NPY, galanin, and CRH. The handling associated with repeated injections reduced hippocampal levels of NPY-and galanin-like immunoreactivities (LI) while NPY-and CRH-LI levels were increased in the hypothalamus, regardless of strain or treatment. In the hippocampus, concentrations of NPY-LI, galanin-LI, and CRH-LI were lower in FSL than FRL animals. Repeated topiramate treatment selectively normalized NPY-LI in this region in the FSL animals. In the hypothalamus, galanin-LI was reduced in FSL compared to FRL animals. Topiramate elevated the hypothalamic concentrations of NPY-LI, CRH-LI, and galanin-LI in both strains. Furthermore, topiramate elevated serum leptin but not corticosterone levels. The present findings show that topiramate has distinct effects on abnormal hippocampal levels of NPY, with possible implications for its anticonvulsant and mood-stabilizing effects. Furthermore, stimulating hypothalamic NPY-LI, CRH-LI and galanin-LI as well as serum leptin levels may be associated with the weight loss-inducing effects of topiramate.

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“…It has also been proposed as a mood stabilizer for patients with bipolar disorders who have not responded to the traditional treatments [7][8][9] . Neuropsychiatric symptoms may emerge after the use of TPM, the most common complaints are: somnolence, dizziness, tiredness, ataxia, headache, depression, and cognitive impairment such as mental confusion, slow reasoning, speech difficulty, and disturbance of memory [10][11][12][13][14][15][16][17][18] .…”

mentioning

confidence: 99%

Acute psychotic disorders induced by topiramate: report of two cases

Stella

Caetano

Cendes

et al. 2002

Arq. Neuro-Psiquiatr.

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-We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.KEY WORDS: psychiatric disorders, hallucination, delusion, topiramate. Episódio psicótico agudo induzido por topiramato: relato de dois casosRESUMO -Relatamos dois pacientes epilépticos que manifestaram quadro psicótico agudo induzido por topiramato (TPM). Um paciente apresentou agitação psicomotora grave, heteroagressividade, alucinações auditivas e visuais, e delírios de conteúdo paranóide e místico. O outro paciente apresentou agitação psicomotora, despersonalização, desrealização, ansiedade intensa e delírio de que estava perdendo a memória. Ambos os pacientes foram conduzidos ao serviço de emergência e, após a interrupção do TPM em um deles e redução da droga em outro, houve remissão total dos sintomas psicóticos sem necessidade de medicação antipsicótica. Alertamos os clínicos para o risco de surgimento de sintomas psicóticos em pacientes em uso do TPM.

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Open-label adjunctive topiramate in the treatment of bipolar disorders

Cited by 185 publications

References 24 publications

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Topiramate Normalizes Hippocampal NPY-LI in Flinders Sensitive Line ‘Depressed’ Rats and Upregulates NPY, Galanin, and CRH-LI in the Hypothalamus: Implications for Mood-Stabilizing and Weight Loss-Inducing Effects

Acute psychotic disorders induced by topiramate: report of two cases

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