Use of topiramate, a new anti-epileptic as a mood stabilizer

Rationale: Because some anti-epileptic drugs (AEDs) are effective in bipola r affective disorders, the new AED topiramate (TPM) may be effective in psy chiatric illnesses. TPM was evaluated in mood disorders refractory to previ ous therapies including newer AEDs. Methods: Charts of 58 consecutive patie nts, 39 outpatients (15 males, 24 females) and 19 inpatients (6 males, 13 f emales) were reviewed. TPM 25 mg. b.i.d. was added to existing therapy and titrated in 50 mg increments every 3-7 days. Improvement was rated on a Lik ert global assessment scale of marked, moderate, mild, or no improvement or worse, based on quality of sleep, appetite, mood, and concentration. Resul ts: Of the 58 patients with psychiatric disorders, 44 patients had rapid cy cling bipolar disorders characterized by manic, hypomanic, or mixed episode s. Eighteen patients had previously failed to respond to lamotrigine and/or gabapentin in addition to conventional mood stabilizers. Fourteen were Bip olar I, six Bipolar II, and seven mixed, ten patients had cyclothymic disor der, seven had bipolar disorder not otherwise specified. Of the remaining 1 4 patients, nine had schizoaffective disorder, three patients had dementia and two had psychosis. Mean duration of TPM treatment was 16.0 weeks; mean TPM dosage approximately 200 mg/day. Thirty-six of 58 (62%) patients exhibi ted marked or moderate improvement, usually within days or weeks. Twenty-th ree of 44 (52%) patients with bipolar affective disorders showed marked or moderate improvement. Minimal/no improvement was observed in 16; six were r ated as worse. Adverse events included delirium in one patient with Bipolar Disorder Type I who overmedicated with TPM (800 mg) and tranylcypromine su lfate (170 mg) combined with alcohol. Other adverse effects were minor and included: paresthesias, somnolence, fatigue, impaired concentration and mem ory, nausea, and diarrhoea. Limitations: This study was performed in a nonr andom open and retrospective fashion. Therefore, any findings are limited b y the design of this study. Conclusion: TPM may be useful in patients with mood disorders unresponsive to traditional therapy and warrants further cli nical investigation. (C) 1998 Elsevier Science B.V. All rights reserved.