Before wading into the muddy waters of whether Topamax is effective for bipolar disorder, let’s look at one thing that everybody can agree on: Topamax causes weight loss. In terms of efficacy, TCR‘s reading of the literature is that Topamax is probably not effective as monotherapy for acute mania, but that it works pretty well as adjunctive therapy for treatment resistant bipolar disorder. While TCR often slams drugs that have no better quality of evidence than this, we have to admit that there is an impressive number of published trials, and that the results are pretty consistently positive for Topamax (1). The typical result is that Topamax add-on results in improvement in 50-60% of patients. Susan Mc Elroy and her colleagues at the University of Cinncinatti devised a study to see whether adding Topamax to the existing regimens of bipolar patients would make any difference (2). These patients were then regularly assessed with standard rating scales, and the mean duration of treatment was about 7 months; the average final dose of Topamax was 245 mg QD. The results were fairly dramatic, in that adjunctive Topamax worked great for the 63% of patients who entered the study with hypomanic, manic, or mixed symptoms, but it didn’t do much of anything for most of the patients with bipolar depression. The bottom-line from the Mc Elroy study: use Topamax as add-on for your bipolar patients when they have some manic component to their presentation; it’s unlikely to be helpful when they are depressed. A nice chart review published by Marcotte and colleagues reviewed the results of adding Topamax to the regimens of 58 treatment refractory patients, most of whom had either bipolar disorder or schizoaffective disorder, and 44 of whom were rapid cyclers (3).
The depressive episode may include these symptoms: This can make the symptoms and suicide risk worse. Depression and mania symptoms may occur together. Talk to family members about your symptoms and overall health. With medicines, you may begin to feel better. Or side effects from the medicines may occur. As a result, you may be tempted to stop taking your medicine or change the way you are taking them. Ask family members or friends to help you take medicines the right way. You will need regular visits with a psychiatrist to talk about your medicines and their possible side effects. People who are in the middle of a severe manic or depressive episode may need to stay in a hospital until they are stable and their behavior is under control. Joining a support group may help you and your loved ones. Involving family members and caregivers in your treatment may help reduce the chance of symptoms returning. Watch for the return of symptoms, and know what to do when they return. They may also have problems with relationships, school, work, and finances. You are not taking medicine the right way.
0.2 kg in 12 weeks) [ 9 ] and perhaps similar weight gain to the second generation antipsychotics [ 10 , 11 ]. Clozapine and olanzapine have been associated with the greatest weight gain, but significant weight gain has also been reported with quetiapine and risperidone. PHARMACOLOGICAL INTERVENTIONS FOR WEIGHT GAIN WITH ANTIPSYCHOTICS AND MOOD STABILIZERS. Given the increased cardiovascular risk of sibutramine and concern for potential to worsen psychosis, these agents cannot be recommended for the treatment of antipsychotic-related weight gain. The impact of norepinephrine reuptake inhibitors on weight gain was small (1.3 kg), only marginally significant, and with potential for adverse cardiovascular effects on heart rate and blood pressure. Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. Topiramate for prevention of olanzapine associated weight gain and metabolic dysfunction in schizophrenia: a double-blind, placebo-controlled trial. Metformin for prevention of weight gain and insulin resistance with olanzapine: a double-blind placebo-controlled trial. A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. A randomized, double-blind, placebo-controlled trial of metformin treatment for weight gain associated with initiation of risperidone in children and adolescents. Nizatidine for the treatment of patients with quetiapine-induced weight gain. Metformin plus sibutramine for olanzapine-associated weight gain and metabolic dysfunction in schizophrenia: a 12-week double-blind, placebo-controlled pilot study. Amantadine for weight gain associated with olanzapine treatment.
If dose too high side effects increase, may increase appetite. Lithium is the best studied and may also treat unipolar depression. Depakote may best help rapid cycling and mixed mania/depression. Lamotrigine may help non-Bipolar depression too. All these may help migraines and nerve pain (gabapentin). Depakote and Lithium may increase weight somewhat. Avoid with Depakote and increase dose slowly.
Bipolar in children and teens , mixed bipolar disorder , bipolar symptoms , schizophrenia , cyclothymia , mental health , bipolar 1 , depression , managing mania , ADD/ADHD , rapid cycling bipolar , bipolar 2. Doctors use a number of different classes and brands of drugs to treat bipolar disorder. Treatment for bipolar mania may include lithium , certain anticonvulsants, antipsychotics, and sometimes benzodiazepines. This is called maintenance therapy for bipolar disorder . Lithium and other mood stabilizers, certain antipsychotic drugs that treat bipolar depression , and sometimes antidepressants are used to treat bipolar depression . Mood stabilizers are medicines that treat and prevent highs (manic or hypomanic episodes) and lows (depressive episodes).
Lithium is extremely helpful for most patients and it significantly reduces the rate of hospitalizations in bipolar disorder. Because lithium is eliminated from the body by the kidneys, any drugs or dietary factors that slow the kidneys' actions may increase lithium blood levels and should be used with great caution. They also may be used in combination with lithium, atypical antipsychotics, or other drugs. Lamotrigine (Lamictal) may be used for maintenance treatment of adults with bipolar I disorder, for patients with rapid cycling, and for bipolar II disorder, in whom depression remains problematic after taking other mood stabilizer. Antiseizure drugs can increase the risk for suicidal thoughts and behavior as soon as 1 week after starting drug therapy. Olanzapine was the first atypical antipsychotic approved for treatment and longterm maintenance of bipolar disorder. Symbyax, a drug that combines olanzapine and the antidepressant fluoxetine is approved for treatment of bipolar depression. Ariprazole and risperidone are also approved for the acute treatment of mania and mixed episodes in children ages 10 - 17 with bipolar I disorder. Quetiapine is approved for treatment of bipolar mania and bipolar depression, making it the only drug approved for treating both manic and depressive states. The risk is highest for olanzapine, and lowest for aripiprazole and ziprasidone. Particularly with olanzapine, increased risk for high levels of trigylcerides and total cholesterol. High levels can cause menstrual abnormalities and may increase the risk for osteoporosis and possibly breast cancer. Patients with risk factors for diabetes (obesity, family history of diabetes) should undergo fasting blood sugar testing at the beginning of atypical antipsychotic treatment and periodically during treatment. This side effect is uncommon and tends to occur in patients with eating disorders (anorexia or bulimia) or those with risk factors for seizures. Dry mouth, which can increase the risk for cavities and mouth sores.
Weight gain occurs in about 25% of patients, and ranges from 4.5 to 12 kg over the course of long-term treatment. Weight gain occurs in 20- 25% of patients, and ranges from 3-10 kg over 3-12 months, but one study reported a mean weight gain of 21 kg in 11 of 22 epileptic women over 7 years. CBZ has been shown to cause moderate weight gain in studies of epilepsy, but this has been less prominent in studies of bipolar disorder. One study of bipolar patients reported a mean weight gain of 0.9-3 kg after 12 weeks of treatment. In many large studies, lamotrigine has been shown to produce no weight gain. Haloperidol, molindone, loxapine, and pimozide cause little or no weight gain in most patients.
In addition, the reference lists of identified studies were screened. Study designs of evaluations included in the review. Specific interventions included in the review. Participants included in the review. Outcomes assessed in the review. How were decisions on the relevance of primary studies made? The author did not state how the papers were selected for the review, or how many reviewers performed the selection. The author did not state how the data were extracted for the review, or how many reviewers performed the data extraction. For each study, where possible, the weight gain plus a measure of variance and the p-value for the statistical significance of the treatment effect of the drug of interest compared with the control were tabulated. How were the studies combined? The number of studies which reported statistically significant or clinically relevant changes in weight was reported; where possible, effect sizes were pooled across similar studies. ‘Clinically relevant’ was not defined in the review. Differences between the studies were described in the narrative summary. The studies were grouped by intervention and duration of treatment . Results of the review.
Mood Stabilizers for Bipolar Disorder – Effects and Side Effects. 6 Seeking Help from the List of Mood Stabilizers for Bipolar Disorder. Mood stabilizers for bipolar disorder are much needed to reduce or completely manage the symptoms and effects of the condition. Mood stabilizers for bipolar disorder will be very useful in helping patients deal with the effects and live normal and healthy lives. Mood stabilizers for bipolar disorder are licensed and regulated drugs that require a doctor’s prescription. There are a number of mood stabilizers for bipolar disorder recommended by doctors depending on the condition and severity. The list of mood stabilizers for bipolar mood disorder also includes carbamazepine, lamotrigine, valproate and divalproex. Choosing from the List of Mood Stabilizers for Bipolar Disorder. Other medications in the list of mood stabilizers for bipolar disorder include valproate, lamotrigine, carbamazepine and divalproex which keep the person from going from one state to the next or mood cycling per se. More Mood Stabilizers for Bipolar Disorder. Mood stabilizers for bipolar disorder will help patients cope with the effects and other possible risks and complications. The Side Effects of Mood Stabilizers for Bipolar Disorder. Individuals should follow the prescription, dosage and instructions provided by their doctors for the list of mood stabilizers for bipolar disorder to ensure safety and efficacy. Seeking Help from the List of Mood Stabilizers for Bipolar Disorder.
Most often, the first medicines used are called mood stabilizers They help you avoid mood swings. With medicines, you may begin to feel better. Or side effects from the medicines may occur. As a result, you may be tempted to stop taking your medicine or change the way you are taking them. Family members or friends can help you take medicines the correct way. Regular visits with a psychiatrist to talk about your medicines and side effects are needed. Joining a support group may help you and your loved ones. Involving family members and caregivers in your treatment programs may help reduce the chance of symptoms returning in the patient. Taking medicines correctly and how to manage side effects.
A mood stabilizer that doesn't make you gain weight? I am so fed up, I put on loads of weight with the depakote, since coming off it I have lost some of it and now they want me to go on zyprexa which is another one for gaining weight. You can keep the weight off wiwth zyprexa. Unforunatly most mood stabilzers can cuase weight gain but diet and exercise can take care of that.
Bipolar disorder can be treated with a number of medications. Because of this, finding the medications that best treat your symptoms may require some trial and error. Medications for bipolar disorders include mood stabilizers, antipsychotics and antidepressants. It appears that aripiprazole, lurasidone and ziprasidone are more weight neutral than the others, but that can vary from person to person. Certain antidepressants for bipolar disorder may be more likely to cause weight gain than others, but this can vary from person to person. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder. Some weight gain may be inevitable when taking medications to control your bipolar symptoms. Continue to work with your provider to find the best way to keep your bipolar symptoms and your weight under control. Bipolar disorder: Parents' medication guide for bipolar disorder in children and adolescents. Managing the side effects associated with commonly used treatments for bipolar depression. Weight gain associated with taking psychotropic medication: An integrative review. Weight gain and glucose dysregulation with second-generation antipsychotics and antidepressants: A review for primary care physicians.
Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine. Side effects may go away after you take the medicine for a while. If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. Do not suddenly quit taking your medicine unless your doctor tells you to. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor. You should taper off of these drugs slowly with the help of your doctor to avoid negative and serious side effects. Your doctor may want you to have regular blood tests to check your medicine levels, liver function , and blood counts. Your doctor will need to periodically test the function of your kidneys and thyroid gland if you are taking lithium. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you are pregnant or planning to get pregnant , you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
The effect of Lamictal on weight has been studied quite a bit — in fact, some researchers even have looked at the drug as a possible treatment for obesity and as a treatment for binge-eating disorder . The results from the various clinical trials that have been conducted on Lamictal should be reassuring to people with bipolar disorder , since so many medications used to treat the condition can cause weight gain. Lamictal and Weight Gain or Loss. In the first clinical trials involving the drug, 5% of adults with epilepsy lost weight while taking Lamictal, while between 1% and 5% of patients with bipolar I disorder gained weight while on the drug. Meanwhile, a 2006 study comparing the effects on weight of Lamictal, lithium, and a placebo found that some patients receiving Lamictal gained weight, some lost weight, and most remained at about the same weight. Obese patients taking Lamictal lost an average of four pounds, while non-obese patients' weight remained essentially the same. Therefore, if you're already overweight, you and your psychiatrist may want to consider the possibility of additional weight gain in determining your medication regimen for your bipolar disorder. Those taking the placebo, meanwhile, lost around 7 pounds, so while those taking Lamictal lost more weight, they didn't lose all that much more. That study included 51 people with the condition — 26 of them received Lamictal, while 25 received a placebo. Those taking Lamictal lost more weight than those on the placebo (about 2.5 pounds versus about one-third of a pound), and they did have significant improvements in their blood sugar and cholesterol lab test results. Impact of Lamotrigine and Lithium on Weight in Obese and Nonobese Patients With Bipolar I Disorder.
Bpcookie responded: Hello Scorpio, Its very nice to meet you and welcome to the board. I take Lamictal and have been on it now for about 4 yrs. It has worked wonders for me and I havent had any problems with weight gain. I hope it works as well for you as it has for me. Thanks for your Reply! Maddie8415 responded: The only thing you have to watch out for is a very rare rash that can appear when you first go on it, in the case you get it call the doc and you simply stop taking it. Ffltat responded: The rash that she was talking about with lamictal well for me it looked like it was an acne break out from greasy foods. Next was the itching and sore throat and then the swelling. Look for any kind of rash any where.
Her YMRS score was 1, and her BPRS score was 18. Her YMRS score was 0, and her BPRS score was 18. Her weight before topiramate was 284 lb (128 kg), which decreased to 242 lb (109 kg) at 1-month, 240 lb (108 kg) at 2-month, and to 228 lb (103 kg) at 3-month follow-up. Her weight was 176 lb (79 kg) before topiramate was added, and she had a DSM-IV diagnosis of bipolar disorder. Her YMRS score was 4, and her HAM-D score was 8. Her YMRS score was 8, and her HAM-D score was 7. Her YMRS score was 0, and her HAM-D score was 6. Her weight prior to topiramate treatment was 176 lb (79 kg), which decreased to 165 lb (74 kg) at 1-month, to 162 lb (73 kg) at 2-month, and to 156 lb (70 kg) at 3-month follow-up. Her weight was 180 lb (81 kg) before topiramate was added, and her DSM-IV diagnosis was schizoaffective disorder. She reported feeling depressed and was concerned about her weight. Her weight before topiramate treatment was 196 lb (88 kg). Her YMRS score was 3, her BPRS score was 19, and her HAM-D score was 6. Her YMRS score was 1, and her HAM-D score was 2.
The Dangers of Weight Loss Drugs Belviq and Qysmia. In June and July of 2012, the Food and Drug Administration (FDA) approved two new weight loss drugs, Belviq (lorcaserin) and Qsymia (phentermine/topiramate). Cautions With Belviq and Qysmia. Each of these two anti-obesity drugs can have negative effects on people with mood and sleep disorders, and there are some potentially problematic interactions with psychiatric drugs. Since many psychiatric meds also work on the serotonin system, it's not surprising that there's a potential for serious side effects when these medicines are combined. The risk and safety of Belviq when used with other drugs that affect serotonin hasn't been evaluated yet, but the label contains a warning to "use extreme caution" when administering Belviq with SSRIs, SNRIs, TCAs, Wellbutrin, MAOIs, antipsychotics, lithium and St. Side Effects of Belviq. Potential side effects of Belviq include: Qsymia is a combination of two drugs, phentermine and Topamax (topiramate). The Bottom Line on Belviq, Qsymia and Mood Disorders. Work with your doctors closely if either Belviq or Qsymia is prescribed for you, and make sure you tell them about any changes in mood, sleep, anxiety, stress or physical health. US Food and Drug Administration: Approved Label for Belviq. US Food and Drug Administration: Approved Label for Qsymia.
You can click links in the first table below for details about each one (or you can walk you through how the main medications are used, and how we choose between them, in the Treatment section of this website). Nearly all of the other options can cause very significant weight gain. Please understand that these are only suggestions based on the literature and experience with patients, not “guidelines” for choosing. Lithium and valproate/divalproex had been running neck-and-neck for years for “where to start?” In this study, the combination was best but if you were to start with one alone, lithium was well ahead of valproate/divalproex. For one more way to look at all these options, here are the same medications listed by their specific advantages. However, you must not miss more than three doses of this medication in a row, where you have to start the increase all over again from the beginning. It was already known that this is a very good medication, particularly a good antidepressant and bipolar disorder (except for the massive weight gain that can result, which is why I don’t use it at all). So, as you can imagine, the issue of “rash” comes up frequently this medication. However, these side effects can be quite subtle and sometimes it takes a while to figure out that they are really happening, and that they are coming from the medication. (If you are a woman between the ages of 12 and 50, unfortunately you should probably take this medication off your list of options, for two reasons. For a discussion of the latest data on this risk, read about divalproex and PCOS . Even these folks can get used to the medication if the smallest size (125mg “sprinkles”) are used and increased by one pill per week or so. I have seen very few patients gain weight who did not experience the appetite increase. And, not all patients will experience the weight gain problem.
Doctors and parents should do everything to lessen this burden on the child. The atypical antipsychotics cause by far the most weight gain and Clozaril (clozapine) and Zyprexa (olanzapine) are the worst offenders. The atypical antipsychotic medications are increasingly prescribed for children with bipolar disorder because they target some symptoms that the mood stabilizers do not. Diabetes is a disease that affects the body’s ability to absorb and break down sugars. The risk for this kind of diabetes is increased by approximately two-fold in mildly obese people, and ten-fold in the more seriously obese. Often there are more subtle changes in the glucose levels and an emerging case of diabetes is not apparent for some time. These drugs also seem to have synergistic effects on the H-1 receptors and certain serotonergic receptors, and thus cause more weight gain than other medications. Medications with a high affinity for histamine H-1 receptors in the brain typically cause sedation and weight gain. The patients assigned to 150 mg twice-a-day dosing gained an average of 4.41 kg (9.7 pounds); and the group assigned to the 300 twice-a-day dosing, gained the least amount of weight (2.76 kg, or 6.1 pounds). Brody sits down with the parents alone and discusses her concerns about weight-gain and possible medical complications. However, if 50-75 mg of Topamax are taken at night, the drug promotes sleep and fights weight gain for quite a few children. But for now, the available atypical antipsychotic drugs are the best we have, and with knowledge aobut them comes protection from their adverse effects.
The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), and may include education and support groups. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder. Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder. The diagnosis and treatment of bipolar disorder: Decision-making in primary care. Bipolar disorder in children and adolescents. Bipolar disorder in children and teens. Current landscape, unmet needs and future directions for treatment of bipolar depression.
This medication wouldn’t even be on the mood stabilizer map except for the fact that it causes weight loss, where so many medications for bipolar disorder cause weight gain. For example, in a large study where everyone received diet counseling, half of the group took zonisamide and half took a placebo. The zonisamide group lost 6 kg (13 pounds) in 4 months while the placebo group lost 1 kg (about 2 pounds). In a fairly large “open trial” (no control group; usually makes the medication look better than it will look later) of this medication that was strongly positive. In the Mc Elroy study, 20% of the patients dropped out because their mood was worse. One patient did very well on it, better at 500 mg than at 400 — but she couldn’t talk properly at the higher dose, and couldn’t think straight (“cognitive impairment”, a recognized side effect). By the time you get to this page you’ve probably also learned about lamotrigine (or you should have, since lamotrigine is much more widely used and studied, so on that basis may be somewhat safer). The same rash problem — “Stevens-Johnson syndrome” — that is the main risk for lamotrigine is also a significant risk for zonisamide.
“In psychiatry, many medications have the potential to cause weight gain, says Christoph Correll, MD, a psychiatrist and psychopharmacologist at Zucker Hillside Hospital and Schneider Children’s Hospital in Glen Oaks, New York. “And among all psychiatric medications, the two classes used most in bipolar disorder, mood stabilizers and the new generation antipsychotics, are among the ones that cause the most weight gain.” Dr. Many people think, and I agree, that the effects are [related] mainly to food intake.” Individuals with bipolar who are on these drugs eat far more than they need, as many consumers have observed. As for certain weight loss drugs that are much used among the general population, Dr. Allison says, “Some drugs are popular and fairly effective for weight loss in general. Correll emphasizes that nearly every person with bipolar who takes antipsychotic medications to control his or her illness runs the risk of gaining weight; there are simply no easy answers in his view. Reason: The increased appetite a person with bipolar feels may cause him or her to eat too fast and to overeat before the brain has had time to register a sensation of fullness. Beginning on lithium for the bipolar disorder, Carolyn says she “quickly gained about 100 pounds. That was the last time I saw him,” she says. I have a really good doctor right now, but I learned the most from online groups by talking to other people about what makes you gain weight, what doesn’t, and what you can do about it.” Last January, Carolyn began taking a mood stabilizer and with it, she says, “The anorexia came back. I do look different and I honestly try not to think about it all the time. Although his doctors immediately initiated effective drug therapies for Tom and briefly mentioned the possibility of weight gain as a side effect, in his view they did not devote enough time to talking about his illness, nor his tendency to eat for emotional reasons. Tom also volunteers for the Depression and Bipolar Support Alliance (DBSA). The situation worries him and his family, and he is taking steps to address his weight problem.