What is topamax used for in depression

In the FDA approved Topamax for the treatment of partial onset or primary generalized tonic-clonic seizures and for people with seizures associated with Lennox-Gastaut syndrome. Topiramate was also approved in for use in combination with another drug called phentermine for weight loss. This product goes by the brand name Qsymia. Vivus Inc. In , the FDA approved Topamax for the prophylaxis prevention of migraine in patients 12 years of age and older.

Janssen Pharmaceutical Inc. One theory is that Topamax calms overactive nerve system cells in the brain that lead to migraine attacks.

Off label means the drug is used to treat a condition for which it is not approved. Prescribing a drug off label is not illegal, though it is illegal for a drug manufacturer to market the drug specifically for the off-label use. For this reason, a doctor may decide, after careful evaluation, to prescribe Topamax off label for treating depression. Your doctor will help you figure out if need to adjust the dose or try a new medication instead.

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It is important to discuss the risks and benefits of treatment with your doctor and caregivers. Topiramate has been associated with an increased risk of oral cleft birth defects. There may be precautions to decrease the risk of this effect. Do not stop taking topiramate without first speaking to your healthcare provider.

Discontinuing similar medications during pregnancy has been associated with a significant increase in symptom relapse. Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to mg. Only your health care provider can determine the correct dose for you. Sprinkle capsules: Swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately. Do not chew the sprinkle capsule or contents. Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.

If you miss a dose of topiramate, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your dose or take more than what is prescribed. Avoid drinking alcohol or using illegal drugs while you are taking topiramate.

They may decrease the benefits e. If an overdose occurs call your doctor or You may need urgent medical care. You may also contact the poison control center at To date, there are no known problems associated with long term use of topiramate. It is a safe and effective medication when used as directed. If this happens, you may get confused, disoriented, or have difficulty thinking. The people had about twice the risk of suicidal thoughts or behaviors than people taking a placebo.

In these studies, suicidal behavior or thoughts occurred in:. These symptoms can include:. If you have any symptoms of new or worsening depression while taking Topamax, talk with your doctor right away. They can suggest ways to ease this condition. They may also recommend that you switch to a different medication. If you need to stop taking Topamax, your doctor will explain how to taper off the drug gradually.

However, weight gain has been reported with some anticonvulsant drugs that are in the same class as Topamax. A drug class is a group of medications that work in a similar way. Topamax can cause weight loss.

However, the drug may reduce your appetite, which may lead you to lose weight. This depended on the dosage and condition treated. One review of studies looked at the average weight loss in people who took Topamax. It also looked at how long it took them to lose weight when they took the drug.

People who took Topamax for at least 4 months lost an average of But your doctor might recommend Topamax for preventing seizures or migraine if you would also benefit from weight loss.

You should take it as prescribed by your doctor for seizures or migraine. Note: Weight loss is an approved use for the brand-name medication Qsymia. Qysmia contains topiramate the active drug in Topamax with another drug called phentermine.

The drug is also approved for use in people who are overweight and have an increased risk of health problems. These can include conditions such as high blood pressure , high cholesterol , and type 2 diabetes.

Typically, your doctor will start you on a low dose. Your doctor will ultimately prescribe the smallest dose that provides the desired effect. The following information describes dosages that are commonly used or recommended.

However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs. The usual recommended dosage is 50 mg taken once in the morning and once in the evening. Your doctor will gradually increase your dosage to this level over the first 4 weeks of treatment. This allows your body to get used to the medication and helps reduce the frequency and severity of side effects.

Topamax is used to treat epilepsy a condition that causes repeated seizures in certain situations. The dosage of Topamax is gradually increased over the first few weeks of treatment. Topamax can be used on its own to treat partial-onset seizures and generalized tonic-clonic seizures. The usual recommended dosage for treating these types of seizures is mg twice per day.

The drug should be taken once in the morning and once in the evening for a total of mg per day. This is the dosage for both adults and children ages 10 years and older. Topamax can be used with other seizure medications to treat partial-onset seizures, generalized tonic-clonic seizures, and seizures linked to Lennox-Gastaut syndrome LGS.

LGS is a rare form of childhood epilepsy that causes several different types of seizures. For the first week of treatment, the starting dosage is usually 25 mg to 50 mg per day.

After this, your doctor may increase your daily dosage by 25 mg to 50 mg each week until the recommended dosage is reached. The usual recommended dosages for treating these types of seizures in adults ages 17 years and older are:. The recommended dose per day is split into two equal doses.

One dose is taken in the morning and the other is taken in the evening. Topamax is used to treat certain seizures in children ages 2 years and older. The usual recommended dosage of Topamax in children ages 12 years and older is the same as it is for adults. For children ages 10 years and older, the usual recommended dosage of Topamax is the same as it is for adults. Below is information for treating children ages 2 to 9 years. For the first week of treatment, the starting dosage is 25 milligrams mg taken every evening.

If your child tolerates this well, for the second week of treatment, their doctor may increase the dosage to 25 mg twice per day. This is a total of 50 mg daily. This will take place over the first few weeks until the recommended dose is reached. After this, their doctor may increase their daily dosage by 25 mg to 50 mg each week.

This is done until your child is at the minimum recommended dose for their body weight. This increase will continue until your child is at the maximum dose for their body weight. For children ages 2 to 9 years, the usual recommended dosage of Topamax is based on body weight as follows:. Children ages 17 years and older typically take the same dosage of Topamax as adults. The following sections discuss the dosages for children ages 2 to 16 years. For the first week of treatment, the starting dose per day is usually about 1 milligram mg to 3 mg per kilogram kg of body weight.

Topamax is typically taken as a single dose every evening. This allows their body to get used to the medication and helps reduce the frequency and severity of side effects. The medication is split into two equal doses. The daily dose is increased until your child is at the minimum recommended dose for their body weight. For children ages 2 to 16 years, the usual recommended daily dose is 5 mg to 9 mg per kg of body weight.

The recommended daily dose is split into two equal doses. One dose is taken in the morning, and the other dose is taken in the evening. Take your next dose at your usual time. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too. Topamax is meant to be used as a long-term treatment.

You should avoid drinking alcohol with Topamax. Drinking alcohol during Topamax treatment can increase the frequency and severity of Topamax side effects, such as:. In serious cases, drinking alcohol with Topamax may lead to serious side effects.

These may include slow, shallow breathing, loss of consciousness, coma, and in rare cases, death. Topamax is more likely to make you feel sleepy, low in energy, or a bit dazed and confused.

You may also have trouble with concentration, memory, or speech while taking it. Topamax has a half-life of about 21 hours. The half-life of a drug is the time it takes for the amount of the drug in your body to fall by half. It takes about five half-lives for a drug to be almost completely removed from your body.

So for Topamax, most of the drug will be flushed out of your system within about 5 days after you stop taking it. Controlled substances are drugs that have certain effects that give them a high potential for being misused. They also have a high risk of leading to drug dependence. Because of these risks, there are special rules about how controlled substances are prescribed and dispensed. Mood stabilizers are drugs that help prevent extreme changes in mood, such as those that occur with bipolar disorder.

People with bipolar disorder typically have episodes of depression and episodes of mania. Mania is a mood disorder that gives you an unnatural feeling of physical and mental energy.

Several anticonvulsant medications also work as mood stabilizers in people with bipolar disorder. Topamax, which is an anticonvulsant medication, is sometimes used in this way. Anticonvulsants are also called antiepileptic drugs. Anticonvulsants are mainly used to treat epilepsy a condition that causes repeated seizures.

These include migraine and nerve pain. However, once Topamax controls your condition, you will need to keep taking it to continue to prevent seizures or migraine. If you stop taking Topamax, your seizures or migraine headaches may happen more often.

They could also become more severe. Sometimes people without epilepsy have had seizures after suddenly stopping Topamax. If you and your doctor decide to stop treatment, you may need to stop taking Topamax gradually. This can help reduce your risk for seizures. Topamax can interact with several other medications. It can also interact with certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe. Below are examples of medications that can interact with Topamax.

Before taking Topamax, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take.

Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. Topamax can make birth control drugs that contain estrogen less effective at preventing pregnancy. Topamax treatment can also make certain birth control medications less effective at preventing pregnancy. These include:. If you use birth control that contains estrogen, your doctor may recommend switching to a different type of birth control medication while you take Topamax.

Taking Topamax with phenytoin Dilantin or carbamazepine Tegretol can lower the level of Topamax in your blood. This could make Topamax less effective at preventing seizures or migraine headaches. If you need to take Topamax with phenytoin or carbamazepine, your doctor may prescribe a higher dosage of Topamax.

This should increase the chances that the drug works for you. If you need to take Topamax with valproic acid, your doctor may recommend blood tests.

These will monitor the amount of ammonia in your blood. Taking Topamax with drugs called carbonic anhydrase inhibitors can raise your risk for a side effect called metabolic acidosis a high level of acid in your blood. Metabolic acidosis can also raise your risk for kidney stones. All the patients had a long history of severe bulimia nervosa combined with significant different co-morbid conditions major depression, bipolar disorder II, substance misuse, post traumatic stress disorder, dysthymia, social phobia, border line personality disorders and general anxiety disorder.

During a follow up period of 7—18 months, 3 patients responded to topiramate, 1 did not respond and 1 subject discontinued treatment because of gastro-intestinal related side effects.

Only 1 case reported simultaneous improvement in the co-morbid affective disorder. Adverse events occurred in 2 patients paraesthesias and constipation. Dosage titration was slow with an initial dose of The main duration of treatment was 33 weeks range 1— weeks. Thirteen patients discontinued for various reasons during the study period. There were no serious side effects reported a part from a case of acute secondary narrow-angle glaucoma.

Response assessment used the last observation carried forward. Johnson and associated [ ] conducted a double blind randomised controlled week clinical trial comparing topiramate to placebo for treatment of individuals with alcohol dependence.

Of these individuals, 75 were assigned to receive topiramate escalating dose of 25— mg per day and 75 had placebo as an adjunct to weekly-standardised medication compliance management. Primary variables were: self reported drinking drinks per day, drinks per drinking day, percentage of heavy drinking day, percentage of day abstinent and plasma gamma-glutamyl transferase as an objective index of alcohol consumption. The secondary efficacy variable was self-reported craving measured on the item obsessive compulsive drinking scale.

In the topiramate group 55 subjects completed the study versus 47 in the placebo group. The authors adopted intention to treat analysis. Response supervened between 6 and 8 weeks. At study end, participants on topiramate, compared with those on placebo, had 2. Topiramate induced differences in craving were also significantly greater than those of placebo, of similar magnitude to the self-reported drinking changes, and highly correlated with them.

There were no discontinuations due to side effects and topiramate was generally well tolerated. Abuzzahab et al.

In both cases, previous medication were tapered down and discontinued during the first two weeks of treatment. Significant weight loss was noted: weight dropped from to lb for case 1 and Lacks of concentration, loss of appetite, thirst and lethargy sensitive to dose reduction were reported. Cassano et al. Teter et al. Borderline symptoms improved in 6 weeks. Considerable weight loss was also reported.

Topiramate was generally well tolerated. Conversely, slow dose titration was associated with a lower rate of side effects [e. This indicates that individuals on complex pharmacological treatments are more vulnerable to side effects, particularly with sodium valproate and lithium [ 80 ].

There was one reported case of psychotic features [ 71 ], a case of delirium in a patient who overmedicated with mg of topiramate and tranylcypromine sulphate mg combined with alcohol [ 76 ], a case of acute narrow angle glaucoma [ ] and 2 cases of hematuria [ 92 ]. Occurrence of hematuria is consistent with the known 2 to 4 increased risk of nephrolithiasis during topiramate treatment [ 45 ]. Rare but serious adverse events have been described with topiramate e.

Weight change was not systematically evaluated in 11 trials [ 71 , 76 , 85 , 90 , 93 - 95 , 99 , 97 , , ]. Among the studies, a frequent finding was that the initial BMI affected topiramate-induced weight loss and that greater weight loss was associated with higher BMI at baseline [e. In diabetic patients, topiramate induced weight loss was also associated with glycemic control and normalization of blood pressure in hypertensive subjects [ 78 , 96 ].

Preliminary reports [ 70 - 72 ], available for review, suggested a trend towards improvement in acute mania but more recent unpublished controlled studies, not available for review, showed lack of efficacy [[ 74 ]; Calabrese, personal communication]. It emerges that in the light of current evidence, there is limited scope for the use of topiramate in acute mania. The only randomised single blind study by McIntyre et al.

This study, according to the authors, was not powered to detect a difference in efficacy between the two treatment groups and, given the small sample size, it only aimed to corroborate the antidepressant property of topiramate already shown in naturalistic studies [ 89 ].

If demonstrated efficacious in further adequately powered controlled studies, topiramate could fill the therapeutic vacuum in the treatment of bipolar depression as alternative or adjuvant to mood stabilisers.

The role of topiramate in the treatment of rapid cycling bipolar disorders [ 75 ], and as adjunctive treatment in refractory bipolar disorder in adults [ 76 - 87 ] and children [ 90 ], is limited by the open label nature of the published studies: lack of randomisation and blindness, heterogeneous patient, population resistant to conventional treatment regimes, incomplete information on current or past treatment for illness, concomitant medications with possibly inflating side effects profile and therapeutic effect, self-reported weight and side effects, qualitative assessment of response to treatment, various settings and variegated level of symptoms, co-morbid psychiatric and medical conditions.

Although there is no sufficient evidence for its use in these conditions, its trend towards improvement warrants controlled studies. However, it may not be sustained in randomised studies as observed in acute mania. The effectiveness of topiramate in schizophrenia is similarly based on uncontrolled studies.

Only Drapalski et al. Dursum and Deakin [ 94 ] also noted no reduction in BRPS scores when topiramate was augmented with antipsychotic medications.

These controversial results, conveys doubts about the efficacy of topiramate in schizophrenia and uncertain the postulated stabilizing properties of topiramate in the interaction between the glutamatergic and dopaminergic systems. Alternatively, these observations may reflect that patients analysed were a heterogeneous group in many aspects of their illness and future studies would probably require more strict research criteria.

Evidence for the use of topiramate in binge eating disorders and bulimia nervosa is encouraging and suggest a complementary role of topiramate in the treatment of these conditions together with established treatment strategies e. Hoopes at al. The relative short duration of the trial did not allow exploration of a possible prophylactic role of topiramate. However, similarly to bipolar spectrum disorder, the naturalistic nature of this report constitutes a limitation for its validity.

The only study by Johnson et al. It indicated that topiramate, as an adjunct to standardised medication, is more efficacious in reducing alcohol consumption than placebo. This study warrants further investigation and indicates that topiramate could be included in the rather limited pharmacological armamentarium to defeat alcohol dependence.

The effectiveness of topiramate in unipolar depression [ 91 , 92 ], emotionally unstable personality disorder [ , ] and Gilles de la Tourette's syndrome [ ] is entirely based on case reports and case series.

The evidence is sometimes controversial and at the time of writing there is no clear indication for treatment with topiramate. Weight change was not always systematically reported across the studies. However, findings are encouraging considering the rather disappointing success rates of efficacious prevention programs [ ] and have potential implications in reversing increased body weight and obesity induced by psychotropic medication [ , ].

Weight loss was also proportional to the initial BMI and it was associated with glycemic control and normalization of blood pressure in hypertensive subjects. Polypharmacy often contributed to an increased rate of side effects. I would like to acknowledge Dr LJ Simmons's contribution to the completion of the manuscript. National Center for Biotechnology Information , U. Journal List Ann Gen Psychiatry v.

Ann Gen Psychiatry. Published online Feb Danilo Arnone 1. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Danilo Arnone: ku. Received Oct 12; Accepted Feb This article has been cited by other articles in PMC. Abstract Background Topiramate is a new antiepileptic drug, originally designed as an oral hypoglycaemic subsequently approved as anticonvulsant. Methods A comprehensive search from a range of databases was conducted and papers addressing the topic were selected.

Results Thirty-two published reports met criteria for inclusion, 4 controlled and 28 uncontrolled studies. Conclusions Topiramate lacks efficacy in the treatment of acute mania. Keywords: topiramate, mood stabilisers, psychotropic medications, psychiatric disorders. Background The use of mood stabilizing antiepileptic drugs has increasingly been explored for the treatment of different psychiatric conditions.

Pharmacokinetic and pharmacodynamic profile Topiramate is a sulfamate substituted, derivative of the monosaccharide D-fructose [ 1 ]. Rationale for evaluating topiramate in psychiatric disorders The use of topiramate in bipolar spectrum disorders is based on the putative shared biological mechanism between epilepsy and bipolar disorders suggested by the amygdala-kindled seizures in animal models [ 14 - 16 ] and the high rate of co-morbid psychiatric conditions in epilepsy [ 17 ].

Results Thirty-two published reports met criteria for inclusion, 4 controlled and 28 uncontrolled studies see Additional file-table 3. Table 2 Characteristics of the studies included in the review. Open in a separate window. Bipolar disorders Bipolar mania Following encouraging results from preliminary reports in acute mania [ 70 - 72 ], topiramate was compared with placebo in one double-blind randomised trial [ 73 ]. Rapid-cycling bipolar disorders Kusumakar et al.

Adjunctive therapy in treatment-refractory bipolar disorders Marcotte et al. Bipolar depression McIntyre et al. Unipolar depression Gordon and Price [ 91 ] reported topiramate lack of efficacy in a case report of recurrent major depression.

Schizophrenia, schizoaffective disorders and psychosis unspecified Millson et al. Eating disorders and disordered eating McElroy et al. Alcohol dependence Johnson and associated [ ] conducted a double blind randomised controlled week clinical trial comparing topiramate to placebo for treatment of individuals with alcohol dependence.

Gilles de la Tourette's syndrome Abuzzahab et al. Emotional unstable personality disorder Cassano et al. Adverse events, safety and tolerability Topiramate was generally well tolerated. Table 1 Adverse events in order of frequency. Conclusion Preliminary reports [ 70 - 72 ], available for review, suggested a trend towards improvement in acute mania but more recent unpublished controlled studies, not available for review, showed lack of efficacy [[ 74 ]; Calabrese, personal communication].

Competing interest The author s declare that they have no competing interests. Drug names Topiramate Topamax. Supplementary Material Additional File 1: Details of published studies included in the review.

Click here for file K, doc. Acknowledgement I would like to acknowledge Dr LJ Simmons's contribution to the completion of the manuscript. Anticonvulsant O-alkyl sulpamates. J Med Chem.

Topiramate: pharmacokinetics and pharmacodynamics. Can J Neurol Sci. Single dose pharmacokinetics and effect of food on the bioavailability of Topiramate, a novel antiepileptic drug. Journal of Clinical Pharmacology. Topiramate: a review of preclinical, pharmacokinetic, and clinical data.

Clin Ther. Steady state pharmacokinetics of Topiramate and carbamazepine in patients with epilepsy during monotherapy and concomitant therapy. Topamax package insert. Ortho-McNeil Pharmaceutical. Wauquier A, Zhou S. Topiramate: a potent anticonvulsant in the amygdale-kindled rat. Epilepsy Research. Topiramate increases cerebral GABA in healthy humans.

Topiramate modulates GABA — evoked currents in murine cortical neurons by non-benzodiazepine mechanism. Cellular actions of Topiramate: blockade of kainite-evoked inward currents in cultured hippocampal neurons. Selective effects of topiramate on sustained and repetitive firing and spontaneous bursting in cultured hippocampal neurons Abstract Epilepsia.