TOPIRAMATE TREATMENT OF RAPID-CYCLING MOOD DISORDER
Fava, M.D.
Mohammad Z. Hussain, M.D., Prince Albert Health District, Mental Health
Centre, 2727 2nd Avenue West, Prince Albert, SK S6V 5E5, Canada; Zabaida
A. Chaudhry, M.D., Seema Hussain, M.D.
Bipolar disorder is a serious, debilitating illness affecting over 2% of the population. Up to 20% suffer from rapid cycling. In some, it is transient and associated with antidepressants, whereas for others it is a natural course of their illness that is more severe and treatment resistant. Novel anticonvulsants have increased treatment options. Long-term studies are essential to assess efficacy and patient acceptability.
Sixty patients meeting criteria of rapid cycling disorder received open-label treatment with topiramate monotherapy or in combination. All had history of >2 years of rapid cycling and had been treated with lithium carbonate, valproate, risperidone, and other medications with limited response. Twenty-three were bipolar I, 37 bipolar II, with a mean age of 38.5, range 17-57. They were rated on HAMD, Young Mania scales, and CGI at baseline, 1/2-1-2-3-6-12-18-24-30 and 36-month intervals. Topiramate was given at a starting dose of 25 mg hs, rising every two nights to 200 mg hs and later up to 600 mg hs. All patients completing the 36-month trial were good responders. Thirteen patients required alternative strategies and were intolerant of topiramate. Seven patients have dropped out of follow-up. Combination therapy includes lithium, gabapentin, valproate, novel neuroleptics, and thyroid supplementation, and antidepressants in Bipolar II patients. Topiramate is clinically effective in rapid cycling mood disorder.
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