TOPIRAMATE IN THE TREATMENT
OF REFRACTORY BIPOLAR DEPRESSION
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, a serious debilitating illness, affects over 2% of the population. Frequent treatment failure remains a major concern. The novel antiepileptic drugs lamotrigine, gabapentin, and topiramate have been successfully used as mood stabilizers. Most trials have been short-term with limited followup. Long-term studies are essential to assess efficacy and patient acceptability because of the chronic, recurrent nature of this illness.
A total of 135 patients meeting DSM-IV criteria for bipolar I or II disorder, depressed phase, received open-label treatment with topiramate: 46 males, 89 females, mean age 34, mean age of onset 21, mean duration of current episode 11 weeks, bipolar I(62) and bipolar II(73). All were previously treated with mood stabilizers and antidepressants but failed to respond adequately. They were rated on the Hamilton Depression Rating Scale, met criteria for major depression, and were subsequently rated at 1-2-3-6-12-18-24-30-36-month intervals. Topiramate was given at a starting dose of 25 mg/hs, rising every two days to 200 mg/hs, and later up to a maximum of 600 mg/day. All patients completing the 36-month trial were good responders (HDRS score 0-8). Clinically significant responses were seen within two to four weeks. A total of 47 patients discontinued medication. Results support evidence that topiramate is an effective mood stabilizer. Mean weight loss was 17.2 kg by completion of the study.
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