Treatment of affective disorder and obesity with topiramate.

OBJECTIVE

To report a case of weight loss and mood stabilization in a patient being treated with the antiepileptic drug topiramate.

METHODS

A 37-year-old obese white woman with affective instability and obesity was being treated with adjunctive topiramate therapy. The patient lost 10 kg over 10 weeks of treatment with topiramate and improved clinically, as evidenced by a reduction in the number of times that she had to be admitted to a management unit for constant observation, and a decrease in the number of times that mechanical restraints or medication interventions were required for aggressive outbursts. Furthermore, the patient successfully completed two home visits while receiving topiramate therapy and was out of the hospital on her third home visit at the time of this writing.

CONCLUSIONS

This case further strengthens previous reports that topiramate may be useful in treating affective disorders as well as inducing weight loss in a patient population in which weight gain is common. The patient discussed in this case report had no acute illnesses or changes in health status, no changes in diet, and no changes in her medications that could have accounted for the sudden weight loss. In addition, the patient's behavior did not improve until topiramate was added as adjunctive therapy of valproic acid, citalopram, and chlorpromazine during an adequate trial period.

CONCLUSIONS

Controlled studies need to be performed to evaluate the use of topiramate in the psychiatric population and, in particular, the benefits of topiramate therapy in psychiatric patients with an additional diagnosis of obesity.