Influence of topiramate on olanzapine-related adiposity in women: a random, double-blind, placebo-controlled study.
Clinic for Psychosomatic Medicine, Inntalklinik, Simbach/Inn, Germany.Journal of Clinical Psychopharmacology (Impact Factor: 3.24). 07/2005; 25(3):211-7.
The aim of this study was to compare the efficacy of topiramate versus a placebo in the treatment of adiposity in women undergoing olanzapine therapy. We also assessed changes health-related quality of life, the patient's actual state of health, and psychologic impairments. The 10-week, random, double-blind, placebo-controlled study included 43 women who had been treated with olanzapine (mean dose 7.8 +/- 3.6 in the topiramate group and 7.2 +/- 3.1 in the placebo group) and had gained weight as a side effect. The subjects were randomly assigned to topiramate (n = 25) or a placebo (n = 18). Primary outcome measures were weight checks and self-reported changes on the scales of the SF-36 Health Survey, Bf-S Scale of Well-Being, and the Adjective Checklist EWL-60-S. Weight loss was observed and was significantly more pronounced in the topiramate-treated group (difference in weight loss between the 2 groups: 5.6 kg, 95% CI = -8.5, -3.0, P < 0.001). In comparison with the placebo group, significant changes on 7 (7/8) scales of SF-36 Health Survey (all P < 0.001), on all 6 scales of the EWL-60-S, and on the Bf-S were observed in the topiramate-treated subjects after 10 weeks. All patients tolerated topiramate well. Topiramate appears to be a safe and effective agent in the treatment of weight gain that occurred during olanzapine treatment. Significantly positive changes in health-related quality of life, the patient's actual state of health, and psychologic impairments were observed.
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- "Topiramate has also received approval for the prophylaxis of migraine. Other indications for which topiramate may be effective include neuropathic pain syndromes, alcoholism but not necessarily smoking,[2–7] obesity, eating disorders, and drug-induced weight gain. Although efficacy in posttraumatic stress disorder is uncertain, the drug is ineffective in bipolar disorder. "
ABSTRACT: Some patients experience cognitive disturbances with topiramate. A 19-year-old bipolar woman and her 46-year-old mother with paranoid personality disorder both used topiramate (25-50 mg/day) off-label for weight loss. Both women suffer from learning disorders, and both are excessively sensitive to the sedative adverse effects of psychotropic medications. Within days of starting topiramate, the women began to exhibit troublesome word- and phrase-repetition and word substitution, both occurring only in their written expression. The symptoms were associated with mild sedation, persisted during two weeks of topiramate treatment, and remitted days after topiramate was withdrawn. The presence of the learning disorders and the sensitivity to the sedative adverse effects of drugs may explain why cognitive adverse effects, known to occur with topiramate, developed at the low dose of 25-50 mg/day. The proclivity of topiramate to affect language functions and a possible familial vulnerability herein may explain why the women explained similar, language-specific symptoms. An investigation of topiramate-induced cognitive impairments in family members with epilepsy may throw light on the subject.Indian Journal of Psychiatry 07/2010; 52(3):260-3. DOI:10.4103/0019-5545.70986
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- "Thus, the total number of study arms (N ¼ 32 + 2 ¼ 34) and patients (n ¼ 1482 + 82 ¼ 1564) in the analyses is higher than the total number of studies (N ¼ 32) and patients (n ¼ 1482). To examine potential moderator variables, four sensitivity analyses were performed: (1) intervention studies (N ¼ 22, n ¼ 947) (Arman et al, 2008; Assuncao et al, 2006; Atmaca et al, 2003, 2004; Baptista et al, 2007, 2008b, 2009; Borovicka et al, 2002; Bustillo et al, 2003; Carrizo et al, 2009; Deberdt et al, 2005; Goodall et al, 1988; Graham et al, 2005; Henderson et al, 2005, 2007, 2009; Joffe et al, 2008; Klein et al, 2006; Ko et al, 2005; Modell and Hussar, 1965; Nickel et al, 2005; Wu et al, 2008b), that is, weight loss agent given after weight gain with antipsychotic treatment, vs prevention studies (N ¼ 10, n ¼ 535) (Baptista et al, 2006; Cavazzoni et al, 2003; Hinze-Selch et al, 2000; Kim et al, 2006; Lu et al, 2004; Poyurovsky et al, 2002, 2003, 2004, 2007; Wu et al, 2008a), that is, weight loss agent was given concomitantly with newly initiated antipsychotic treatment; (2) short-term trials of p8 weeks (N ¼ 10, n ¼ 296) (Atmaca et al, 2003, 2004; Henderson et al, 2009; Hinze-Selch et al, 2000; Modell and Hussar, 1965; Nickel et al, 2005; Poyurovsky et al, 2002, 2003, 2004, 2007) vs medium-term trials of 12–16 weeks (N ¼ 22, n ¼ 1186) (Arman et al, 2008; Assuncao et al, 2006; Baptista et al, 2006, 2007, 2008b, 2009; Borovicka et al, 2002; Bustillo et al, 2003; Carrizo et al, 2009; Antipsychotic-related weight gain and metabolic abnormalities L Maayan et al Cavazzoni et al, 2003; Deberdt et al, 2005; Goodall et al, 1988; Graham et al, 2005; Henderson et al, 2005, 2007; Joffe et al, 2008; Kim et al, 2006; Klein et al, 2006; Ko et al, 2005; Lu et al, 2004; Wu et al, 2008a,b); (3) outpatient status (N ¼ 12, n ¼ 454) (Assuncao et al, 2006; Borovicka et al, 2002; Bustillo et al, 2003; Carrizo et al, 2009; Goodall et al, 1988; Graham et al, 2005; Henderson et al, 2005, 2007, 2009; Kim et al, 2006; Nickel et al, 2005; Wu et al, 2008b) vs inpatient status (N ¼ 14, n ¼ 514) (Arman et al, 2008; Baptista et al, 2006, 2008b, 2009; Hinze-Selch et al, 2000; Klein et al, 2006; Ko et al, 2005; Lu et al, 2004; Modell and Hussar, 1965; Poyurovsky et al, 2002, 2003, 2004, 2007; Wu et al, 2008a) vs mixed status (N ¼ 6, n ¼ 514) (Atmaca et al, 2003, 2004; Baptista et al, 2007; Cavazzoni et al, 2003; Deberdt et al, 2005; Joffe et al, 2008); and (4) adults with chronic antipsychotic treatment (N ¼ 23, n ¼ 1149) (Assuncao et al, 2006; Atmaca et al, 2003, 2004; Baptista et al, 2006, 2007, 2008b, 2009; Borovicka et al, 2002; Carrizo et al, 2009; Cavazzoni et al, 2003; Deberdt et al, 2005; Goodall et al, 1988; Graham et al, 2005; Henderson et al, 2005, 2007, 2009; Hinze-Selch et al, 2000; Joffe et al, 2008; Kim et al, 2006; Ko et al, 2005; Lu et al, 2004; Modell and Hussar, 1965; Nickel et al, 2005) vs first episode or youth samples (N ¼ 9, n ¼ 333) (Arman et al, 2008; Bustillo et al, 2003; Klein et al, 2006; Poyurovsky et al, 2002, 2003, 2004, 2007; Wu et al, 2008a,b). "
ABSTRACT: Antipsychotic-related weight gain and metabolic effects are a critical outcome for patients requiring these medications. A literature search using MEDLINE, Web of Science, PsycNET, and EMBASE for randomized, open and double-blind, placebo-controlled trials of medications targeting antipsychotic-induced weight gain was performed. Primary outcome measures were change and endpoint values in body weight and body mass index (BMI). Secondary outcomes included >or=7% weight gain, all-cause discontinuation, change in waist circumference, glucose and lipid metabolism parameters, and psychiatric symptoms. Sensitivity analyses were conducted to explain heterogeneity of the results. Across 32 studies including 1482 subjects, 15 different medications were tested: amantadine, dextroamphetamine, d-fenfluramine, famotidine, fluoxetine, fluvoxamine, metformin, nizatidine, orlistat, phenylpropanolamine, reboxetine, rosiglitazone, sibutramine, topiramate, and metformin+sibutramine. Compared with placebo, metformin had the greatest weight loss (N=7, n=334, -2.94 kg (confidence interval (CI:-4.89,-0.99)), followed by d-fenfluramine (N=1, n=16, -2.60 kg (CI:-5.14,-0.06)), sibutramine (N=2, n=55, -2.56 kg (CI:-3.91,-1.22)), topiramate (N=2, n=133, -2.52 kg (CI:-4.87,-0.16)), and reboxetine (N=2, n=79, -1.90 kg (CI:-3.07,-0.72)). Weight loss remained significant with metformin initiation after weight gain had occurred, but not when started concomitantly with antipsychotics. Nausea rates were not higher with any treatment compared with placebo. In all, 5 of 15 psychopharmacologic interventions aimed at ameliorating antipsychotic-induced weight gain outperformed placebo. Results were most robust for metformin, although these were modest and heterogeneous. Only one (negative) combination treatment study was available and head-to-head studies are absent. None of the agents were able to entirely reverse weight gain because of antipsychotics. At present, no treatment has sufficient evidence to recommend broad clinical usage. Antipsychotics with no or minimal cardiometabolic liability, as well as interventions that prevent or normalize adverse antipsychotic cardiometabolic effects are needed.Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 03/2010; 35(7):1520-30. DOI:10.1038/npp.2010.21 · 7.05 Impact Factor
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ABSTRACT: Obesity is a global epidemic and a health priority, and several psychiatric disorders, including major depressive disorder, bipolar disorder, and schizophrenia, are associated with an elevated risk of comorbid obesity. Moreover, persons with psychiatric disorders often have multiple risk factors (e.g., poverty and use of psychotropic medications) for excess weight. Excess weight in turn is associated with serious health consequences, both medical and psychiatric. Mental health care professionals must be familiar with the appropriate screening and treatment strategies for obesity. The authors provide a syn- thesis of the epidemiology, psychiatric and medical consequences, risk factors, and management strate- gies for obesity in psychiatric populations, giving particular consideration to management of the psychiatric patient who experiences psychotropic-associated weight gain. To formulate answers to 10 commonly asked questions about obesity and mental health, the authors conducted a MEDLINE search of all English-language articles published between 1966 and June 2005. The search terms were obesity, overweight, body mass index (BMI), metabolism, bariatric treatment, weight-loss treatment, major depressive disorder, bipolar disorder, schizophrenia, binge-eating disorder, eating disorder, and psychotropic medication. The search was supplemented with a manual review of relevant references.10/2005; 3(4). DOI:10.1176/foc.3.4.511
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