Influence of topiramate on olanzapine-related adiposity in women: a random, double-blind, placebo-controlled study

ArticleinJournal of Clinical Psychopharmacology 25(3):211-7 · July 2005with17 Reads
Impact Factor: 3.24 · Source: PubMed
Abstract

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.

    • "...Topiramate. This medication attenuated olanzapine-induced weight gain [Ko et al. 2005; Nickel et al. 2005; Kim et al. 2006]. Switching antipsychotic agents. ..."
    [Show abstract] [Hide abstract] ABSTRACT: The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.
    Full-text · Article · Oct 2012 · Therapeutic advances in endocrinology and metabolism
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    • "...m but not necessarily smoking,[2–7] obesity,[8] eating disorders,[9] and drug-induced weight gain.[1011] Although efficacy in posttraumatic stress disorder is uncertain,[12] the drug is ineffective in ..."
      Topiramate has also received approval for the prophylaxis of migraine. Other indications for which topiramate may be effective include neuropathic pain syndromes,[1] alcoholism but not necessarily smoking,[2–7] obesity,[8] eating disorders,[9] and drug-induced weight gain.[1011] Although efficacy in posttraumatic stress disorder is uncertain,[12] the drug is ineffective in bipolar disorder.[1314]
    [Show abstract] [Hide abstract] 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.
    No preview · Article · Jul 2010 · Indian Journal of Psychiatry
    0Comments 1Citation
    • "...l therapy and adjunctive pharmacotherapy in helping to achieve weight reduction. [8,23,31323334353637383940 In a randomized, placebo-controlled trial, metformin plus lifestyle intervention showed the b..."
      Some promising results point to the effectiveness of behavioral therapy and adjunctive pharmacotherapy in helping to achieve weight reduction. [8,23,31323334353637383940 In a randomized, placebo-controlled trial, metformin plus lifestyle intervention showed the best effect on weight loss. [41] This is some of the best empirical evidence to date for the efficacy of treating weight gain during treatment with antipsychotics.
    [Show abstract] [Hide abstract] ABSTRACT: This study focuses on exploring the relationship between changes in appetite or eating behaviors and subsequent weight change for adult patients with schizophrenia or bipolar disorder treated with olanzapine and adjunctive potential weight mitigating pharmacotherapy. The aim is not to compare different weight mitigating agents, but to evaluate patients' characteristics and changes in their eating behaviors during treatment. Identification of patient subgroups with different degrees of susceptibility to the effect of weight mitigating agents during olanzapine treatment may aid clinicians in treatment decisions. Data were obtained from 3 randomized, double-blind, placebo-controlled, 16-week clinical trials. Included were 158 patients with schizophrenia or bipolar disorder and a body mass index (BMI) > or = 25 kg/m2 who had received olanzapine treatment in combination with nizatidine (n = 68), sibutramine (n = 42), or amantadine (n = 48). Individual patients were analyzed for categorical weight loss > or= 2 kg and weight gain > or = 1 kg. Variables that were evaluated as potential predictors of weight outcomes included baseline patient characteristics, factors of the Eating Inventory, individual items of the Eating Behavior Assessment, and the Visual Analog Scale. Predictors/correlates of weight loss > or = 2 kg included: high baseline BMI, low baseline interest in food, and a decrease from baseline to endpoint in appetite, hunger, or cravings for carbohydrates. Reduced cognitive restraint, increase in hunger, and increased overeating were associated with a higher probability of weight gain > or = 1 kg. The association between weight gain and lack of cognitive restraint in the presence of increased appetite suggests potential benefit of psychoeducational counseling in conjunction with adjunctive pharmacotherapeutic agents in limiting weight gain during antipsychotic drug therapy. This analysis was not a clinical trial and did not involve any medical intervention.
    Full-text · Article · Apr 2009 · BMC Psychiatry
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