topiramate and Depressive-Disorder--Major

A 41-year-old woman with Major Depressive Disorder-Recurrent was treated with topiramate at 150 mg/day. After this administration, she developed intense pruritus and skin lesions due to scratching. Consequently, she was weaned off topiramate and the lesions regressed. Pruritus and cutaneous lesions are extremely rare side effects of topiramate, so we report an interesting case of skin reaction to this drug.

Topics: Adult; Antidepressive Agents; Depressive Disorder, Major; Female; Fructose; Humans; Pruritus; Skin; Topiramate

Alcohol use disorders (AUDs) represent a significant health burden worldwide. Currently, there are three medications approved by the U.S. Food and Drug Administration for the treatment of AUDs, and other drugs are being prescribed off-label for this purpose. However, response rates for pharmacologic treatment are low, and extant research suggests that treatment effects may partially depend on genetic factors. Personalized medicine, or using a patient's genetics and/or personal history to determine efficacy of treatment prior to prescription, is an emerging tool that will help clinicians treat their patients more effectively and safely. This review systematically discusses current findings from AUD pharmacotherapy trials examining disulfiram, acamprosate, naltrexone, the injectable naltrexone, and topiramate. Furthermore, it presents pharmacogenetics findings associated with these medications in an attempt to further the field of personalized medicine. Research from trials examining AUDs and comorbid major depressive disorder and anxiety disorders is also presented, and pharmacogenetic findings for these treatments are discussed. Lastly, the authors comment on the present and future states of the field of personalized medicine for AUD.

Topics: Acamprosate; Alcohol Deterrents; Alcohol-Related Disorders; Anxiety Disorders; Comorbidity; Depressive Disorder, Major; Disulfiram; Fructose; Humans; Naltrexone; Pharmacogenetics; Precision Medicine; Taurine; Topiramate; United States

Despite evolution of new antidepressant treatment, clinicians still encounter challenges in the treatment of depressed patients. Looking for new medications that can potentiate the effects of current antidepressants seems to be necessary. Our objective is to survey the efficacy of topiramate augmentation in resistant major depressive disorder (MDD).. This augmentation trial was designed as an 8-week randomized, placebo-controlled, double-blind study. Fifty three patients with DSM-IV diagnosis of MDD who had failed to respond to at least 8 weeks of treatment with an adequate dose of one of the SSRIs (fluoxetine, citalopram or serteraline) were included in the study. Patients were randomized to receive a flexible dose of topiramate (100-200 mg/day) or placebo beside their current antidepressant medication for a period of eight weeks. Outcome measures were Hamilton Depression Scale (HAM-D) and Clinical Global Impression (CGI).. 42 patients completed the study and there were 6 and 5 dropouts in topiramate and placebo groups, respectively. The topiramate group demonstrated significant improvement over the study period based on mean HAM-D score at week 8 compared to baseline (P = .000, Z = 3.699). Those receiving topiramate demonstrated to have a mean decrease of 32.0% in HAM-D score, compared to only 5.5% for those receiving placebo. Depressed mood, suicidality, insomnia (early, middle and late), agitation and anxiety symptoms were significantly improved in the topiramate group.. Our double-blind placebo-controlled study demonstrated that topiramate augmentation potentiate the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treatment of resistant major depressive disorder. Of note is that our study is preliminary and larger double-blind studies are needed to confirm the results.

Topics: Adult; Citalopram; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Female; Fluoxetine; Fructose; Humans; Male; Neuroprotective Agents; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Sertraline; Topiramate

Tobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy. There are some preliminary reports on topiramate efficacy for tobacco dependence. The aim of this study is to determine whether topiramate is as effective as the standard NST treatment for tobacco cessation at 1-year follow-up in patients with depression.. A randomised, controlled trial involving two groups, one of which is the control group consisting of patients on the standard pharmacological treatment for tobacco cessation (NST) and the other is the intervention group consisting of patients on topiramate as pharmacological treatment.. 29 primary care health centres in the city of Zaragoza, Spain.. 180 patients, aged 18-65 years, diagnosed with major depression, smoke more than 20 cigarettes/day, who have voluntarily asked for tobacco cessation therapy.. A multi-component programme for tobacco cessation is offered to all of the patients in the study. This programme is made up of pharmacological therapy + group cognitive-behavioural therapy. Pharmacological therapy consists of NST for the control group and topiramate (200 mg/day) for the intervention group. Psychological therapy is made up of 16 sessions of manualised group therapy.. Cessation will be assessed by patient self-declared abstinence, expired air carbon monoxide levels, and cotinine levels in saliva. Questionnaires on tobacco dependence, anxiety, depression, impulsiveness and self-efficacy will be administered. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, D (cessation day) -1, D+1, weeks 1, 2, 3, 4, 6, 8, 10 and 13, and months 4, 5, 6, 8, 10 and 12.. Tobacco cessation rates and tobacco dependence.. The analysis will be per intent to treat. We will use the general linear models of the SPSS version 15 statistical package, to analyse the effect of the treatment on the result variable (tobacco cessation rate).. It is necessary to develop new and more effective pharmacological treatments for tobacco cessation. This randomised clinical trial will determine whether topiramate is effective for tobacco cessation in patients with depression.. Current Controlled Trials ISRCTN93532081.

Topics: Adolescent; Adult; Aged; Depressive Disorder, Major; Female; Follow-Up Studies; Fructose; Humans; Male; Middle Aged; Neuroprotective Agents; Nicotine; Psychotherapy; Smoking Cessation; Tobacco Use Disorder; Topiramate

Depression is associated with increased aggression and diminished ability and quality of life. The goal of this study was to compare the efficacy of topiramate in influencing depressive symptoms, aggression, ability, and health related quality of life in depressive women.. We conducted a randomized, double-blind, placebo-controlled 10-week study of topiramate in 64 female subjects from the general population who met criteria for recurrent major depressive disorder. Primary outcome measures were changes on the Hamilton Depression Rating Scale (HDRS), the State-Trait Anger Expression Inventory (STAXI), the Test of Attention (d2), and the SF-36 Health Survey (SF-36).. According to the intent-to-treat principle, a significant difference on the HDRS (P=0.02), all scales of STAXI (all P<0.001), Total efficiency of d2 (P<0.001), and on most scales of SF-36 (P between 0.15 and <0.001) were observed in the topiramate-treated subjects comprised the placebo group. The reduction in expression of anger correlated significantly with changes on the HDRS, and several scales of d2 and SF-36. Additional weight loss, which was significantly more pronounced in the topiramate group than in those treated with a placebo, was ascertained (difference in weight loss between the two groups: 4.2 kg, P<0.001). All the patients tolerated topiramate relatively well.. Only moderately ill women were included.. Topiramate appears to be an effective agent in the reduction of depressive symptoms and anger and in the improvement of ability and health-related quality of life in depressive women. Additional weight loss can be expected.

Topics: Adult; Anger; Anticonvulsants; Depressive Disorder, Major; Double-Blind Method; Female; Follow-Up Studies; Fructose; Humans; Surveys and Questionnaires; Topiramate; Weight Loss

This is the first case report of the safety of therapeutic repetitive transcranial magnetic stimulation (rTMS) in a patient with an intracranial space-occupying lesion who had recurrent major depression. In this case, the intracranial space-occupying lesion was a mixed cystic and solid enhancing pineal region mass measuring approximately 16.9 × 12.2 × 15.5 mm. The patient remitted from depression with 36 sessions of dorsolateral prefrontal cortex rTMS treatments over a 6-week period. During the rTMS treatment course, patient's medication list included bupropion that potentially can increase the risk for a seizure and topiramate that potentially can reduce the risk for seizure associated with the treatment. The patient tolerated the rTMS treatment well, reporting only transient headache and discomfort at the site of stimulation after the treatment. She tolerated the procedure well and had no incidental seizure activity throughout her treatment sessions.

Topics: Anticonvulsants; Antidepressive Agents, Second-Generation; Brain Neoplasms; Bupropion; Depressive Disorder, Major; Female; Fructose; Humans; Magnetic Resonance Imaging; Middle Aged; Pinealoma; Recurrence; Topiramate; Transcranial Magnetic Stimulation

Topics: Adult; Anticonvulsants; Depressive Disorder, Major; Dextromethorphan; Excitatory Amino Acid Antagonists; Fructose; Humans; Male; Opioid-Related Disorders; Stress Disorders, Post-Traumatic; Topiramate

Headache is a common adverse effect of electroconvulsive therapy. The analgesic medications acetaminophen, nonsteroidal anti-inflammatory agents, muscle relaxants, or narcotics usually produce only short-term benefit. Topiramate was an effective therapy for a post-electroconvulsive therapy headache that did not respond to typical pain medicines.

Topics: Adult; Analgesics; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Fructose; Headache; Humans; Neuroprotective Agents; Pain Measurement; Suicidal Ideation; Topiramate; Treatment Failure

A 46-year-old man inhaled combustible smoke of unknown chemical composition for 15-20 min in an automobile body shop. Within 1 month, he noted headache, sadness, anergia, anhedonia, agitation, poor sleep and impairment of concentration, attention and learning skills. Three years later, mental status examination showed major depression and cognitive disorder manifested by apprehension, continuous sadness, agitation, exhaustion, difficulty with word finding, bradyphrenia, short-term and long-term memory impairment, and judgement impaired by impulsive and affect-laden reactions without reflection. Impairments were noted on neuropsychiatric tests, and positron emission tomography (PET) scan of the brain with (18)F-fluorodeoxyglucose showed globally decreased and heterogeneous metabolic activity in the entire brain. Treatment included sertraline, methylphenidate, valproic acid and topiramate. At 14 years after smoke inhalation injury, he had persistent cognitive impairment. Repeat brain PET scan showed areas of improvement and deterioration. This case shows long-term brain and psychiatric dysfunction resulting after toxic smoke inhalation, with some areas of the brain having progressive deterioration between years 3 and 14 after smoke inhalation.

Topics: Activities of Daily Living; Brain; Cognition Disorders; Depressive Disorder, Major; DNA Damage; Fluorodeoxyglucose F18; Fructose; Humans; Male; Memory, Long-Term; Methylphenidate; Middle Aged; Neurodegenerative Diseases; Neuropsychological Tests; Oxidative Stress; Positron-Emission Tomography; Radiopharmaceuticals; Sertraline; Smoke Inhalation Injury; Time Factors; Topiramate; Valproic Acid

Adolescent mania is often misdiagnosed. This case study describes the clinical course and diagnostic reclassification from schizophrenia to bipolar disorder in a 15-year-old girl. This case study also describes the pedigree of the siblings, familial aggregation, and anticipation of mood disorders. In addition, we present the successful use of topiramate, a new antiepileptic drug, which is increasingly being used as a mood stabilizer in paediatric bipolar disorder. The efficacy of topiramate in this case supports its role as a promising agent in treatment-resistant adolescent mania associated with familial aggregation.

Topics: Adolescent; Age of Onset; Anticipation, Genetic; Anticonvulsants; Bipolar Disorder; Depressive Disorder, Major; Diagnosis, Differential; Drug Therapy, Combination; Family; Female; Fructose; Humans; Lithium Compounds; Pedigree; Schizophrenia; Topiramate; Treatment Outcome

In recent years topiramate has been used for psychiatric patients, mainly for controlling substance use and food intake. A total of 46 patients who received topiramate treatment during the study period were identified from a computer database. Nineteen had received topiramate for at least 1 month. Twelve patients received topiramate for anticraving effects (alcohol, n = 9; heroin/amphetamine, n = 1; meperidine, n = 1; and nicotine, n = 1). On an average dosage of 112.5 mg/day, nine of the 12 patients (excluding three alcoholic patients) achieved complete or partial remission from the substance use disorders. The present results show that six of the nine patients achieved full or partial remission from alcohol use disorder on a dosage of 100 mg/day. Topiramate was also used to control seven patients' bodyweight (mean bodyweight change, 1.53 kg). Four of them achieved bodyweight loss in the 1-month follow up, with an average change of 2.65 kg. Based on the present findings topiramate <100 mg/day may be effective in treating patient with alcohol use disorder, and that topiramate has not shown remarkable benefit of bodyweight loss.

Topics: Adult; Agoraphobia; Anti-Obesity Agents; Body Weight; Databases, Factual; Depressive Disorder, Major; Eating; Female; Fructose; GABA Antagonists; Humans; Male; Middle Aged; Retrospective Studies; Substance-Related Disorders; Topiramate; Treatment Outcome

Alprazolam is successful in reducing anxiety but has a high addictive/misuse potential. Topiramate is a novel anticonvulsant which has been used as a mood stabilizer. Other anticonvulsants, such as carbamazepine and valproate, have been used in alcohol and benzodiazepine withdrawal. Topiramate has recently been used in alcohol, cocaine and opiates withdrawal. There has been also one report of topiramate use in midazolam withdrawal. In our case of a patient with recurrent major depressive disorder, subthreshold anxiety disorder and addiction to alprazolam, topiramate appears to be efficient and safe in alprazolam withdrawal.

Topics: Adult; Alprazolam; Anti-Anxiety Agents; Anticonvulsants; Antidepressive Agents, Second-Generation; Anxiety Disorders; Cyclohexanols; Depressive Disorder, Major; Female; Fructose; Humans; Substance Withdrawal Syndrome; Substance-Related Disorders; Topiramate; Treatment Outcome; Venlafaxine Hydrochloride

To report observations on the efficacy and tolerability of topiramate in a sample of five patients with severe symptoms of bulimia nervosa and comorbid mood and/or anxiety disorders.. Topiramate was added to other psychotropic medication under open-label conditions up to the maximum tolerated dose or until remission of the eating disorder was achieved.. Topiramate almost completely eliminated binging and purging behavior in three of the five patients. Improvement was maintained throughout the period of follow-up for up to 18 months. One patient showed a partial, temporary response, and the fifth was intolerant of the drug and unable to complete an adequate trial.. These results suggest strongly that the efficacy of topiramate in patients with bulimia nervosa with and without comorbid mood and anxiety disorders should be investigated more fully.

Topics: Adult; Anxiety Disorders; Bipolar Disorder; Bulimia; Chronic Disease; Comorbidity; Depressive Disorder, Major; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Fructose; Humans; Male; Middle Aged; Recurrence; Topiramate; Treatment Outcome

Topics: Adult; Antidepressive Agents; Bulimia; Depressive Disorder, Major; Drug Resistance; Female; Fructose; Humans; Topiramate

Topiramate, a novel anticonvulsant, has shown promise in preliminary open trials in bipolar disorder, but there are no studies in primary depression. Topiramate's tendency to cause weight loss could be advantageous for many patients with mood disorders.. A chart review was conducted on 16 female outpatients with a primary major depressive episode and mild to moderate obesity who received open-label adjunctive topiramate. Ongoing psychotropics were continued at previous doses. Self-report symptoms were assessed before and after acute phase (4-8 weeks) treatment in a subset of 11 patients, and clinician ratings were assessed at all visits during extended phase (up to 40 weeks) treatment for the entire group.. Patient and clinician symptom ratings dropped significantly during acute phase treatment (5.5+/-1.2 weeks), but only 36% of patients were judged responders. At extended phase endpoint (17.7+/-13.4 weeks), 44% of patients were responders. Body mass index decreased significantly on topiramate, reflecting a mean weight loss of 6.1+/-8.2% from baseline. Central nervous system side effects were prominent.. Topiramate may have potential for the adjunctive treatment of depression in obese patients, but close monitoring of weight and adverse effects is warranted.

Topics: Adult; Antidepressive Agents; Body Weight; Depressive Disorder, Major; Female; Fructose; Humans; Obesity; Retrospective Studies; Topiramate