topiramate and Obsessive-Compulsive-Disorder

It has not been examined trialed whether obsessive compulsive symptoms in patients with bipolar disorder respond to topiramate as an adjuvant treatment.. This 4-month double-blind placebo-controlled randomized clinical trial examined the efficacy and safety of augmentation with topiramat for treating the patients with bipolar disorder, manic phase type-I, and obsessive compulsive disorder symptoms. Both groups received lithium+olanzapine+clonazepam. However, one group received topiramate and the other group placebo as adjuvant medications. Yale Brown obsessive compulsive behavior scale was used to assess the outcome. Adverse effects were also recorded.. A total of 32 patients completed this trial. The mean score decreased from 24.2(4.8) to 17.6(8.7) in the topiramate group (P<0.003) and from 20.9(2.9) to 9.6(3.5) in the placebo group during this trial (P<0.0001). Additionally, 9(52.9%) out of 17 patients in the topiramate group and 2(12.5%) out of 16 patients in the placebo group showed more than 34% decline in YBOC score (x2=6.0, df=1, P<0.01). No serious adverse effects were detected.. The limitations of the present study were its small sample size and the fact that it was conducted in a single center.. The combination of lithium+olanzapine+clonazepam decreased the symptoms of obsessive compulsive disorder in the patients with bipolar disorder type I. However, topiramate had a more significant effect than placebo on improvement of the patients with bipolar disorder and obsessive compulsive symptoms. This combination seems to be without serious adverse effects.

Topics: Adult; Antimanic Agents; Benzodiazepines; Bipolar Disorder; Clonazepam; Double-Blind Method; Drug Therapy, Combination; Female; Fructose; Humans; Lithium Compounds; Male; Middle Aged; Neuroprotective Agents; Obsessive-Compulsive Disorder; Olanzapine; Selective Serotonin Reuptake Inhibitors; Topiramate; Treatment Outcome

From 40% to 60% of obsessive-compulsive disorder (OCD) patients fail to tolerate or respond to selective serotonin reuptake inhibitors (SSRIs). Preclinical and neuroimaging studies have shown abnormally high glutamatergic concentrations in OCD patients and an association between decreased caudate glutamatergic concentrations and reduced OCD symptom severity after SSRI treatment. Topiramate inhibits glutamatergic conduction.. Thirty-six adult patients with DSM-IV-defined OCD were randomly assigned to topiramate (n = 18) and placebo (n = 18) groups in this 12-week, double-blind, placebo-controlled, parallel-groups trial. Subjects were taking the maximum SSRI dose they could tolerate for at least 12 weeks and their current dose for at least 6 weeks, which was maintained throughout the study. Primary outcome measures were changes in the Yale-Brown Obsessive Compulsive Scale (YBOCS) total score and compulsions and obsessions subscores. Patients were recruited and followed up between April 1, 2003, and April 13, 2006.. Using mixed regression models (time [weeks] × treatment), we found a significant treatment effect on the YBOCS compulsions (P = .014) subscale, but not the obsessions (P = .99) subscale or the total score (P = .11). Over the 12-week trial, the topiramate group (mean endpoint dose = 177.8 ± 134.2 mg/d; range, 50-400 mg/d) showed an average linear decrease of 5.38 points on the compulsions subscale compared to 0.6 points in the placebo group. Thirteen topiramate and 14 placebo subjects completed the study. Topiramate was not well tolerated in this trial: 28% (5/18) of the subjects discontinued the drug for adverse effects, and 39% (7/18) had a dose reduction for this reason.. The results of this first double-blind, placebo-controlled trial of topiramate augmentation for treatment-resistant OCD suggest that topiramate may be beneficial for compulsions, but not obsessions. Modifications in glutamatergic function may be responsible, at least in part, for the improved response in compulsions seen with topiramate.. clinicaltrials.gov Identifier: NCT00211744.

Topics: Adolescent; Adult; Aged; Double-Blind Method; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Female; Fructose; Glutamic Acid; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Topiramate; Treatment Outcome; Young Adult

Topics: Adult; Antidepressive Agents; Drug Resistance; Drug Therapy, Combination; Female; Fructose; Humans; Male; Middle Aged; Neuroprotective Agents; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Topiramate

This study assessed the long-term effectiveness and tolerability of topiramate in binge-eating disorder (BED) with obesity.. Sixty-one patients with BED (DSM-IV-TR criteria) and obesity enrolled in a 14-week, single-center, randomized, double-blind, placebo-controlled study. Completers (N = 35) were offered participation in a 42-week, open-label extension trial of topiramate. Fifteen patients who received topiramate and 16 patients who received placebo in the double-blind study entered the open-label trial. Topiramate was titrated from 25 mg/day to a maximum of 600 mg/day. The primary endpoint was change from baseline to final visit in weekly binge frequency using the last observation carried forward for all patients who received topiramate. Baseline for patients receiving double-blind topiramate was the beginning of the controlled study; for patients receiving placebo, baseline was the beginning of the open-label trial. Open-label data were gathered from December 1998 to November 2000.. Forty-four patients (31 who received topiramate in the open-label trial plus 13 who received topiramate in the double-blind study only) received at least 1 dose of topiramate; 43 patients provided outcome measures at a median final dose of 250 mg/day. Mean weekly binge frequency declined significantly from baseline to final visit for all 43 patients (-3.2; p < .001), for the 15 patients who received topiramate during the controlled and open-label studies (-4.0; p < .001), and for the 15 patients who received topiramate only during the open-label trial (-2.5; p = .044). Patients also exhibited statistically significant reduction in body weight. The most common reasons for topiramate discontinuation were protocol nonadherence (N = 17) and adverse events (N = 14).. Topiramate treatment was associated with enduring improvement in some patients with BED and obesity but was also associated with a high discontinuation rate.

Topics: Adolescent; Adult; Anticonvulsants; Body Mass Index; Body Weight; Bulimia; Comorbidity; Double-Blind Method; Drug Administration Schedule; Fructose; Humans; Longitudinal Studies; Middle Aged; Obesity; Obsessive-Compulsive Disorder; Patient Compliance; Patient Dropouts; Placebos; Topiramate; Treatment Outcome

Topics: Adult; Anti-Anxiety Agents; Anticonvulsants; Citalopram; Drug Synergism; Fear; Female; Fructose; Humans; Lorazepam; Obsessive-Compulsive Disorder; Paroxetine; Recurrence; Selective Serotonin Reuptake Inhibitors; Sertraline; Topiramate; Treatment Refusal

Topics: Adult; Central Nervous System Agents; Compulsive Behavior; Female; Fructose; Humans; Obsessive-Compulsive Disorder; Topiramate; Treatment Outcome

Topics: Adolescent; Anticonvulsants; Female; Fructose; Humans; Obsessive-Compulsive Disorder; Self-Injurious Behavior; Skin; Topiramate; Treatment Outcome

Topics: Adult; Clonazepam; Drug Therapy, Combination; Excitatory Amino Acid Antagonists; Fructose; GABA Modulators; Humans; Lamotrigine; Male; Monoamine Oxidase Inhibitors; Obsessive-Compulsive Disorder; Phenelzine; Riluzole; Topiramate; Treatment Outcome; Triazines

A 45-year-old patient with a medication-resistant obsessive-compulsive disorder was treated successfully by topiramate augmentation. Obsessive-compulsive disorder is associated neurobiologically with overactivation of the cortico-striato-thalamo-cortical circuit. Because the neurotransmitter glutamate plays an important role in this circuit, medication that has glutamate antagonism, such as the antiepileptic drug topiramate, may reduce the symptoms of obsessive-compulsive disorder. Further study is needed to find out whether topiramate augmentation is more effective than placebos in patients with a medication-resistant obsessive-compulsive disorder.

Topics: Anticonvulsants; Drug Resistance; Excitatory Amino Acid Antagonists; Fructose; Glutamic Acid; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Topiramate; Treatment Outcome

Topics: Adult; Anticonvulsants; Commerce; Compulsive Behavior; Female; Fructose; Humans; Obsessive-Compulsive Disorder; Topiramate

Serotonin reuptake inhibitors (SRIs) are considered first-line treatments for obsessive-compulsive disorder (OCD). Many patients achieve some response but remain symptomatic despite an adequate SRI trial. Recent neuroimaging data found abnormally high glutamatergic concentrations in children with OCD. Following selective serotonin reuptake inhibitor (SSRI) treatment, a decrease in OCD symptom severity was associated with a decrease in caudate glutamatergic concentrations. We initiated an investigation of adjunctive topiramate (an anticonvulsant agent with glutamatergic properties) in the treatment of patients with OCD who were partially or nonresponsive to SRI treatment. Sixteen consecutive outpatients with OCD (mean age = 41.1 years; range = 21-58 years), who were partial or nonresponders to SRI monotherapy or SRI combination therapy (antipsychotic, other antidepressant, or benzodiazepines), and had topiramate added over a minimum of 14 weeks, were reviewed. Baseline and endpoint Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I) were evaluated retrospectively. Eleven of 16 patients were responders (68.8%) with a CGI-I score of much improved or very much improved. The mean dose of topiramate was 253.1 +/- 93.9 mg/day. The mean time to response was 9.2 +/- 4.5 weeks. CGI-S scores decreased significantly from initiation of topiramate until 26 weeks, from 6.1 +/- 0.9 to 4.5 +/- 1.3 (P < .001). This case series suggests some preliminary evidence that the addition of topiramate may be useful in treatment-resistant OCD.

Topics: Adult; Anticonvulsants; Antipsychotic Agents; Anxiety Disorders; Caudate Nucleus; Drug Resistance; Drug Synergism; Female; Fructose; Glutamic Acid; Humans; Male; Mental Disorders; Middle Aged; Obsessive-Compulsive Disorder; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Topiramate

We report a case of treatment-resistant obsessive-compulsive disorder (OCD) that was successfully treated with a pharmacological augmentation of topiramate plus paroxetine. The patient, a 45-year-old woman, was on a stable dose of paroxetine (40 mg/day) when she was started on topiramate (up to 150 mg/day). After 9 weeks of this treatment, her clinical condition remarkably improved, as indicated by a significant decrease of the evaluation scales (Yale-Brown Obsessive-Compulsive Scale and Clinical Global Impression Scale). Our case suggests that topiramate might be beneficial in augmentation with selective serotonin reuptake inhibitors in patients with treatment-resistant OCD, although further investigations are warranted to confirm our findings.

Topics: Anticonvulsants; Drug Resistance; Drug Therapy, Combination; Female; Fructose; Humans; Middle Aged; Obsessive-Compulsive Disorder; Paroxetine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Time Factors; Topiramate

Topics: Anticonvulsants; Female; Fructose; Humans; Middle Aged; Migraine Disorders; Multiple Sclerosis; Obsessive-Compulsive Disorder; Topiramate

Topics: Adult; Anticonvulsants; Antidepressive Agents, Second-Generation; Carbamazepine; Citalopram; Dose-Response Relationship, Drug; Epilepsies, Partial; Fructose; Humans; Lamotrigine; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Topiramate; Triazines

Topics: Adult; Anticonvulsants; Dose-Response Relationship, Drug; Drug Administration Schedule; Fructose; Humans; Male; Obsessive-Compulsive Disorder; Psychoses, Substance-Induced; Topiramate