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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by DedeD on April 3, 2002, at 20:08:18
Dear Dr. kramer,
Thank you in advance for reading my post. I have been diagnosed as BiPolar for about a year. My ARNP has finally settled on my course of medication. I am taking Prozac (anti depressant), Lithium (mood stabilizer), Seroquel (for sleep), Valium (for anxiety, although I rarely take that), and now I've requested Topamax because I've heard that it reduces the weight I put on (54 lbs) with the Depakote I was taking previously. Also my hair had fallen out with the Depakote, not a pretty sight. I really want the topamax because I can't stand myself after the weight gain and hair loss. I go to college now, something I wasn't able to do before my medication. You don't know what it's like to be 40 and go to school with those perfect, flat bellied 18 year olds. I notice that as it is, I have to try extra hard to focus in order to get my schoolwork done. Surprisingly I pull A's and B's, but it's hard work. Will the Topamax make this even harder? Am I overmedicated as it is? Will my diagnosis keep me on medication forever? Please advise.
Posted by TSA West on April 4, 2002, at 0:30:24
In reply to Kramer: Overmedicated? Topamax? Is this forever?, posted by DedeD on April 3, 2002, at 20:08:18
I believe the Topamax in the long run will not affect your cognition negatively. At first, you will not be able to remember trivial facts without dedicated and highly concentrated thought. But studies done over six months reveal no cognitive deficits and a large substantial emotional gain:
Epilepsia, Volume 42(9) September 2001 pp 1134
Postmarketing Experience with Topiramate and Cognition:"The P.A.D.S. (post-marketing antiepileptic drug survey) group, a cooperative group of 14 epilepsy centers that collaborate on obtaining data about new AEDs and devices, prospectively collected standardized data forms before and during treatment with Topiramate (TPM) for epilepsy, and analyzed the postmarketing experience of CNS adverse events with TPM. We were unable to demonstrate a specific population, dose titration, or concomitant AED that was at risk to discontinue treatment.
We conclude that most patients treated with TPM will continue therapy beyond 6 months. Cognitive complaints and not efficacy reflect the primary reason for discontinuing therapy. Psychomotor slowing was the most common complaint, yet most patients elect to continue treatment, with "better" or "much better" ratings of both seizure and global improvement during treatment."
Posted by Bekka H. on April 4, 2002, at 0:37:55
In reply to Kramer: Overmedicated? Topamax? Is this forever?, posted by DedeD on April 3, 2002, at 20:08:18
Hi DedeD:
Have you and your doctor discussed the possibility of Lamictal? I've read that it is the one med in that category that is LEAST likely to cause cognitive dysfunction.
The main problems with Lamictal are 1)a VERY long titration period and 2)you have to be vigilant about rashes.
Bekka
Posted by Dr. Kramer on April 4, 2002, at 13:45:36
In reply to Kramer: Overmedicated? Topamax? Is this forever?, posted by DedeD on April 3, 2002, at 20:08:18
The bad news:
Topamax doesn't really do that much for weight loss. Diet and excercise are pretty much the only safe ways to do that.
It also makes pts spacey, particularly in the beginning. A colleague of mine calls it "Dopamax." It's not going to help your school work.
Some good news:
Zinc and selenium supplements often help Depakote induced hair loss.
I can't comment on whether you're over medicated on the basis of this. Most people who need mood stabilizers need them indefinitely, but I can't predict for you.
Be well.
Posted by Zo on April 5, 2002, at 0:57:10
In reply to Re: Kramer: Overmedicated? Topamax? Is this forever?, posted by Dr. Kramer on April 4, 2002, at 13:45:36
It's rude of me to contradict Dr. Kramer, I know, but my pdoc, a Behavorial Medicine expert here in Northern California, happened to mention recently that he had just given a seminar on Topamax as a primary medication for weight loss.
Can't tolerate the stuff myself, but thought I'd pass it along.
Zo
Posted by Bekka H. on April 5, 2002, at 16:17:38
In reply to Re: Topamax = weight loss » Dr. Kramer, posted by Zo on April 5, 2002, at 0:57:10
my pdoc, a Behavorial Medicine expert here in Northern California, happened to mention recently that he had just given a seminar on Topamax as a primary medication for weight loss.> Can't tolerate the stuff myself, but thought I'd pass it along.> Zo
***********************************************
Hi. I've read that it helps weight loss, but I've also read that of all the anticonvulsants now being used for affective disorders, Topamax causes the MOST cognitive impairment; Lamictal probably causes the least impairment.
By the way, Zo, Northern California must be beautiful!
Bekka
Posted by DedeD on April 5, 2002, at 19:01:08
In reply to Re: Topamax = weight loss - Zo, posted by Bekka H. on April 5, 2002, at 16:17:38
I'm the person who started this thread. The reason I asked for the Topamax was to shed the 54 lbs the Depakote put on me. My doc said had she known that topamax was available on my "free" program at the time, she would have prescribed it then, but my hair would have still fallen out (Depakote is evil, IMHO).The reason I asked for it was because my niece is on it and she has noticably lost weight. My doc confirmed that topamax was supposed to go on the market as a diet pill but there was too many politics surrounding it (don't know what the politics were). About the cognitive loss, that scares me. I'm in college now and pulling A's and B's. Don't want to lose that, but being fat REALLY disturbs me. I HATE myself for it. Dieting has worked for a little while, but I've put the weight right back on. Exercise is kind of tough, I live in Southwest Florida where it is ALWAYS hot. I can't afford a gym. What to do? What to do? Slim and stupid? Fat and hating myself, but smart.
Posted by Bekka H. on April 5, 2002, at 23:07:21
In reply to Re: Topamax = weight loss, posted by DedeD on April 5, 2002, at 19:01:08
Hi DedeD,
Many people on Psychobabble have good things to say about Lamictal. Have you and your doctor looked into this possibility?
Bekka
Posted by DedeD on April 6, 2002, at 7:56:25
In reply to Re: Topamax = weight loss - DedeD, posted by Bekka H. on April 5, 2002, at 23:07:21
Hi Bekka, thanks for posting. Two things. 1) Will Lamictal help me with the large amount of weight I've gained from the Depakote? 2) and since I'm going to a sliding-scale service and getting free meds, I will have to ask if Lamictal is covered under this plan. But I'll ask ONLY if Lamictal reduces my weight. That is the only reason my doc and I agreed on the Topamax. Otherwise I wouldn't be taking it at all.
Posted by Bekka H. on April 7, 2002, at 0:12:04
In reply to Re: Topamax = weight loss - DedeD, posted by DedeD on April 6, 2002, at 7:56:25
Hi DedeD,
Some Psychobabblers have not gained any weight on Lamictal; others have. Several of those who have gained weight seemed to feel that it was largely water-weight from water retention, and the weight came off when they lowered the dose or got off the med. I think that weight gain is such an "individual issue;" you probably just have to try it and see. I certainly sympathize with you regarding the weight issue. It is so distressing and frustrating to put on weight from a medicine that is supposed to make you LESS depressed! What's the matter with those drug researchers??? Can't they come up with a decent antidepressant that doesn't cause weight gain, among other problems?
I do think, however, that you have to consider other things as well. You said that you are back in school after a long hiatus, and I think it would make you feel really good (i.e., less depressed) to do well in school. If Topamax doesn't interfere with your cognition, then that would be great. Maybe you can try it and see how it goes. If it does impair your cognition and your ability to study and remember what you studied, then perhaps you and your doctor could look into Lamictal as a possibility. Several posters on this board have successfully combined a small dose of a stimulant WITH Lamictal, so maybe that combo would help with the weight issue.
As far as the insurance company paying for Lamictal, I know mine DID pay for it. I had to pay a $5.00 copayment.
I hope this goes well for you. Let me know what you decide.
Bekka
Posted by Bekka H. on April 7, 2002, at 1:02:52
In reply to Re: Topamax = weight loss - DedeD, posted by DedeD on April 6, 2002, at 7:56:25
Hi again.
I just want to mention that if you do decide to try Lamictal, the titration must be VERY slow, over a number of weeks, in order to avoid the rare but serious rash. If you do get a rash of ANY kind, you're supposed to have a doctor check it out just to make sure it isn't the dangerous rash. Other than that, I've heard/read many good things about Lamictal.
Bekka
Posted by Zo on April 7, 2002, at 5:39:09
In reply to Re: Topamax = weight loss - Zo, posted by Bekka H. on April 5, 2002, at 16:17:38
No doubt!
Thought: maybe in healthy people, it doesn't? I believe he was lecturing before just plain ol' MDs. . .?
It IS gorgeous here, always. I'm in Berkeley. .where are you?
Zo
Posted by Zo on April 7, 2002, at 5:40:02
In reply to Re: Topamax = weight loss, posted by DedeD on April 5, 2002, at 19:01:08
Posted by MichelleMyBelle on May 10, 2003, at 12:36:26
In reply to Topamax and Cognition » DedeD, posted by TSA West on April 4, 2002, at 0:30:24
Hi,
I realize that this message is more than a year old, but I'm just starting on Topamax 25mg am&pm. I am planning on returning back to college full time (hopefully). Will the cognitive deficits get in the way of me retaining short AND long term memory?> I believe the Topamax in the long run will not affect your cognition negatively. At first, you will not be able to remember trivial facts without dedicated and highly concentrated thought. But studies done over six months reveal no cognitive deficits and a large substantial emotional gain:
>
> Epilepsia, Volume 42(9) September 2001 pp 1134
> Postmarketing Experience with Topiramate and Cognition:
>
> "The P.A.D.S. (post-marketing antiepileptic drug survey) group, a cooperative group of 14 epilepsy centers that collaborate on obtaining data about new AEDs and devices, prospectively collected standardized data forms before and during treatment with Topiramate (TPM) for epilepsy, and analyzed the postmarketing experience of CNS adverse events with TPM. We were unable to demonstrate a specific population, dose titration, or concomitant AED that was at risk to discontinue treatment.
>
> We conclude that most patients treated with TPM will continue therapy beyond 6 months. Cognitive complaints and not efficacy reflect the primary reason for discontinuing therapy. Psychomotor slowing was the most common complaint, yet most patients elect to continue treatment, with "better" or "much better" ratings of both seizure and global improvement during treatment."
Posted by glaciergirl on May 12, 2003, at 8:55:49
In reply to Re: Topamax and Cognition » TSA West, posted by MichelleMyBelle on May 10, 2003, at 12:36:26
Hi, I just thought I would give my take on Topamax. I took the same dose you are taking and after two weeks went up to 50 am&pm. I had mild tingeling from day 1, but it didn't bother me much. I really liked the fact that I didn't get hungry and felt like I was losing weight, but after a week of the higher dosage, my neck and shoulders became sooo sore and tense that I could barley move my head...I don't know if this was a side effect or not, but I quit taking it and my neck and shoulders have loosened up. I didn't like the fact that I couldn't think fast, that was the most bothersome for me. My doc put me on Strattera so we'll see how that goes. Good luck!
Brooke
Posted by MichelleMyBelle on May 12, 2003, at 12:35:16
In reply to Re: Topamax and Cognition, posted by glaciergirl on May 12, 2003, at 8:55:49
Hey,
You should have stuck in there a little longer. You know there are other meds to help with muscle tension. My mom is a psych nurse and I was just telling her last night I was clenching my jaw with the Topamax , but I was afraid to tell my doctor b/c the last time I had that was with Lexapro and he took me off. I really want to give Topamax a fair try, but I hate this jaw clenching stuff. My mom told me in the hospital they give Cogentin to people for this stuff to off set the side effects. It's actually for Parkinson's disease and tremors (which would actually be helpful for a lot of other med side effects). But, if you did well on the Topamax and the muscle tension was the only bothersome side effect - maybe you should ask your doc about going back on it and adding Cogentin or at least seeing if there's something that could decrease the tension. P.S. What's Strattera for? I've never heard of that one. Michelle
> Hi, I just thought I would give my take on Topamax. I took the same dose you are taking and after two weeks went up to 50 am&pm. I had mild tingeling from day 1, but it didn't bother me much. I really liked the fact that I didn't get hungry and felt like I was losing weight, but after a week of the higher dosage, my neck and shoulders became sooo sore and tense that I could barley move my head...I don't know if this was a side effect or not, but I quit taking it and my neck and shoulders have loosened up. I didn't like the fact that I couldn't think fast, that was the most bothersome for me. My doc put me on Strattera so we'll see how that goes. Good luck!
> Brooke
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