Topiramate for Bulimia Nervosa With Bipolar II Disorder

Ms. A, a 27-year-old professional with a body mass index of 26, was treated with topiramate for bipolar II disorder. After 3 months of taking 75 mg/day, her mood stabilized, and she noticed life-changing differences in her eating disorder. In her teens, Ms. A had struggled with body-image concerns and began purging to lose weight at 18 years of age. She binged and purged from three to 10 times per week, occasionally refraining from this behavior for 3–4 weeks. She tried group therapy and treatment with a selective serotonin reuptake inhibitor with little improvement. When depressed, she binged for comfort and distraction from her negative self-image. When hypomanic, she binged for the “rush” of purging, making her feel powerful. When euthymic, she binged and purged out of boredom.

Ms. A began topiramate therapy when she was bingeing and purging three to four times a week but soon found her eating behavior had returned to normal. Although she lost minimal weight while taking topiramate (2–4 lb), she gained a sense of satiety. She noticed reduced anxiety, minimizing her need to binge for comfort. The most interesting change was in her self-image. She still felt overweight, but it no longer bothered her. She felt better about herself and kept her weight in perspective. Ms. A has been taking topiramate for 7 months and has not binged or purged and reports no desire to do so.