Chapter 41.Topiramate

Topiramate was approved by the U.S. Food and Drug Administration (FDA) for the treatment of epilepsy in 1996, for migraine prevention in 2004, and in combination with phentermine for chronic weight management in 2012. Reports appearing in the late 1990s of the drug having potential beneficial effects in bipolar disorder led Johnson & Johnson Pharmaceutical Research and Development, the discoverer and manufacturer of topiramate, to conduct a large clinical study program of topiramate in the treatment of acute bipolar mania (McElroy and Keck 2004). Controlled trials of the drug in adults with manic or mixed symptoms of bipolar disorder failed to demonstrate significant separation between the topiramate and placebo groups (Kushner et al. 2006; Roy Chengappa et al. 2006). However, topiramate has been shown in placebo-controlled trials to be efficacious in several neuropsychiatric conditions often comorbid with bipolar disorder, including binge-eating disorder, bulimia nervosa, alcohol use disorder, borderline personality disorder, psychotropic-associated weight gain, and obesity, in addition to migraine headache. Additionally, mounting evidence suggests that topiramate augmentation of antipsychotic therapy may reduce psychological symptoms in schizophrenia spectrum disorders.