Topiramate Plus Antipsychotic Medication Better Than Antipsychotics Alone for Schizophrenia Spectrum Disorders
A 2016 meta-analysis has shown that the combination of the anticonvulsant topiramate and antipsychotic medication reduces symptoms of schizophrenia spectrum disorders more than antipsychotic medication alone. Researchers led by Christoph U. Correll analyzed the results of eight studies in which the topiramate-antipsychotic combination was compared to antipsychotics alone or with placebo.
The combination of topiramate and antipsychotic medication was superior at reducing general psychopathology, including both negative and positive symptoms of schizophrenia. The combination was also associated with lower body weight and body mass index (BMI) compared to antipsychotics alone.
The studies included in the meta-analysis used a variety of antipsychotic medications. When these were compared, the combination of topiramate and clozapine was more effective than other combinations at reducing psychopathology. However, the combination of topiramate and clozapine was also associated with less weight loss than combinations using other antipsychotics.
In terms of side effects, topiramate was associated with more paresthesia (a burning or prickling sensation, often in the hands or feet) than placebo.
The study was published in the Journal of Clinical Psychiatry.
Topiramate Added to Quetiapine Can Reduce Marijuana Craving in Young People
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Melissa P. DelBello reported that compared to placebo, the anticonvulsant topiramate reduced marijuana craving in young people aged 12–21 who were already taking the antipsychotic quetiapine. Functional magnetic resonance imaging (fMRI) revealed that topiramate altered the activation of brain regions common to both drug craving and mood dysregulation. Topiramate could be a good treatment to reduce marijuana abuse. The antioxidant n-acetylcysteine (NAC) is another option.
High Risk of Suicide Attempts in Bipolar Disorder with Substance Abuse
At the 2014 meeting of the International College of Neuropsychopharmacology, researcher Rieva et al. reported that 60% of bipolar patients with comorbid alcohol abuse have attempted suicide, and 48% of bipolar patients with cocaine abuse have attempted suicide. Thus, both of these comorbidities deserve specific attention and treatment. Unfortunately there are currently no Federal Drug Administration–approved drugs for bipolar patients with these comorbidities. The most promising treatments, based on data in patients with primary addictions, are the nutritional supplement N-acetylcysteine and topiramate, which have both performed better than placebo in studies of alcohol and cocaine abuse disorders.
Topiramate Added to Regular Treatment Helps OCD symptoms in Bipolar Disorder
Until now, there has been little research about treating obsessive compulsive symptoms in people with bipolar disorder.
In a recent four-month double-blind placebo-controlled randomized clinical trial presented by Sharaian et al. at the 2014 meeting of the International Society for Bipolar Disorders, topiramate was more effective than placebo at reducing these symptoms in patients with bipolar disorder when added to their regular treatment. Nine of 17 study participants responded to topiramate (53%), while only two of 16 responded to placebo (12.5%).
Editor’s Note: These findings add to the list of comorbidities that topiramate may help with, even though it does not have any efficacy in the treatment of mania itself. Topiramate has helped with avoidance of cocaine and alcohol, bulimia and weight gain, anger attacks, and now obsessive compulsive disorder (OCD). Topiramate is also FDA-approved for migraine prevention in adolescents and adults.
Adjunctive Topiramate Is Effective In Schizophrenia
Many patients with schizophrenia do not reach full remission on antipsychotic drugs alone. The anticonvulsant drug topiramate (Topamax) has shown some promise as an adjunctive treatment for schizophrenia. To clarify the results of studies of topiramate, researcher Christoph Correll and colleagues performed a meta-analysis of nine randomized, placebo-controlled clinical trials of the drug. They found that when topiramate was added to antipsychotic treatment, it improved both positive and negative symptoms of schizophrenia, and it also led to reduced weight.
Editor’s Note: Topiramate might also be useful for patients with schizophrenia who have the common comorbidities of alcohol and cocaine abuse, since in other studies of patients with these primary disorders, topiramate was helpful.
