ABSTRACT
Topiramate in the Treatment of Obesity Induced by Psychotropic Drugs in a Patient with Bipolar Disorder: A Case Report
Mental Health Unit-District 44 - ASL Napoli 1 and *Department of Pharmaceutical and Biomedical Science, University of Salerno, Italy
The overweight and obesity are conditions that often occur in patients suffering from psychosis or affective disorders such as bipolar disorder. Multiple causes may be involved: from genetic interactions to lack of physical activity, from eating disorders to the wrong use of psychoactive drugs (Aronne et al. 2003; Keck et al. 2003) It is well known that different classes of psychoactive drugs, like antipsychotics, antiepileptics and some other antidepressants may induce significative weight gain (Nemeroff et al. 2003). The first-generation of antiepileptic drugs used as mood stabilizers in bipolar disorder, such as carbamazepine and valproate in particular, tend to increase the appetite and the weight markedly whereas the second-generation antiepileptic drugs, such as topiramate and zonisamide tend to reduce food-intake, thus, to lose weight. Here we report the clinical case of a patient being treated with topiramate for bipolar disorder who had presented two years earlier in a marked weight gain induced by previous treatment with an antipsychotic and antimanic used as a mood stabilizer.
Our patient named A.C., 32 years old, who suffers from bipolar disorder according to DSM IV, for over 4 years, was treated pharmacologically, in the two years prior to our observation, with olanzapine (10 mg/day) as antimanic and valproate (1000 mg/day) as a mood stabilizer. Treatment with these drugs has significantly improved the symptoms, reducing the mood swings but they induced a progressive increase in the appetite and the weight, a weight gain of 9 kg in 18 months, going from a body mass index (BMI ) of 24.5 to a BMI of 28.0. After about 18 months, we have been suspended olanzapine treatment confirming only valproate treatment (2000 mg/day) for further 6 months. Although her clinical picture has remained in good hand, the weight was further increased by 4 kg, bringing the BMI to 30. Despite the weight gain, we did not observed significant metabolic and cardiac abnormalities. In light of this clinical conditions, the therapy with valproate was suspended and replaced with topiramate treatment as mood stabilizer. Topiramate was administered at a dose of 25 mg/day for the first week, 50 mg/day for the second week and 100 mg/day by the third week. Throughout the observation period, lasting 6 months, our patient monitored both the weight and BMI. During the 6 months of topiramate treatment, our patient has maintained a good stabilization of mood, also, the patient lost 7 kg (BMI from 30 to 26.5) with an average reduction of about 1.2 kg per month. The results of our case report demonstrate that topiramate not only is able to control the typical symptoms of bipolar disorder but also to induce a significant weight loss induced by other psychoactive drugs, commonly used for the treatment of bipolar disorder, without causing significant side effects.
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