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Adjunctive topiramate in bipolar II disorder
Eduard Vieta1, José Sánchez-Moreno, José M Goikolea
1Bipolar Disorders Programme, Barcelona Stanley Research Medical Institute, Centre Hospital Clinic, University of Barcelona, Barcelona, Spain. evieta@clinic.ub.es
Summary
Adjunctive topiramate shows promise for bipolar II disorder, offering significant symptom improvement in treatment-resistant patients. This study found topiramate generally well-tolerated, with notable efficacy in managing hypomanic and depressive symptoms.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Bipolar II disorder presents challenges in treatment, particularly for patients resistant or intolerant to standard mood stabilizers like lithium, carbamazepine, and valproate.
- Identifying novel therapeutic options is crucial for improving patient outcomes in bipolar II disorder.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive topiramate in patients with bipolar II disorder.
- To assess topiramate's effectiveness in individuals with treatment-resistant or intolerant profiles to established mood stabilizers.
Main Methods:
- A 12-week, open-label study involving 19 patients diagnosed with DSM-IV bipolar II disorder.
- Patients received adjunctive topiramate for hypomanic or depressive symptoms, with dose escalation.
- Symptom severity was assessed using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Clinical Global Impression-Bipolar (CGI-BP-M).
Main Results:
- Significant improvements were observed in YMRS, HDRS, and CGI-BP-M scores (p=0.0001).
- In hypomanic patients, 53% responded to topiramate, with 33% achieving remission.
- In depressive patients, 50% responded, and 25% achieved remission.
- Topiramate was generally well-tolerated, with one-third of patients experiencing weight loss.
Conclusions:
- Adjunctive topiramate demonstrated significant efficacy in reducing hypomanic and depressive symptoms in bipolar II disorder patients.
- Topiramate appears to be a potentially useful and well-tolerated treatment option for individuals with treatment-resistant or intolerant bipolar II disorder.
- Further research is warranted to confirm these preliminary findings in larger, controlled studies.