Q:  Topamax Effective Replacement for Lithium?  Weight Gain?


CAN TOPAMAX BE AN EFFECTIVE REPLACEMENT FOR LITHIUM AND DOES TOPAMAMAX NOT HAVE THE SIDE EFFECT OF WEIGHT GAIN?

Dear Ms. V'
No mood stabilizer can be a sure "replacement" for any other; they 're all pretty different, and may work well, but may not.  Trileptal and lamotrigine (see same section) and maybe thyroid hormone, are options without weight gain as a significant risk, and all in my view are better than Topomax, which has pretty severe effects on memory and thinking and even balance in more than half the people who take it.  Generally if we were considering Topomax I'd add it to your lithium, very very slowly, and see what happened to your appetite and weight.  If you were doing really well on it for several months we might very slowly, like over 6 months or more, inch your lithium dose down and see if you continued to do well.  

Dr. Phelps  


Published August, 2001