Excess Hair Growth (Hirsutism) & Lithium/Topamax
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Q:  Excess Hair Growth (Hirsutism) & Lithium/Topamax

Hi Dr. Phelps,

I was on lithium for 7 years and suffered many side effects mostly in the last 1.5 years I was on it- weight wouldn't budge, frequent urination, fatigue, dry skin and hair, cognitive blunting.  I went from 900mg to 675mg and added 100mg Topamax for 4 months.  I was wondering if I had insulin resistance because of the lithium.  After I went off the lithium, I experienced excess hair growth on most of my body. My TSH level went from 1.34 to .52.  Any input would be great. Was the hair growth a side effect of years of lithium or the Topamax?


Hello Sara -- 
Hmm, this isn't easy.  For starters, as a friend of mine says, "medicines are guilty until proven innocent".  From that perspective, we should consider it possible that either did this.  However, I haven't seen that with either coming off lithium or going on Topomax.  

A quick literature search showed no clear connection of hirsutism (the technical term for what you describe) and topiramate, but such a relationship has been recognized for another anti-seizure medication (phenytoin/Dilantin).  

Hirsutism has been associated with insulin resistance, as it appears you have learned, but of course you might have been going in the opposite direction in terms of insulin at the time this occurred (if you were getting the commonly observed weight loss with topiramate).  For more on that relationship, in case you want to check that out further, here's my little essay on "metabolic syndrome" and the related PCOS story.  

Dr. Phelps

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