Are Any of These Drugs Better for Adolescents...?
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Q:  Are Any of These Drugs Better for Adolescents...?

My daughter is 15, and has been on 100 mg Zoloft, and 1000 mg Depakote for 1 year. She has gained over 20 lbs, is having increased moodiness, and less interest in spending time with her friends. She is very athletic( participates in cross country and track), but has not wanted to exercise for the last month. Her doctor is having us decrease the Zoloft( down to 75 mg this month), and asked me to research changing her to Topamax, Zonegran, or Trileptal. I've never felt that the Zoloft helped her and didn't see improvement in her moods until she got up to 75 mg on Depakote. I'd like to see her off Zoloft completely, and feel Trileptal could be the best choice for her. She is allergic to penicillin, so Zonegran concerns me, are any of these drugs better for adolescents that are very active in sports? She also has severe periods/ cramping at times.

Dear Ms. B' -- 
The increased moodiness could be "cycling" and/or mixed symptoms, so lowering the Zoloft could still, conceivably, lead to improvement without any other changes -- particularly if, as is usually the case, the Zoloft came first and then the Depakote and you don't really know yet what Depakote alone would do. 

However, you're understandably concerned about the Depakote weight effect.  We really don't know if Trileptal  (oxcarbazepine) is a sufficiently strong mood stabilizer.  Most of what we expect from it is basically extrapolated from our experience with its cousin, carbamazepine.  It's appealing because of the lack of weight gain and the smaller number of serious side effects compared to carbamazepine, but most doc's I've talked to have concluded that it just doesn't have the "punch" of carbamazepine.  I have no patients doing well on Trileptal alone; all of them have had to add something to it.  But, we're still learning about that one.  

Topomax did not beat placebo in two randomized trials so I don't trust it.  It's a strange one.  Makes people worse a lot of the time, but boy, when it works, it's great to see weight go down not up.  

Zonegran is so new, I don't think anyone really knows what to expect from it.  The few data I know of on it are summarized here.  I'll post an update there when I see one (just checked; nothing new listed on  PUB MED).  

No one has established what's "better" among these medication for anyone, let alone adolescents, or sporty types.  My approach to choosing is laid out on my website in the treatment section of the bipolar II material, in case that's of use.  Good luck to you and your daughter. 

Dr. Phelps

Published July, 2004


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