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Titolo:
The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder
Autore:
Chengappa, KNR; Gershon, S; Levine, J;
Indirizzi:
Univ Pittsburgh Hlth Syst, Western Psychiat Inst & Clin, Pittsburgh, PA 15213 USA Univ Pittsburgh Hlth Syst Pittsburgh PA USA 15213 ittsburgh, PA 15213 USA Mayview State Hosp, Special Studies Ctr, Pittsburgh, PA USA Mayview State Hosp Pittsburgh PA USA ial Studies Ctr, Pittsburgh, PA USA Stanley Ctr Innovat Treatment Bipolar Disorders, Pittsburgh, PA USA Stanley Ctr Innovat Treatment Bipolar Disorders Pittsburgh PA USA PA USA
Titolo Testata:
BIPOLAR DISORDERS
fascicolo: 5, volume: 3, anno: 2001,
pagine: 215 - 232
SICI:
1398-5647(200110)3:5<215:TEROTA>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
CULTURED HIPPOCAMPAL-NEURONS; RAT CA1 NEURONS; KINDLING EPILEPTOGENESIS; EPILEPTIC PATIENTS; SODIUM CURRENTS; ACUTE MANIA; COGNITIVE FUNCTION; AFFECTIVE-ILLNESS; GRANULE CELLS; CARBAMAZEPINE;
Keywords:
anticonvulsants; bipolar disorder; depression; mania; obesity; topiramate; weight loss;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
98
Recensione:
Indirizzi per estratti:
Indirizzo: Chengappa, KNR Univ Pittsburgh Hlth Syst, Western Psychiat Inst & Clin, 3811 Ohara St, Pittsburgh, PA 15213 USA Univ Pittsburgh Hlth Syst 3811 Ohara St Pittsburgh PA USA 15213
Citazione:
K.N.R. Chengappa et al., "The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder", BIPOL DIS, 3(5), 2001, pp. 215-232

Abstract

Objectives: Topiramate, a structurally novel anticonvulsant, is being S evaluated for other neurological conditions such as migraine, neuropathic pain, and essential tremor, and also for psychiatric conditions such as bipolar disorder, bulimia, post-traumatic stress disorder, and schizoaffective disorder, in addition to obesity. This article will focus on the use of topiramate for bipolar disorder. Methods: The pharmacological profile of topiramate is compared to other established and putative mood stabilizers, and a rationale for its use in bipolar disorder is presented. Data from open clinical trials of topiramate for depression, mania, and rapid-cycling bipolar disorder are summarized. Preliminary data from one pilot dose-finding, double-blind, random-assignment,placebo-controlled, 3-week parallel group study of two doses of topiramatefor acute bipolar I mania is reported. Safety data regarding topiramate was reviewed. Finally, the potential place of this agent in bipolar illness is considered. Results: The pharmacological advantages for topiramate are low protein binding, minimal hepatic metabolism and mainly unchanged renal excretion, a 24-h half-life, and minimal drug interactions. Open clinical studies suggest a 50-65% response for refractory bipolar mania, and a 40-56% response for refractory bipolar depression in mainly add-on treatment. Open clinical studies of topiramate for rapid-cycling subjects and those for comorbid bulimia, substance abuse, post-traumatic stress, migraine, and obesity report effectiveness. The primary efficacy endpoint data (change from baseline Y-MRS total scores) of the placebo-controlled, random assignment parallel group phase II dose-finding study were not statistically significant. However, oncethe antidepressant-associated manias (28 of the sample, of 97 subjects) were excluded from the controlled study, the post-hoe analyses indicated the higher dose (512 mg/day) topiramate treatment group showed a statistically significant reduction in endpoint Y-MRS change scores as compared to placebo (p < 0.03). Adverse effects of topiramate in bipolar subjects include attention, concentration and memory problems, fatigue, sedation, transient paraesthesias, nausea, and anorexia. Some subjects experience word-finding difficulty. Weight loss may be seen in several topiramate-treated subjects with bipolar disorder. Conclusions: Topiramate appears to show promise as an addition to the agents available to treat bipolar disorder. More definitive controlled data on the efficacy of topiramate in the acute and continuation phases as well as for the prophylaxis either as monotherapy or as combination treatment of bipolar disorder are ongoing, and the results are awaited.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 19:06:19