It is not possible to draw any firm conclusions about the use of topiramate in clinical practice from this evidence .
BACKGROUND Bipolar disorder is a common recurrent illness with high levels of chronicity .
Previous trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder .
This is an up date of a previous Cochrane review ( last published 2006 ) on the role of topiramate in bipolar disorder .
OBJECTIVES To assess the effects of topiramate for acute mood episodes  in bipolar disorder in adults compared to placebo , alternative pharmacological treatment , and combination pharmacological treatment as measured by treatment of symptoms on specific rating scales for individual episodes .
Adjunctive topiramate therapy in patients receiving a mood stabilizer for bipolar I disorder: a randomized, placebo-controlled trial.
OBJECTIVE To investigate the efficacy and safety of topiramate versus placebo as adjunctive therapy for the outpatient management of bipolar I disorder . METHOD In this 12-week , r and omized , double-blind , placebo-controlled trial , adults with bipolar I disorder ( DSM-IV criteria ) experiencing a manic or mixed episode with a Young Mania Rating Scale ( YMRS ) score of > or= 18 while taking therapeutic levels of valproate or lithium received adjunctive topiramate or placebo . Topiramate was titrated from 25 to 400 mg/day over 8 weeks and was continued for 4 additional weeks . The study was conducted from October 2001 through October 2003 . The primary outcome measure was the change in YMRS score from baseline to last study visit during the double-blind phase . RESULTS The mean + /- SD change in YMRS score from baseline was -10.1 + /- 8.7 ( -40.1 % ) in the topiramate group ( N = 143 ) and -9.6 + /- 8.2 ( -40.2 % ) in the placebo group ( N = 144 , p = .797 ) . Greater than 50 % reduction in YMRS was achieved by 39 % of the topiramate group and 38 % of the placebo group ( p = .914 ) . No significant treatment differences were observed for secondary efficacy measures . Compared with adjunctive placebo , adjunctive topiramate did not worsen mania or induce depression . Paresthesia , diarrhea , and anorexia were more common in the topiramate group . The topiramate group achieved greater reductions than the placebo group in body weight ( -2.5 vs. 0.2 kg , p < .001 ) and body mass index ( -0.84 vs. 0.07 kg/m(2 ) , p < .001 ) . CONCLUSION In patients treated with lithium or valproate , there was no difference in the reduction of YMRS score in the topiramate and placebo groups . Both groups showed declines of 40 % . Topiramate reduced body weight significantly relative to placebo without worsening depressive or manic symptoms
It is not possible to draw any firm conclusions about the use of topiramate in clinical practice from this evidence .
BACKGROUND Bipolar disorder is a common recurrent illness with high levels of chronicity .
Previous trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder .
This is an up date of a previous Cochrane review ( last published 2006 ) on the role of topiramate in bipolar disorder .
OBJECTIVES To assess the effects of topiramate for acute mood episodes  in bipolar disorder in adults compared to placebo , alternative pharmacological treatment , and combination pharmacological treatment as measured by treatment of symptoms on specific rating scales for individual episodes .