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 .
Topiramate versus Valproate Sodium as Adjunctive Therapies to a Combination of Lithium and Risperidone for Adolescents with Bipolar I Disorder: Effects on Weight and Serum Lipid Profiles
Objective To compare the effects of topiramate versus valproate sodium as an add-on therapy to a combination of lithium and risperidone ( Li+Ris ) on body weight and serum lipid profile in children and adolescents with bipolar disorder . Methods In a single-blind r and omized clinical trial , thirty children and adolescents with bipolar disorder type I in the manic or mixed phase , treated with the combination of Li+Ris at therapeutic doses for at least 4 weeks who had the indication of add-on therapy due to a recurrent episode ; a partial response or non response in the current episode or relapse were included . Participants were r and omly assigned to receive either topiramate or sodium valproate as the third drug add-on therapy for a total of 6 weeks . Weight , height and serum lipid profiles were determined at baseline and at the end of week 6 . Results Differences in the mean levels of lipid profiles at baseline and after week 6 evaluation were not significant in both treatment groups . BMI z-score increased in both treatment groups , being significant only in the Li+Ris/Valproate group , increasing from ( mean±SD ) 0.38±0.55 to 0.72±1.23 ( p<0.05 ) . Between group changes in BMI z-score was not significant . Among the BMI percentile categories , participants in the normal weight subgroup showed a significant increase in BMI z-score during the 6 week trial , compared to overweight/obese subgroup , in both Li+Ris/Valproate and Li+Ris/Topiramate treatment groups . Elevated mean serum level of triglyceride and a high proportion of participants with elevated total cholesterol ( ≥ 170 mg/dl ) , triglyceride ( ≥ 110 mg/dl ) , and BMI percentile 85-<95 at baseline ( before r and omization ) and at the end of 6 week study were noted . Conclusion When topiramate and valproate sodium are used for six weeks as adjunctive treatment to a combination of Li+Ris , they act alike on lipid milieu of children and adolescents with bipolar disorder . Both Li+Ris/Valproate and Li+Ris/Topiramate therapies can lead to an increase in BMI z-score . This increase is statistically significant with Li+Ris/Valproate therapy . This suggests that topiramate could attenuate the ongoing weight  gain from lithium and risperidone . In this study , the majority of participants who gained weight were those with BMI less than 85th percentile . This suggests that normal weight patients may have greater weight gain potential than overweight/obese patients .High proportion of metabolic abnormalities among the patients at baseline , which remained elevated throughout the trial , warrants cardiometabolic monitoring in this population
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 .