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 as an adjuvant treatment for obsessive compulsive symptoms in patients with bipolar disorder: a randomized double blind placebo controlled clinical trial.
BACKGROUND It has not been examined trialed whether obsessive compulsive symptoms in patients with bipolar disorder respond to topiramate as an adjuvant treatment . METHODS This 4-month double-blind placebo-controlled r and omized clinical trial examined the efficacy and safety of augmentation with topiramat for treating the patients with bipolar disorder , manic phase type-I , and obsessive compulsive disorder symptoms . Both groups received lithium+olanzapine+clonazepam . However , one group received topiramate and the other group placebo as adjuvant medications . Yale Brown obsessive compulsive behavior scale was used to assess the outcome . Adverse effects were also recorded . RESULTS A total of 32 patients completed this trial . The mean score decreased from 24.2(4.8 ) to 17.6(8.7 ) in the topiramate group ( P<0.003 ) and from 20.9(2.9 ) to 9.6(3.5 ) in the placebo group during this trial ( P<0.0001 ) . Additionally , 9(52.9 % ) out of 17 patients in the topiramate group and 2(12.5 % ) out of 16 patients in the placebo group showed more than 34 % decline in YBOC score ( x2=6.0 , df=1 , P<0.01 ) . No serious adverse effects were detected . LIMITATIONS The limitations of the present study were its small sample size and the fact that it was conducted in a single center . CONCLUSIONS The combination of lithium+olanzapine+clonazepam decreased the symptoms of obsessive compulsive disorder in the patients with bipolar disorder type I. However , topiramate had a more significant effect than placebo on improvement of the patients with bipolar disorder and obsessive compulsive symptoms . This combination seems to be without serious adverse effects
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 .