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 and divalproex in combination with risperidone for acute mania: a randomized open-label study
Mood stabilizers and atypical antipsychotics are commonly combined for the treatment of bipolar mania . The aim of this study was to compare the effectiveness and tolerability of topiramate and divalproex in combination with risperidone for treating acute mania patients in a naturalistic treatment setting . Seventy-four patients who met the DSM-IV criteria for bipolar mania were enrolled in this study . In order to assess the efficacy and the extrapyramidal symptoms ( EPS ) , the Young Mania Rating Scale ( YMRS ) , Clinical Global Impression ( CGI ) and Simpson-Angus Rating Scale ( SARS ) were measured at the baseline and at weeks 1 , 3 and 6 . From the baseline to the endpoint , the YMRS and CGI scores were reduced by 67.9 % and 56.6 % in the topiramate plus risperidone group ( TPMG ) . The YMRS and CGI scores were also reduced by 63.7 % and 58.2 % in the divalproex plus risperidone group ( DVPG ) . The weight and body mass index ( BMI ) increased significantly by 3.6 % and 3.3 % from the baseline to the endpoint in the DVPG , while they decreased by 0.5 % and 0.4 % , respectively , with no significant difference in the TPMG . There were no serious adverse events in either group . Despite the method ological limitations , topiramate was effective and tolerable for treating acute mania and may also be a promising alternative to a weight-gain liable mood stabilizer ( MS ) such as divalproex
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 .