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 .
Open-label adjunctive topiramate in the treatment of bipolar disorders
BACKGROUND To preliminarily explore the spectrum of effectiveness and tolerability of the new antiepileptic drug topiramate in bipolar disorder , we evaluated the response of 56 bipolar out patients in the Stanley Foundation Bipolar Outcome Network ( SFBN ) who had been treated with adjunctive topiramate in an open-label , naturalistic fashion . METHODS In this case series , response to topiramate was assessed every 2 weeks for the first 3 months according to st and ard ratings in the SFBN , and monthly thereafter while patients remained on topiramate .  Patients ' weights , body mass indices ( BMI s ) , and side effects were also assessed . RESULTS Of the 54 patients who completed at least 2 weeks of open-label , add-on topiramate  treatment , 30 had manic , mixed , or cycling symptoms , 11 had depressed symptoms , and 13 were relatively euthymic at the time topiramate was begun . Patients who had been initially treated for manic symptoms displayed significant reductions in st and ard ratings scores after 4 weeks , after 10 weeks , and at the last evaluation . Those patients who were initially depressed or treated while euthymic showed no significant changes . Patients as a group displayed significant decreases in weight and BMI from topiramate initiation to week 4 , to week 10 , and to the last evaluation . The most common adverse side effects were neurologic and gastrointestinal . CONCLUSIONS These preliminary open observations of adjunctive topiramate treatment suggest that it may have antimanic or anticycling effects in some patients with bipolar disorder , and may be associated with appetite suppression and weight loss that is often viewed as beneficial by the patient and clinician . Controlled studies of topiramate 's acute and long-term efficacy and side effects in bipolar disorder appear warranted
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 .