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 Unstable Bipolar Disorder
Objective : To assess open-label adjunctive topiramate in the treatment of out patients with unstable bipolar disorder ( BD ) . Method : Out patients with DSM-IV – defined BD ( I or II ) exhibiting mood instability were enrolled in this 16-week , open-label , multicentre study . Topiramate was added to existing mood stabilizers and other psychotropic treatments . The primary effectiveness measure was the Clinical Global Impression of Severity ( CGI-S ) scale ; other scales included the Young Mania Rating Scale ( YMRS ) and the Montgomery – Asberg Depression Rating Scale ( MADRS ) . Safety assessment s included monitoring adverse events , measuring tremor , monitoring vital signs and weight , and laboratory indices . We also evaluated patient satisfaction with treatment . Results : A total of 109 patients were enrolled . Intent-to-treat analysis showed significant improvement from baseline in the CGI-S , YMRS , and MADRS , starting at Week 2 ( P < 0.001 ) , with further accrual of benefit between Week 2 and Week 16 ( P < 0.001 ) . The mean modal dosage of topiramate during the stable dosing period was 180 mg daily . There was a mean 1.8 kg decrease in patient weight  from topiramate initiation to Week 16 ( P < 0.001 ) . Topiramate was well tolerated by most patients ; 11 % withdrew from the study owing to adverse events . We noted a significant reduction in the mean severity score for preexisting tremor by Week 8 of treatment ( P < 0.005 ) ; no notable changes in vital signs were observed . At Week 16 , 50 % of the patients were “ completely satisfied ” with topiramate treatment . Conclusions : Adjunctive topiramate treatment can reduce the severity of manic and depressive symptoms , as well as reducing tremor and weight in out patients with BD I or II
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 .