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According to the literature available on its side effects, weight gain is an infrequent (about 2%) side effect of Gabatril (tiagabine). Sedation, dizziness, and confusion are listed as more common side effects, and are also seen in a number of other drugs with anticonvulsant properties. Topamax (topiramate) is relatively unique in being associated with weight loss as a side effect. The most problematic side effects of Topamax tend to be cognitive ones: memory impairment and impaired word finding ability. Some studies have shown that Topamax can reduce verbal IQ scores by an average of about 10 points in both volunteer and epileptic populations.
I think that the most important question for you to consider about these medications is: what diseases or symptoms are they being prescribed to treat. Both of these medications are anticonvulsants and are effective for treating seizure disorders. Because the anticonvulsants Depakote (valproate), Tegretol (carbamazepine), Trileptal (oxcarbazepine), and Lamictal (lamotrigine) have mood stabilizing properties, researchers are interested to study whether other new anticonvulsants may have mood stabilizing properties. But having anticonvulsant properties does not automatically confer mood stabilizing properties – Dilantin (phenytoin) and Phenobarbital clearly are not mood stabilizers, and Neurontin (gabapentin) has been shown to lack mood stabilizing properties, much to the chagrin of many who used it for that purpose and of its maker, which suggested to doctors to use it for that purpose.
Topamax has so far failed to demonstrate acute anti-manic properties in 5 controlled studies in adults, although clinical reports (open studies and case reports) suggest (but do not prove) that Topmax may help as an adjunctive (add-on) agent in mixed states, rapid cycling, and bipolar depression. Topamax certainly is helpful for many people with migraine headaches, and may also help alcohol dependence, certain forms of eating behavior, and certain forms of chronic pain, based on at least one positive study for each of these disorders, but remember that it takes several positive double-blind studies, or one with at least several hundred patients in it, to prove that a drug is effective for a given condition.
Gabitril has not been shown to be effective for mood disorders, but is being studied for use in certain anxiety disorders, and has shown benefit in open label studies. It may also help sleep. Gabitril increases the availability of the neurotransmitter GABA (gamma amino butyric acid), which is the major inhibitory neurotransmitter in the brain. Some other drugs that increase the activity of the GABA system (benzodiazepines, Neuronin) also decrease anxiety.
The problems with taking a taking a drug that has not been proven to work for your particular disorder or symptoms are that not only are you exposed to that drug’s side effects and costs for no benefit, but that you are not getting a drug that is likely to work, if the drug is being used for a condition in which there are effective alternatives (such as depression and bipolar disorder). Thus, you are more likely to experience prolonged symptoms and/or relapses of the illness, than if you took a drug with proven efficacy. I have difficulty thinking of many psychiatric scenarios in which Topamax would be my drug of choice, but the combination of a binge eating disorder or bulimia with bipolar depression would make it an interesting choice for the binge eating, in order to avoid antidepressant induced mood cycling.
When a prescriber recommends a particular medication, I think it is very reasonable to ask them what that medication is specifically supposed to do, what are the common side effects, and what alternatives exist. Informed consent means that you, the consumer, understand and weigh the risks and benefits of different available courses of action.
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