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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by chinaboy on October 29, 2013, at 22:33:00
i have a friend who cannot tolerate any of the established mood stabilizers. Lithium, Lamotrigine, etc,etc all made her angry and irritated.(why???)
Now she is considering topamax. But reading from wikipedia seems to leave us an impression that it does not do the trick.
what do you guys think of topamax when it comes to mood stabilization?
I wanna hear your opinions!
Posted by SLS on October 30, 2013, at 7:57:42
In reply to can topamax stabilize one's mood?, posted by chinaboy on October 29, 2013, at 22:33:00
> i have a friend who cannot tolerate any of the established mood stabilizers. Lithium, Lamotrigine, etc,etc all made her angry and irritated.(why???)
> Now she is considering topamax. But reading from wikipedia seems to leave us an impression that it does not do the trick.
> what do you guys think of topamax when it comes to mood stabilization?
> I wanna hear your opinions!
>I have seen Topamax work very well for a female with a bipolar II disorder, mixed-state hypomania. She was extremely angry and irritable, and able to act on her thoughts because she had increased energy. The initial target dosage was 200 mg/day. She was maintained on 100 mg/day. I tried Topamax once myself. I started at 12.5 mg/day and moved up very slowly. Doing this is supposed to prevent the emergence of cognitive side effects and memory impairments. It had no adverse effects on me at all. The only real concern is not to develop metabolic acidosis. This is acomplished by routine blood tests to assay bicarbonate levels.
This is the dosage titration schedule I used to prevent cognitive side effects.
Morning Evening
Week 1 12.5 mg
Week 2 12.5 mg 12.5 mg
Week 3 25 mg 25 mg
Week 4 50 mg 50 mg
Week 5 75 mg 75 mg
Week 6 100 mg 100 mg
- Scott
Posted by chinaboy on October 31, 2013, at 3:48:49
In reply to Re: can topamax stabilize one's mood? » chinaboy, posted by SLS on October 30, 2013, at 7:57:42
Thank you for your reply! What do you think of maintaining on 2oo mg per day? Is that too high? Or unnecessary? I¡¯ve read so many negative comments about this drug, can you tell me more positive things about it to boost my confidence? Thank you again for your help!
Posted by SLS on October 31, 2013, at 17:10:16
In reply to Re: can topamax stabilize one's mood?, posted by chinaboy on October 31, 2013, at 3:48:49
> Thank you for your reply! What do you think of maintaining on 2oo mg per day?
I think 200 mg/day is a good dosage, but your friend might find that 100 mg/day works equally well. I initially set 200 mg/day as my target dosage. I then tested for metabolic acidosis (blood bicarbonate). Everything was normal. Metabolic acidosis is dose-dependent, so it makes sense to find the minimum effective dosage. I would probably try going up to 200 mg/day first in order to save time and determine the maximum therapeutic effect. At that point, she can reduce the dosage gradually and see if she can be maintained on 100 mg/day.
I can't guarantee that someone won't experience cognitive and memory side effects, but these can be minimized, and possibly completely avoided by using the dosage titration schedule I suggested in my previous post.
Of course, your friend will work with your doctor to create a treatment plan.
- Scott
This is the end of the thread.
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