Hi Travelbug,

I take both Lamictal and Topamax and can speak of my personal experience with them. I started with Lamictal, which I am sure you know from your research you start very small and increase slowly because one of its notable side effects is a rash that can be fatal (the risk of which is lessened by starting small and slow increases up to a therapeutic dose). I had no notable weight gain (or loss) with Lamictal.

I added Topamax a little bit down the road. Lamictal was helpful for me and Topamax added in has seemed to enhance it. But, fair warning, they don't call it "dopamax"for nothing. I certainly felt the "brain fog" and the most upsetting part of that was the difficulty or inability to recall words. I am a teacher, so being able access all of my vocabulary to explain just about anything is a pretty critical thing. Also, and maybe it's just one of those bipolar characteristics, but I consider myself very GOOD with words... when I used to get manic I loved to wordplay and would laugh at my cleverness, etc. (I know, lovely.) So, suddenly not being able to think of even the most simple words was unsettling. For example, one day with my children I kept pointing to a box of pizza but couldn't recall the word "pizza." One day with a student I couldn't recall the word "ruler." Not being able to recall a high school student's name, even though I'd known her for over 2 years. Driving in a car and telling the passenger that the "eyes on the cars" in the oncoming lane were causing a glare. Eyes on the cars = headlights. In that case, I wasn't experiencing word recall difficulty, I just said it and then immediately afterward realized how bizarre it was to have said. Agreeing with RisuNeko about inability to focus when reading! That did increase with Topamax, HOWEVER, I had basically already lost that ability during my 30's before my bipolar was treated. I attribute difficulty with sustained reading tasks to be a combination of some brain degeneration from years of untreated bipolar, ADHD, a Topamax side effect, and the fact that my eyes tire easily from age (though eye problems can be related to Topamax, too).

Anyhow... I take the Topamax before bedtime so I sleep through as much of the brain fog as I can. I try to take it about 30 min before bed because if timed right it seems to have a small sedative effect and when my Pdoc prescribed it he specifically told me he was adding it because he thought it could help me sleep through the night better (I wake a lot). I was also hopeful to try it because when I am hypomanic or having a mixed episode, especially, I pick at my skin. I had read that it was showing some positive results for patients with that condition. My picking at that time was frequently around bedtime when I couldn't sleep. It did help me lessen that considerably.

To your question -- I lost about 5 lbs when I added Topamax. I only noticed because my pants were all loose. Unlike RisuNeko's experience, I will absolutely tolerate the brain fog for the time being because of the enhancement the Topamax has provided to my Rx cocktail. It was a good tweak, for me. Some of the brain fog did lessen with time (I've been on it over a year now). I remind myself that (at least according to my Pdoc) if I were to stop taking it my cognitive function would be right back... there's no indication currently that Topamax causes cognitive degeneration (in fact, if it is keeping mania from being expressed... I would consider that it is in fact protecting my brain from those episodes which would be causing greater than average degeneration. In other words, it's not making me "stupid" even though somedays I sure do feel "stupid." As with all meds, it's a matter of whether the results you get from it outweigh the risk and side effects.

All the things I ever read about Topamax, though (and you are right that the vote is still out), is that it has shown some positive effects when used in combination with other drugs. I don't remember ever reading anything about it used as mono therapy for bipolar.

Re what type of bipolar you have... no worries. I hear lots of Pdocs are thinking of bipolar more as a spectrum anyway and are going away from the subtypes (except for insurance/billing) in favor of treating symptoms not classifications. I would challenge you, though, to think about which "side" of bipolar she it trying to treat. You said she mentioned lithium/"gold standard." True, of course, but lithium is most often noted for its ability to stabilize mania, in addition to maintenance. Lamictal, by contrast, has been noted for its helpfulness with bipolar depression and for bipolar maintenance/ongoing mood stabilization.

Wishing you well.