[travelbug2015]

Well, I had my meeting with my psychiatrist. She told me that it was still too early to decide which type of bipolar I had. She said that she's leaning Bipolar II. Anyway, she told me the variety of medicines that may help my situation. She started praising lithium. She said was the 'gold standard'. Now, I'll be honest, I'm very needle shy. I can tolerate getting blood drawn. But getting drawn every few weeks is kinda terrifying for me. I asked her about other alternatives to lithium. She brought up Lamictal and then she said Topamax. She also listed a few others.

I am a tad overweight. She said that Lamictal may add on more pounds. She then said it might be better to start out on Topamax. Then, if I have a depression breakthrough or mania, we'll change. I've been doing some research online this evening. From what I can tell, Topamax is NOT effective for bipolar mood stabilization, but it will help aid weight loss. But I also saw other websites praising its effects on bipolar. I am confused. Will it help?

I also was thinking...would she put me on it to see if I'll lose some weight, then put me on Lamictal or another med once I've lost some weight? Maybe the weight loss/gain would even out?

Or...am I on a lifetime journey to find my bipolar cocktail?

[Crazy Hitch]

Hello travelbug

Thank you for letting us know how your appointment went today.

I completely agree with your pdoc - no need really to rush into labelling the kind of BP; this is minor for now; what will be managed is your current presenting and future presenting symptoms; regardless of which sub type of Bipolar you belong to. This can come with time as evidence of patterns and symptoms emerge.

Lithium is certainly the Gold Class standard when treating Bipolar. It is a highly successful mood stabiliser for a lot of people. Caution obviously, as with all medication, needs to be exercised when one is on lithium. Regular blood tests are required to test for things like Thyroid Levels and Lithium levels - pending really on your psychiatrists view; around 0.6 - 0.8 is around the equilibrium one looks for in terms of optimal functioning of lithium of the blood; can be marginally higher; pending on episode.

Lamictal; for me; personally is a pretty good mood stabiliser; when I compare them against all of the other mood stabilisers that I have been on. It hasn't caused any weight gain with me what so ever - and I'm pretty sensitive to anything messing around with my metabolism.

I have no exprience with Topomax. I know members that have been on this; and they mostly have positive experiences. Hopefully members can come forward to offer their input.

You will find the right cocktail.

[RisuNeko]

I'm taking my last dose of Topamax tomorrow and good riddance! It didn't help me lose weight, it didn't stabilize my moods (at all), it made my brain into mush (it's often referred to as dopamax at higher doses, like 100+) I was on 200mg, now I'm on my last day of 50mg. Then I get to quit Propranolol which also causes weight gain and cognitive problems.

I wish my old nurse practitioner would have told me ALL of the side effects of the meds he was tossing my way one after the other rather than just the ones he thought I'd be okay with, like weight loss (I gained 115 lbs because of him and all the different antipsychotics and other things he put me on in the course of 2 years).

But back to the subject at hand. Lamictal is honestly probably a better choice for mood stabilization, unless you're pretty stable right now. Though it takes a while to titrate up. It didn't work for me personally, but nothing really works for me other than Geodon, and I've heard a lot of success stories on Lamictal.

Trust me, you do not want the brain fog/cognitive dulling. It's not worth it. You may not notice it at first, but you'll find yourself forgetting things, and having trouble recalling words, not being able to read, not being able to focus on anything, it'll be like you're getting a mild form of dementia over time.

[nycboots]

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.

[travelbug2015]

Thank you for the great responses. I'm on my 3rd day of taking Topamax. We'll see what happens. Honestly, I think that I may be put on lithium. She really was pushing it. But whatever will help me, right?

No side effects yet, besides a little dizziness. However, that passed. Really, I haven't felt anything. I guess it'll take more time. I have an appointment with my caseworker in less than two weeks. Then, I have a meeting with my pdoc again late next month.

I'm just glad that I'm receiving treatment. I've spent almost 20 years with untreated symptoms. I'm currently in the middle of cycles. I feel relatively ok. Just a little trouble sleeping.

[Mr. Radio]

I was put on Topamax today to help me lose weight. Hopefully it works, I've gained 35 extra pounds. He said it would help me lose it. So I'm hopeful. Don't know if it does anything for bipolar though.

[raspberrytorte]

I've never been on topamax, but I was put on lithium for a little while. My body couldn't tolerate it. I wasn't even up to the right dosage. I could barely walk, made me weak, etc. I'm on lamictal now and really like it. I haven't gained any weight on it. For me it's been weight neutral.

It sucks trying to find the right cocktail of meds that will work out for you. It took me awhile. But once you find it all will be good.

Good luck!

[raspberrytorte]

Originally Posted by RisuNeko

I'm taking my last dose of Topamax tomorrow and good riddance! It didn't help me lose weight, it didn't stabilize my moods (at all), it made my brain into mush (it's often referred to as dopamax at higher doses, like 100+) I was on 200mg, now I'm on my last day of 50mg. Then I get to quit Propranolol which also causes weight gain and cognitive problems.

Does propranolol really cause weight gain? I haven't noticed that while on it. I actually don't even know if it does anything in all honesty. I just kind of take it whenever I feel like it (I know that's bad!).

[Victoria'smom]

I was on topamax because that was the only one I was willing to take at the time. It made it so I couldn't drink soda so I quit it fast. Sounds stupid but if you knew me that would lead to dehydration fast.

Later I was put on lamictal. I'm currently on 200 as is my husband. It works well for us but we both have combos.

[RisuNeko]

Propranolol has been documented to cause weight gain especially around the midsection. I don't think it's a commonly listed or talked about side effect though. I don't know if it does anything either. It didn't seem to do anything for me. That's why im going off it. In a week I'll only be on 3 psych meds. I was on 12 less than a year ago. Feels good. I'm not a zombie anymore.