bipolar disorder, Dr. Paul Markovitz  Q. I am 43 years old and have been on every combination of medication in the books. During my last hospitalization my Doctor was sharing some information with me about Topamax and bipolar. By using Topamax, I would be stopping all antidepressants, etc. Of course, I jumped with joy, just the though of not taking so much medication. I am currently at 300mg a day and had a maniac episode but it was shorter than normal, of course I had to bring out the Klonopin and Sonata and make myself try and stay quiet . Do you think when I reach 400mg a day it will work? I am a rapid cycler, do you think I will continue to have manic episodes or how often? I think this last one may have been because she had given me Effexor to try at one of my follow-up visits, I had complained of crying spells and inability to concentrate, tired, etc, depressed. Anyway, she gave me some samples cause I had been on it before and had to go off cause it had given ! me severe headaches. I gave it a try because every since I had a hysterectomy drugs have affected me differently than before, anyway, I think that is what cause me to go into this last mania so I stopped the Effexor and going back the original plan. Again, my question is, have you seen good results with bipolars maintaining on Topamax alone and with what other medication when they manic or depression?

  A. Topamax is a very good medication in the open trials (no placebo control groups) done to date. It is nice because it causes most bipolar patients to either lose weight or at least not gain. We have had good luck with it in our patients. The belief is that Topamax needs to be doses at 600 mg a day for mania. There is some suggestion that 400 mg per day may work, but 600 mg may be the optimal dose.

There is little data as to topiramte's efficacy in depression, so you may need to add on other medications like Effexor or Zoloft or Serzone, etc., if you get depressed again. I would follow your doctor's advice on this, and see how things go.