Q:  Lithium & Topamax Together?

Hi Dr. Phelps,

I am an ultra-rapid cycler with mixed states.  I'm curious to know how well Lithium and Topamax work together.  I'm currently taking 100mg Topamax and .25mg Risperdal. I'm very sensitive to medication and these dinky amounts are the maximum I can tollerate. Unfortunately, I tend to feel groggy at the wheel after about ten minutes of driving.  My pdoc is going to add some lithium back to my diet and see if we can stay away from the anti-depressants and possibly get off of the Risperdal.  Unfortunately, the Risperdal is the only thing that keeps the "pyscho b---- from h---"  from taking over.  I go into mixed states every time I go off of it.  

I got upto 150mg of Topamax, but I lost complete interest in sex and slept most of the day, plus I had to be off of the Risperdal to tollerate that dosage.  By the end of one week, I was in a nasty mixed state.

We have tried everything.  I started getting a skin reaction to the Lamictal, so I had to discontinue that med and I'm having a hard time seeing that light at the end of the tunnel. While I was on the Lamictal, I noticed I was having more problems with the happy hypomanic highs.  I certainly didn't mind those happy highs. :)

Thank you for your time.

Dear Ms. C'
Generally we combine mood stabilizers hoping for "synergistic" effects, so we combine lithium with pretty much any other mood stabilizer rather frequently.  There seem to be few or no compatibility problems with lithium/Depakote; a few more with lithium/Tegretol, but workable for most folks; none that I've heard of for lithium/lamotrigine; and then as far as lithium/topiramate, we probably have too little experience there to really say.  Like so many other moves in this bipolar treatment, you'll have to figure it out as you go on that particular question (sorry to say).  Sounds like you've got a good doctor working through logical steps, though, that's good.  

Dr. Phelps


Published November, 2001