Dr. Phelps,

I am on Topamax 150mg, Seroquel 200 mg and Synthroid 25 mcg.  I was previously on Depakote with good results but switched to Topamax due to weight gain.  Since starting on the Topamax, I have had control of my weight but less control over my moods.  I have had three mixed episodes in six months.  Are there any better mood stabilizers or combinations of medications for episode control that don't cause weight gain?  What about Trileptal, does it cause weight gain?  Thanks in advance.

Dear Elizabeth -- 
I haven't seen any weight gain so far with Trileptal.  I think it's going to be like it's older brother Tegretol, where "weight gain" is on the list of potential side effects, but I have hardly ever seen that clearly caused by the medication (obviously people gain weight all the time even without these medications).  I like this medication a lot, and I think it will replace Depakote pretty soon except for the guru's in academic medicine who will say there's not enough data to support it's use; anybody who's treating a lot of patients has figured out it's extremely well tolerated and works for sure, pretty much in the same range as Depakote's frequency of effectiveness. 

Then there's some interesting stuff about a thyroid approach you're not on to check out.  I would be concerned about the possibility that Topomax is accelerating or exacerbating your cycling, from the sound of it; it can do that, for sure.  There are quite a few other alternatives to consider as you go along, including low dose lithium (although that has some potential for weight gain, it's much less than Depakote and may be less at lower doses such as could be combined with other mood stabilizers). 

Dr. Phelps


Published December, 2001