Q:  Topomax & Dosage Increases

 
Dear Dr. Phelps, I  am currently a 55 year old graduate student at Harvard who is trying desperately to complete his degree,[a very considerable achievement concidering that I was a high school dropout and have a forty year of  mental illness.To make a very long and brutal story short,I have recently enrolled in a double blind study of Topomax the antiepilepsey drug for which,I gather you harbor some reservations about its use in bipolar disorder. The question I have for you,however, has to with the rate of the increase in the dosage since it is already quite clear with the onset of side effects that I am not taking the placebo,they are increasing my medication by 50 mg each day, do you regard that as outside normal clinical standards and would it account  for the degree of cognitive impairment I most assuredly experienced this past ten days? Clearly this is not an idle concern, thank you, Morgan.



Dear Morgan -- 
I'm sorry for the delay in reply which probably makes things quite moot by now, at the rate you were going, and already experiencing some cognitive problems.  You have interpreted me correctly, although "clinical standards" have not really been defined for this medication for this purpose, so I'd not put it that way.  Some people can manage if they go slower, so you could ask if that could keep you in the study (if you haven't dropped already).  Good luck, in or out of the study...

Dr. Phelps