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I went to my doctors this morning and he said he disagreed with the p-doc about my diagnosis. The GP thinks I'm bipolar, the p-doc thinks I'm both BPD and paranoid sz.

I am having a really hard time controlling my impulses - last week I overdosed on a handful of pills (olanzapine, haldol, zimovane and codeiene). It was a total compulsion out of the blue and I ended up in hospital for 3 days. I still feel the compulsion to overdose every day, at times it is all I can think about. As well as overdosing I have been cutting myself and struggling with cravings for alcohol. AND all the while I have severe binge eating and bulimia (making myself sick up to 10 times a day). My moods swing wildly from elation to despair.

Has anyone used Topamax for impulse control? I really am desperate to try anything, the next time I overdose I plan to do it in the sand dunes where nobody can find me. I even lied to the GP today to get extra Olanzapine and Haldol to overdose on. I have been on a waiting lidt for therapy for over a year now. I see my p-doc tomorrow. I don't want to let my family down but all I can think of is over-dosing, bingeing and hurting myself. Oblivion is really seeming a good option right now. I understand using Topamax would be a last ditch effort. Has anyone ever used it for the same off label problems as I have? I know a lot of you use it for seizure control and peoper on label uses, I am well aware of the risks of taking Topamax, but I am totally at my wit's end

blackbird x

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I know you're asking about Topamax and I'm sorry I can't help there... but I have some things I want to add anyway.

I get really worried, I always read your posts with interest even though we don't really talk. Some of them have given me insight in some of my own psychotic tendencies.

But I had to add, are you living alone? You should not have access to enough pills to overdose on. If you live with someone, can they lock up the meds and just give you your weekly doses and some PRNs? If not, is it possible to have the hospital do the same thing? Or maybe your pdoc can write something on your prescription so that you have to pick it up once a week? I don't know, it should be able to work out. It's a pain in the ass, but it's a good, and probably much needed, security measure.

After my overdose, my mom has my meds locked up. Sure, I can hurt myself in other ways but I always "yearned" the most for pills.

This is not a long term solution, but it might be necessary right now. Long term, is there another waiting list for therapy? Can your meds be adjusted in some other way? Are the impulses related in any way to psychosis, or maybe drinking?

Take care.

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Hi Helena

Thanks for your kindness and concern for me. I live with my mother, she doesn't have control of the pills and I would find it very hard to relinquish that control even though it is probably necessary, the thing is, if she knew what I was really doing with my meds - taking vast quantities of them, she would freak out. I just seem to have compulsions for overdosing and mixing up pills. Last night I took 10mgs of Haldol, 60mgs of Olanzapine, 30mgs of abilify and 7 mgs of lorazepam. I keep playing Russian roulette with my meds, I don't really care if I wake up or not. I thought maybe topamax would stabilize my moods and stop these compulsions - to drink, take pills, binge and purge, harm myself and overdose. I really know it's a last ditch option. I don't know what the compulsions are related to, they just seem to come out of the blue

I have a p-doc appointment tomorrow

thanks again Helena

blackbird x

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But she must have noticed the overdose??

I'm glad you have an appointment, be very honest about what's going on and s/he should be able to help.

Of course, I should also say "go to the hospital" if things get really bad, which is true. But I also don't know what they are like in Northern Ireland, I just know they are horrible here (the one I went to at least, I've changed since then but luckily I haven't had to go there). So that's not always an easy thing to do.

What made them decide to release you after your last overdose?

I'm hoping you'll get some opinions on Topamax. The mood stabilizers I've been on have helped with impulse control (Lithium, Lamictal).

Edit: Re-reading your signature, are they possibly linked to BPD? In that case therapy should help a lot. Sucks with long waiting lists.

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Yes Helena, I would say that my poor impulse control is related to my BPD. They released me last week because I promised them I wouldn't overdose again. I don't think I will overdose as seriously again because of how upset it made my family. I think if I pull a stunt like that again it will kill my mother. So I play around with my medication in a Russian Roulette fashion instead - taking mini overdoses every day. If I was to commit suicide or take a big overdose, it would be for real this time. I want to fight and live, I want a life beyond bulimia, alcohol and self injury and all the other crap that comes with BPD but the urge to escape may grow so bad it clouds my reasoning. The waiting list for therapy is extremely long here, I know Topamax is perhaps not the answer but I'm so fucking desperate, I'm clinging to it like the only beacon of hope left.

thanks again Helena

blackbird x

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i don't have impulses to control, so i'm not sure if topamax did anything for me in that regard. it did help with my ptsd, and is in clinical trials right now to be marketed as a treatment for ptsd.

i know that in the grip of psychosis and impulses that you can't think rationally and clearly, but try to think of my dad, and how his suicide destroyed me, and how i'm still destroyed almost 3 years later. he overdosed on his crazy meds. i found him in the middle of the floor. please, don't do that to your family and friends. you deserve to live and they deserve to have you.

if you know it is time, don't hesitate to go to the hospital. you know that is a safe haven.


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Thanks for your reply Loon, you are always very kind and helpful to me and I hope to repay the favour some day.

I think I have a form of PTSD, this time of the year is very difficult for me. I witnessed my sister having a severe horse riding accident in which she broke her neck, thus paralysing her permanentlyfrom the chest down. At this time of the year, I tend to relive the memory over and over again and I guess I self-medicate and self-injure to cope with these feelings. I feel a lot of guilt about it becuase I badgered her to take me horse riding that day. I know it may not seem like a serious enough event to get traumatised by but it marked the eventual unravelling and downfall of my entire family. In fact I think it triggered my whole borderline illness.

thanks again!

blackbird x

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I take it for executive functioning issues related to an oddball forum of ADD involving temporal lobe dysfunction. It sorta helps. If you can identify probable temporal lobe issues it might be worth a try. If there are issues related to compulsive behavior, it can help.

If the impulse control is due to a poor sense of self-awareness it's less likely to be of use.

You might want to look into yoga and meditation.

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Everyone has some great advice. I am taking Topamax for impulse control. I was eating like a pig and drinking everything alcoholic in sight. Once i got on the topamax I have lost about 5 pounds in a week! Yeah! I am only having 4 beers a night instead 0f 7 . I am sick as a dog but what I won't do for beauty.

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hey blackbird,

there is some info on topamax sort-of related to what you're asking about.

but what i really think would help you the most would be to get into dialectical behavioral therapy. i know that you said that the waiting list for therapy there is really long, but i want to make sure you get into the right kind of therapy. dbt has been extensivley studied and there are a lot of articles on its efficacy in borderline, especially in terms of helping patients reduce impulsive and self-destructive behaviors. (For example, the study Dialectical Behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in the Netherlands showed that "Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation"... click here for free full-text)

until you can get into dbt, you may want to work on mindfulness skills (one of the core skills from dbt, though by no means the only skill) to help you stay in contol and help you be more aware of what is going on inside yourself. i'm a fan of the book the miracle of mindfulness, it's a good starting point. any of pema chodoron's books are also great. the places that scare you has helped me with ptsd and fear issues. (i promise i'm not just plugging the store, i own quite a few of her books and cherish them.)

ok, but you asked about topamax...

these are on impulse exactly...

a study looking at Topiramate treatment for women with borderline personality disorder: a double-blind, placebo-controlled study. found:

"According to the intent-to-treat principle, significant changes (all P so, it seems like it may help with some borderline symptoms.

there are also a few studies on topamax and PTSD. this study: Prospective open-label study of add-on and monotherapy topiramate in civilians with chronic nonhallucinatory posttraumatic stress disorder. is a free full-text and can maybe give you a sense of how it may help some people with PTSD. (there are other studies, but this one i thought was the most straight-forward. other than the one on rats that made a lot of sense, but it was on rats...)

there are also studies showing favorable results in using topamax as a treatment for gambling, substance abuse, and trichotillomania , all of which are impulse control issues of different forms. of course, these studies aren't very large, and topamax is by no means a widely accepted medication for impulse control. (which is to say, by all means look at the studies and talk to your doctor, but impulse control isn't where topamax really shines as a medication.)

hope that helped.



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I'm technically on topomax for nerve pain but I am finding that it is really helping with my impulse control especially in terms of my bulimia. I was throwing up at least 14 times a week and now I'm throwing up maybe once a week because the strong impulse to do it just isnt' there. Also my impulse to cut is almost entirely gone.

So yeah even if it doesn't work for the nerve pain I'll probably stay on it for the impulse control.

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  • 4 weeks later...

Blackbird, I too have read your posts in the past, but have not always felt I had a real hold on them.

I feel so badly for your pain, and I am so concern about your well being, safety at the moment and your future life.

I was so overcome by grief, trauma, then things came back, in flashbacks, and I felt I had to be secret about them, like a child again.

So, I allow the dx of bipolar, and ptsd.

The ptsd was surely correct, but until here where I finally felt safe, I let some out in therapy, how it was explain to me.

Topomax can help greatly if it is right for you, your make up, brain cooties as I am sure you have heard around here.

It helped me when finally on my right amount.

For I am, was very tramautized, but also was so very depressed on top of it.

Nothing could work, while I was there.

Except to reach out for help, or really for husband to take me, for no I was not reaching out, I was not moving.

You need to share that, be with people till that is lifted.

Don't talk, just lay back and listen.

They will be your best support during this time, for they know.

No one wants to go.

Hell I never wanted to.

Always ended up making couple good friends when did.

That kind of very deep depression is very dangerous mixed along with the trauma you have been through.

No pill alone can treat that.

Please don't be without professional help around you daily till that very dark cloud lifts.

You deserve to have the chance to be happy.

Please don't have meds where you can get them, give to your Mom.

Be very honest about all of this with doc tomorrow.

Luv, Aly

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I talked to the shrink last week. He did one of his characteristic volte faces and he says he is willing to prescribe me Topamax after he read an article on it helping women with BPD. I have to go to his office this Monday to read this article and be properly informed about Topamax's side effects etc. before he will prescribe it but I am so desperate for the uncontrollable urge to binge and purge to stop, I will give it a go even though it's probably a shot in the dark... I'm a bit better on the urge to overdose and cut front thank the Lord for small mercies! But the bulimia's a real drag and nothing, not even my trusty Atkins diet, seems to control it.

PS thanks for your kind words Aly, I'm feeling a lot more stable mentally since I went back onto Olanzapine, I'm really glad that Topamax works for you

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Blackbird, you are very welcome.

I will be thinking of you so much.

My topomax just got upped to the 400mg as I was told was planned, today.

With so much that has been coming out in just last few weeks of therapy, I am really hoping it brings me back to that sweet spot I was at prior, at 300.

It is work to get to healthy, fixing back up, what was is broken.

I am feeling much more that it is possible, and worth it.


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  • 1 month later...

Just a quick update:

The P-doc has prescribed me 25mgs of topamax to see how I get on. He offered me therapy with an eating disorders group but to be honest, I feel I have learnt all there is to be learned from therapy over the years. I don't think CBT will help with the Olanzapine-induced craving to stuff my face with food 24 hours a day. I even dream about stuffing my fucking face with food.

My bulimia has progressed to the point in which I am throwing up up to 10 times a day and spending $40 a day on food. My mother is threatening to kick me out of the house if I continue to do this, so I actually go and take the dog for a walk, buy food and go and binge and vomit in the public toilets. My behaviour is so disgusting and degrading. I realise that Topamax is very much clutching at straws, last resort, but the Olanzapine works so well, I can't face having to give it up. When I tried to stop Olanzapine at Christmas, yes the hunger went away but it was a total nightmare and life was unbearable in terms of the severity of my psychotic symptoms. Even whenever I do not make myself sick, I probably eat up to 2 or 3 times more than the average person eats in a day. To illustrate this, my stomach was growling like mad in the psychiatrist's office and he had to take my claim to perpetual hunger seriously.

So yeah, tomorrow I get the script filled

I realise this is very much off label and last-chance-saloonish but wish me luck!

blackbird x

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I'm assuming you are the same one I talk to elsewhere, I don't know.

I'm a chronic binge eater. I stuff my face as fast as I can and I at least used to eat until I got a rush. And i've been fighting on again off again eating disorder NOS (anorexia, med induced and chronic exercise components) since I was 18. Seeing that I am on topamax - and previous to this was on both topa and wellbutrin concurrently as none of my professionals are aware of the extent of my eating disorder it has been a real struggle both to control my eating and my eating disorder.

I just had a weight fluctuation of over 35lbs down and then 30lbs up in under 2.5 months - due to both drinking and pneumonia / severe infection and then getting digestive issues from the Biaxin. After that scare I quit drinking and got a deep, deep emptiness and started eating incredibly rich food and very large portions again - I went from skinny goth to bulgey again and its starting to make the stimulants and skipping meals look like a good idea again (but i'm not going to do it.) ... So I can understand where you're at.

I've changed my eating habits dramatically. Now I only eat during meals or when my blood sugar is crashing. I try to keep my meals to be appropriate, i.e. not ordering appetizers (I sometimes give in) and ordering smaller portions. But its been "creeping" up lately. And what i've been eating has gotten bad... I was eating like a hippie a year ago to the point that I had to re-introduce fats because of joint problems and I was dropping weight on the topamax at a dangerous weight. I'm in the "safe" range right now but ... its not great.

With the zyprexa... I was on a good dose of seroquel monotherapy-wise that was controlling alot of major issues like paranoia, aggression and confused thoughts. Now I just cope with them. I cope with being constantly some degree of agitated and manic (anticonvusants dont help. They might a little and then my body re-adjusts and it goes away and i'm already on 2 and the dose creep is getting out of control.) ... and ONLY anti-psychotics really help. However. I gain INSANE amounts of weight on them. But ... i've got an eating disorder. And a crazy body self image problem. When I was 25 I shot up to 280lbs on Seroquel at a higher dose than what i'm on now and my fiancee started making comments and I got a huge complex. I started eating anything I could hunt. Which is easy in a supermarket. I have heavily limited my anticonvulsant range by insisting on only things which don't have a weight gain. And then done the same with AP's - I went on Risp last spring and had a 15lb water weight gain right away and didn't lose it despite a calorie in calorie out count that was massively in the deficiet for almost two months.

So i'm feeling like i'm in dangerous territory right now, but the one thing i'm thankful for is that i'm not binge eating, or compulsively drinking sugar drinks and that kind of thing. That is something you need to make a concious decision about - because it is concious behavior.

Topamax was what fixed that for me.

However, i'm seriously considering going off topamax right now - my psychiatrist thinks its purpose is moot in my case and i'm getting sick of $220 a bottle, it makes my hypomania worse (but at least predictable) and it messes with my dreams.

But i'm curious about people's word on impulse control as well ... I don't know now if its effect on my rage and impulse issues has been coincidental with me making huge lifestyle changes and concious dietary adjustments ...

I've noticed with quite a few people on topamax, it seems to bring out some major personality issues and withdrawedness ... It does seem to reduce some impulsive behavior and it has been studied for its role in addiction ... but at the same time ... alot of my impulsive behaviors like drinking, etc. are still very much potent issues beyond just habitual, psychological things. The limbic fires still rage.

However. I know with binge eating and food. Now I plan out my meals and don't sit salivating. I can eat a handful of chips (not that I keep that crap in my house) and I can sit and wait for a meal without totally counting the seconds - before I would likely have had a second meal anticipating dinner. Short of waking up in the middle of the night with a seroquel hunger attack I never massively binge short of going to mcdonalds and getting an extra sandwich and feeling too full - or eating a handful of cookies instead of one. And that SHOULD be acceptable, for a normal person.

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