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Switching from Depakote to Topamax


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Guest Wendi

MY pdr is switching me from Depakote to Topamax (Also on Effexor 150 for Panic) because I have been having crappy side effects (It's causing me to be VERY sleepy (Tried provigil and that made me get headaches from hell). All I do is SLEEP! I also still get stress headaches, hair loss, weight gain (this is a huge prob for me! I have been working out and I am GAINING weight!!!!) recently started feeling "dumb". I can't concentrate, mostly while watching TV. My menstrual cycle has also been messed up for months now! I had to take a pill to start it, that was in march and well since then no more period)

I posted this on another board and a few ppl said it wasn't a good idea (Since tomapax isn't for Bipolar 2) and to get another opinion and pdr. So someone else told me to check out this board. Now I am wondering what your opinion is. Have any of you switched from Dep to Top???? How did it work for your BP?

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Really it depends on your particular type of symptoms.

Normally, Topamax isn't Rx'd for BP. In the majority of trials it did suck pretty major for most ppl in controlling moods swings. Unless...the majority of your symptoms just so happen to reside in your temporal lobes. That's where it really kicks ass. At least that's my understanding of it.

But then again, I'm no doctor. That's just my understanding of it. I know it works for me. Granted I take it mainly for seizure control and any mood stabilization I get from it is just a bonus at this point. ;^P

I've been on Depakote before though (many, many moons ago) and we didn't get along. Granted the doctor was evil and put me on Zyprexa at the same time.

The weight loss thing is a side-effect, so keep that in mind. It doesn't happen for everybody and some people have found that they actually gain weight. So that's just kind of a crapshoot. (just warning you)

Hope some of this info helps. Just keep in mind that YMMV. Considerably.

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MY pdr is switching me from Depakote to Topamax (Also on Effexor 150 for Panic) because I have been having crappy side effects (It's causing me to be VERY sleepy (Tried provigil and that made me get headaches from hell). All I do is SLEEP! I also still get stress headaches, hair loss, weight gain (this is a huge prob for me! I have been working out and I am GAINING weight!!!!) recently started feeling "dumb". I can't concentrate, mostly while watching TV. My menstrual cycle has also been messed up for months now! I had to take a pill to start it, that was in march and well since then no more period)

I posted this on another board and a few ppl said it wasn't a good idea (Since tomapax isn't for Bipolar 2) and to get another opinion and pdr. So someone else told me to check out this board. Now I am wondering what your opinion is. Have any of you switched from Dep to Top???? How did it work for your BP?

As Maddy said, I have not *typically* heard of topamax being a top choice rx for bp2. Granted, things do happen, so one can never say never, but... yeah.

I am bp and on topamax, but it does not really act as my primary "mood stabilizer." I take Lamictal for that. The Topamax is primarily for my severe migraine issues.

In regard to your concern about side effects... well... at least from my experience and from the experiences of many others, I would have to say that Topamax has its fair share of side effects. So, if you are trying to switch to a med that will have less side effects, I would have to venture to say that you are probably choosing the wrong drug. You can have menstrual issues with this drug, along with hair loss (just two of the ones you mentioned you were unhappy with). Not to mention, you mentioned that you "started feeling really 'dumb'" and that you "can't concentrate." Topamax is notorious for its cognitive side effects, so I do not think that you would be rid of those any time soon. There are a host of other side effects that are easily found if you look up the drug.

Every drug has side effects of some kind, so it is really a balancing act of deciding which is worse, the condition or the side effects of the meds fixing the condition. With that said, I am not trying to scare you away from the drug, but just say that i am not sure that it is going to do what you want it to do (alleviate side effects). Because it can be the same and worse than the drug you are already on. My point is that if you are looking for a drug with the least amount of side effects, this is not the drug for you... especially if you are looking for it to be your primary mood stabilizer. In my opinion, there are drugs out there that are more suited to the condition and have less of a side effect profile than topamax.

good luck in your decision.

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Maybe there's a new study out? It's normally fairly obscure as a primary mood stabilizer but several people have posted recently about switching to it.

she is talking about feeling "dumb" and having an inability to concentrate, among other things, with the depakote and I am just saying that the chances of *that* getting better, along with other side effects is very likely not to happen and could actually be worse. She does not like all of the side effects from the depakote and, if that is the case, i think that switching to a med like topamax that is very well known for all of its side effects is not a great solution. She wrote that she did not like the fact that she was gaining weight. Yes, it is true that weight lose can be a side effect, but if does not happen for everyone, nor is it what i would base my decision on in choosing a med.

If less side effects are desired, i just do not think that it is the drug of choice *especially* since other options have not been exercised.

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A lot of people like topa...including me. However, keep in mind that the Texas Bipolar Algorithm Project ( or whatever...something like that) has seven levels to go through in treating bipolar. Topamax is on level seven--after ECT! So, not only your pdoc, but andy pdoc, may be rather reluctant to just switch you over. The only reason my pdoc had me on it was cuz my gp originally scripted it (mostly due to alcohol use, and then mood stabilization) and it actually worked rather well.

There are other meds besides topa and depa. Personally I would ignore listed side effects and try those til one works. (God knows, I tend to not get normal side effects but DO get unexpected ones...trial and error)

At any rate, if you're not on Lamictal, I really think you ought to be. (non-professional layman's opinion of course)

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At any rate, if you're not on Lamictal, I really think you ought to be. (non-professional layman's opinion of course)

That is what I forgot to say. I guess I figured that since I said I was on Lamictal, that I had said something... silly, silly me. It is also a mood stabilizer. I mean, I am not a doctor or anything, so I can only tell you from experience and from what i have heard and/or read. I hope you are getting that second opinion pdoc appointment soon...

A lot of people like topa...including me. However, keep in mind that the Texas Bipolar Algorithm Project ( or whatever...something like that) has seven levels to go through in treating bipolar. Topamax is on level seven--after ECT! So, not only your pdoc, but andy pdoc, may be rather reluctant to just switch you over. The only reason my pdoc had me on it was cuz my gp originally scripted it (mostly due to alcohol use, and then mood stabilization) and it actually worked rather well.

There are other meds besides topa and depa. Personally I would ignore listed side effects and try those til one works. (God knows, I tend to not get normal side effects but DO get unexpected ones...trial and error)

I never meant to say that topamax was *bad* *bad* *bad* or anything. I mean, I am on it, ya know! My concern was that it is not the best documented mood stabilizer on the market. Overall it is a very tricky drug. It just would not be my next choice after depa when there are a number of other mood stabilizers out there. I also agree in a way that one should not always let the list of potential side effects dictate whether or not they take a drug. It this case, though, I felt the need to bring some of it up since cognitive impairment was one of the side effects you do not like from depa, but is fairly common with topa.

So i stick by the whole thing that if you have other options, possibly try them first. Talk to this new pdoc about *all* mood stabilizers, not just topamax. It, in the end at some point it turns out to be what you take, okay.... but this is just my opinion....

But, again, I'm not a professional by any means...

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Neuroimaging is showing that there may be a whole lot more subtypes of bipolar than anyone really guessed in the past. The kicker is that on the surface a lot of them are identical. Two people might have the same symptoms but very different brains. The only reason we keep using the present categories is to make the insurance companies happy and because some people like being able to organize things into neat little categories even when the word doesn't really work that way. Oh yeah, for a drug to get FDA approval, it has to work according to the old categories. Drug companies that try to be forward-looking have trouble getting their drugs approved and pushing stuff for off-label uses can get them in trouble (see neurontin). We're in the middle of a paradigm shift regarding how we think about the brain and a lot of confusion is to be expected. That's why it's so hard to define when it's appropriate to use what drug and stuff like that. Not everybody is even on the same page.

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Guest Wendi

Maybe there's a new study out? It's normally fairly obscure as a primary mood stabilizer but several people have posted recently about switching to it.

My pdr never gave me any other options. I asked him a while ago about the weight gain and he said it was from Dep, and if it became a problem he would switch me to Topamax (But didn't want to right away since I was doing well on Dep and didn't want to mess that up). I never asked about any other drug since I had no clue. I'm no dr. He should be the one who knows what's right for me. I've been seeing him for a year now.

Since I posted this a few days ago I have been very pissy. I get mad VERY easy! I guess I am stressed because of what everyone is saying and also scared. This other dr can't get me in till Aug 15. So WTF am I supposed to do till then???????????

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Since I posted this a few days ago I have been very pissy. I get mad VERY easy! I guess I am stressed because of what everyone is saying and also scared. This other dr can't get me in till Aug 15. So WTF am I supposed to do till then???????????

sometimes it is hard to get appointments with doctors. in the meantime, do you have enough drugs (depa, I mean) to last you until August 15th?

I asked him a while ago about the weight gain and he said it was from Dep, and if it became a problem he would switch me to Topamax (But didn't want to right away since I was doing well on Dep and didn't want to mess that up). I never asked about any other drug since I had no clue. I'm no dr. He should be the one who knows what's right for me. I've been seeing him for a year now.

ok. my question, straight up, is this: how are you really doing on your current drug cocktail? You made reference to doing well on depa, but not liking the weight gain. If you really are doing better on your current drugs right now, i would strongly advise you to ask yourself if messing with your drugs would be worth making you more unstable. All drugs have side effects. A lot of the time the benefits we get from a particular drug outweigh the side effects. How much of a problem is the weight gain?

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Maybe there's a new study out? It's normally fairly obscure as a primary mood stabilizer but several people have posted recently about switching to it.

Well... I'm going to go out on a limb and suggest that it might possibly have something to do with how much play it's been getting in the mainstream media lately as a potential weight loss drug. I mean, I think I read something about it in Allure recently, and, in fairness to Allure, they were saying it was not really such a great idea to use it as a diet pill, but all the same, they were putting the name out there in that connection, and, you know, if you ask your pdoc for something enough times, sooner or later you just might get it...

Not to mention the possibility of a push by pharama reps for increased off label usage. I hear things like that do happen, from time to time...

I love topamax, but it doesn't feel like what it does is the same as other meds I take that are more mood stabilizer-y. And while I would seriously NOT want to go back to a topamax free life, I also can't imagine relying on it to keep me anything remotely resembling stable.

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Have you thought about Lamictal? I have been taking it for almost 3 yrs. and it is my "staple" med. It is not sedating, did not make me gain wt., and it works with no side effects taht are too bothersome-and those went away fast. Actually, I don't reemember having SE's on it. But they titrate you on it verrrry slowly so maybe that helps. It has a very strong track record and many people here seem to love it.

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depakote made me f-ing tired and i couldn't concentrate for anything. i was falling asleep all the time, even while driving.

a few years later, as an add-on mood stabilizer, my pdoc put me on topa. it made me stay up all night, crabby, unable to concentrate, and generally funky. but i did lose weight.

i agree that there are different kinds of bp, and you never know what is going to work for you. just give it a shot. all we really have is trial and error with most pdocs.

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Have you thought about Lamictal? I have been taking it for almost 3 yrs. and it is my "staple" med. It is not sedating, did not make me gain wt., and it works with no side effects taht are too bothersome-and those went away fast. Actually, I don't reemember having SE's on it. But they titrate you on it verrrry slowly so maybe that helps. It has a very strong track record and many people here seem to love it.

Once again, please, YMMV. It does sedate some people, and as for other SEs? When combined with topamax, anyways, I had rashes so bad my gp biopsied my leg. No probs now but I'd hardly term that "not too bothersome".

There are side effect profiles. One needs to learn them. One needs to NOT fear them--it's very likely that few, if any, will happen. And yes, often they are not bothersome. But don't blanket the issue with overgeneralities.

I'm no dr. He should be the one who knows what's right for me.

True. But, what we have found here (and a big reason, I think, the vast majority of us are here), is that self-education about the meds you take, and their alternatives, gives you a voice in the treatment process. I can talk frankly with my pdoc about what meds I'm on, should we change them, why. (was on topa, loved it, but had no job--and it's 6x the cost of lith. plus lith is still cheap when the insurance runs out) I also know how all my meds work together (as well as my fiancee's) and I'm able to report what, how much, and when i take them if a doc or nurse asks. (with like 5 different docs, including dentist, and three surgeries this year, this is rather important) Nurses are often impressed by the simple knowledge of what I swallow everyday. This makes me wonder about all those others...

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Neuroimaging is showing that there may be a whole lot more subtypes of bipolar than anyone really guessed in the past. The kicker is that on the surface a lot of them are identical. Two people might have the same symptoms but very different brains. The only reason we keep using the present categories is to make the insurance companies happy and because some people like being able to organize things into neat little categories even when the word doesn't really work that way. Oh yeah, for a drug to get FDA approval, it has to work according to the old categories. Drug companies that try to be forward-looking have trouble getting their drugs approved and pushing stuff for off-label uses can get them in trouble (see neurontin). We're in the middle of a paradigm shift regarding how we think about the brain and a lot of confusion is to be expected. That's why it's so hard to define when it's appropriate to use what drug and stuff like that. Not everybody is even on the same page.

This is really interesting, and the first I've heard about it. Do you have any links?

Thanks!

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