Weight loss on Topamax second time around?

[blackbird]

Is it possible to not lose weight on Topamax 1st time then lose shit loads on it second time around? OK my diet is better now, back then I was eating a lot of fat and using Xenical/Orlistat and having bright orange diarrhoea about 5 times a day I was eating so much fat. I am eating salads, oatmel, salmon and veg and fruit and very low fat and low carb but not losing much weight til all of a sudden I go back on 250mg topamax and the weight's dropping off! Plus no drinking and no bingeing and vomiting (probably restrictive quasi-anorexia)

blackbird x

[Silver]

Well, yes, if your diet's better this time around.

The thing that's interesting to me is this. You were drinking/binging lots the first time, and you're not this time.

Topamax is somewhat useful for disorders of impulse control, including binge eating/binge drinking/ self-mutilative behavior.

And you were using orlistat / Xenical in what sounds like a binge/abusing pattern - you are not supposed to be having oily diarrhea 5x/day on it. I've known people to abuse Xenical as a purgative. Just as nasty as bulimia via vomiting, less controllable, and it does have insidious harmful effects as well.

Totally talking out my ass here - unfortunate phrase - but I'll suggest this: you may have been passing everything through your gut so fast you weren't absorbing much of the Topamax the first time around.

It's not a great explanation, because Topamax is absorbed really quite quickly, so I don't think I buy my little hypothesis here. I'm on airport layover here, bear with me as I mutter to myself.

And there is, of course, that issue of the caloric content of booze. Quite high, that.

I couldn't find the information / study I was looking for - had anyone ever done topiramate serum levels in conjunction with orlistat as it's supposed to be used and at a diarrhea-inducing use pattern.

Because that, I think, would be interesting to know.

I'll poke around a bit - these two HAVE to have been examined in conjunction at therapeutic dosing, and above, and I'm sure the neuro community's run into this at some point. I'm not looking in the right literature, I think.

Big confounder here is that your overall impulsiveness the first time 'round was higher, bb - you said it yourself, you were dialed to 11.

So - eating more, drinking more, taking more - and, I don't know about you, but when I get "more", I tend to get "less" good about taking things like meds (but you're really conscientious about some things, so that may be totally different for you.)

This is one of those chicken/egg questions. Is the drug working better and so you're noticing an effect? Are you in a better place mentally, so you can get more benefit from the drug because you're not engaging in other self-harming behaviors that subverted the drug's intended effect?