Q:  Can Topomax be Added to My Meds w/o Upsetting the Mood Balance?

About 5 years ago I was diagnosed with BPD.  I've been prescribed several things over the past 5 years.  Currently I'm taking 100mg Lamictal, 150mg WelbutrinXL, 40mg Geodon both a.m. and p.m, & Doxepin 50mg.  I also suffer from migraine and my regular physician wants to put me on Topomax.

I've read that Topomax is also for BPD as well as preventing migraine.  My question is can this be added to my regular med schedule without upsetting the mood balance?

Thanks for your time,


Dear Ms. W' -- 
So far I've not seen evidence that Topomax (topiramate) can be destabilizing.  At one point it was thought to act, like other anti-seizure medications, as a mood stabilizer (as well as for migraines; and with the side effect of appetite suppression and weight loss, making it a very attractive option). But then the "randomized trials" came out (with a control group), and these were "negative": there was no difference between how people fared whether they received topiramate as an add-on to their other medications, or a placebo. To my knowledge there was no signal in these studies that people could end up doing worse than the placebo group, if they received topiramate (unlike at least one of the studies on Neurontin, where the Neurontin group was indeed worse than the placebo group). 

Dr. Phelps

Published December, 2005