Psychopharmacology of topiramate: from epilepsy to bipolar disorder

Marco Mula^1,3, Andrea E Cavanna^1,2, Francesco Monaco¹

¹The Neuropsychiatry Research Group, Department of Neurology, Amedeo Avogadro University, Novara, Italy; ²Institute of Neurology, University College London, UK; ³Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Italy

Abstract: Topiramate (TPM) is one of the novel antiepileptic drugs and exhibits a wide range of mechanisms of action. Efficacy of TPM has been demonstrated in partial-onset seizures and primary generalized seizures in adults and children, as both monotherapy and adjunctive therapy. More recently, TPM has been proposed as an add-on treatment for patients with lithium-resistant bipolar disorder, especially those displaying rapid-cycling and mixed states. This paper reviews the multiple mechanisms of action and the tolerability profile of TPM in the light of its therapeutic potential in affective disorders. Studies of TPM in bipolar disorder are evaluated, and the efficacy and tolerability issues as a mood stabilizing agent are discussed.  

Keywords: topiramate, antiepileptic drugs, epilepsy, mood stabilizer, bipolar disorder