Expert: Ivan Goldberg, M.D. - 5/30/2009

Question
QUESTION: CURRENT MEDS INCLUDE 600MG NEURONTIN,200MG DOXEPIN,20MG PROZAC, 0MG ABILIFY,600MG TOPAMAX,10MG AMBIEN, 300MG LAMICTAL,333MG 2X DAILY CAMPRAL.I HAVE BEEN TAKING TENUATE 25MG 3X DAILY AND 100MCG SYNTHROID. I AM UNDERGOING ECT BI WEEKLY SINCE FEB. AM DIAGNOSED WITH BIPOLAR I, PTSD, BULIMIA NERVOSA, SEIZURE DISORDER AND ALCOHOLISM.  I HAVE NOT HAD A DRINK OR A SEIZURE IN 9 MONTHS.  I HAVE GAINED OVER 30LBS WITHIN 8 MONTHS.  WHAT DO YOU THINK OF THE ZONEGRAN AND WELLBUTRIN COMBO. ACCORDING TO MY NEUROLOGIST I CAN TITRATE OFF THE TOPOMAX AND HE SEES NO CONTRAINDICATION WITH THE WELLBUTRIN AND MY SEIZURE DISORDER. ps. you probably don't remember me, but i worked in your office with ida many years ago.

ANSWER: Hi Jeanette , , ,

Unfortunately you are right and I do not remember you. I will ask my daughter Meredith who has a much better memory that I do and see if she can help me remember.

The weight gain caused by psychiatric medications is a big problem and one that psychiatrists do not know enough about, I an surprised that Topamax is one of the medications that you want to stop, as it is the medication that is most often prescribed to help people taking other psychiatric meds lose weight.

Keppra would be a possible substitute for the Topamax, but its record as a drug that causes weight loss and one that reduces the desire to binge with food and alcohol is not nearly as well established as Topamax's.

While Abilify is not usually associated with weight gain, some people do gain large amounts of weight while taking it. In those instances, Moban (mondolone) does a good job of taking the place of Abilify.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%

---------- FOLLOW-UP ----------

QUESTION: I agree with your advise on the Topamax for binging and alcohol cravings. However it has not worked for me as far as any weight loss or apetite suppresent. Have you ever heard of or worked with "Empatic or Excalia" (the combination of Zonegran and Wellbutrin) for the purpose of weight loss? Would you ADD this combination to my already long list of medications as I am willing to do anything safe at this point to help me lose weight.

Answer
Jeanette . . .

I am curious as to the maximum dose of Topamax you took, and for how long your took it.

WhiLE I am aware that both Zonegran and Wellbutrin often cause weight loss, I am unable to find any reports, in the medical literature, of the effectiveness of their combined use.

In regarding my earlier reply, I noted that I had failed to mention the use of metformin as a treatment for weight gain. Metformin is an antidiabetic drug that prevents and/or reverses medication-induced weight gain.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%