Chen Chin-Kang, Shiah I-Shin, Yeh Chin-Bin, Mao Wei-Chung, Chang Chuan-Chia
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
Clin Neuropharmacol. 2005 May-Jun;28(3):136-8. doi: 10.1097/01.wnf.0000169731.93065.ef.
Several open-label studies or case reports have suggested the effectiveness of clozapine or topiramate in the treatment of resistant rapid-cycling bipolar patients, but none of these publications report the long-term effectiveness of these two agents in combination. The authors present a 38-year-old woman with a 22-year history of rapid-cycling bipolar I disorder who failed to respond satisfactorily to various somatic therapies, including combination therapy for complex regimens and a course of bilateral electroconvulsive therapy, but finally responded well to a combination treatment of clozapine and topiramate. Such a combination therapy led the patient to a complete remission for more than 3 years without inducing side effects such as weight gain, hyperglycemia, type II diabetes mellitus, or hyperlipidemia. In addition, she had a weight loss of 12 kg over the past 3 years. This case suggests that the combination treatment of clozapine and topiramate can be safe and effective in some resistant rapid-cycling bipolar patients.
