Unique Research Journal of Medicine and Medical Sciences Vol. 1(4), pp. 031-033, October, 2013 Available [email protected]://www.uniqueresearchjournals.org/URJMMS
Unique Research Journal of Medicine and Medical Sciences Dissociative disorder induced by topiramate in an obese young woman: A case report Omid Rezahosseini and Reza Bidaki*
Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
*Corresponding author. E-mail: [email protected], [email protected] Tel: +03915230584.
Topiramate is an antiepileptic drug and uses to induce weight loss. We introduce a case of Topiramate induced Dissociative disorder with non common presentation. The patient was 27 year old obese girl. Because of depressed mood, increased sleep and slow psychomotor she was treated with Sertraline (Zoloft®, Pfizer, United states of America) 50mg and Bupropion 75 mg/daily. The patient had complained strongly of hyperphagia and overweight. So Topiramate 25 mg/daily was started and was increased to 50 mg/daily. The patient experienced a feeling of great strength and ability to perform every task by her right hand, sense of depersonalization and derealization and feelings of all levels to the steeper slopes and slightly angled. About one day after discontinuation of Topiramate, symptoms had been eliminated and did not repeat any more in two months follow up. Our patient had Sertraline (Zoloft®) 50 mg and Bupropion 75 mg/daily as two contributing factor when Topiramate started. The increased serotonin level can be a justification for patient’s symptoms but alteration of the norepinephrine system is one other mechanism. Physicians should be aware of this interaction and do not prescribe these drugs simultaneously. More studies are suggested to find the exact mechanism for these symptoms.
Topiramate is an antiepileptic drug that use in
is defined as an experience of individual feeling unreality
management of epilepsy and migraine prophylaxis. The
and detachment from him/herself and derealization,
common side effects of this drug include: dizziness,
which defined as an alteration in the perception of one’s
ataxia, somnolence, headache, tiredness, slow reasoning
surroundings and consequently sense of the reality of the
depression and cognitive impairment such as mental
external world is lost (Diagnostic and statistical manual of
confusion, paresthesia and hypoesthesia and speech
difficulty. More over Topiramate induce weight loss in
We report a case which perceived Topiramate for
patients, especially whom with high baseline Body Mass
weight loss and experienced symptoms related to
Index (BMI) (Antel and Hebebrand, 2012; Verrotti et al.,
2011; Stella et al., 2002). There are case reports of
discontinuation. To our knowledge this is the first case
with this symptom and can be interesting for physicians
presentations like visual hallucination and paranoid
delusions (Stella et al., 2002; José et al., 2008; Miller et
al., 2010; Zesiewicz et al., 2006; Singh, 2006) but there
are just limited reports of Dissociative disorder as a side
effect of this drug (Sarwar and McGinnis, 2011).
Dissociative disorder include Depersonalization that
The patient was 27 year old obese girl (BMI = 29.2
kg/m2); she was a college student with a history of
In other hand various ocular adverse effects like acute
pathological grief following the death of grandmother.
onset myopia, glaucoma is reported for Topiramate, but
She was dependent to her sister and lived separated
there is no report of feelings all levels to the steeper
from her family. She did not mention a history of mania
slopes and slightly angled (Mandal et al., 2008).
and organic illness. Because of depressed mood,
In conclusion it seems that concomitant use of
increased sleep and slow psychomotor she was treated
Serotonin Secretion Reuptake Inhibitors (SSRIs) or
with Sertraline (Zoloft®) 50 mg and Bupropion 75
norepinephrine reuptake inhibitor and Topiramate can
mg/daily and Metformin 500 mg/daily. Patient was visited
lead to adverse effects. Physicians should be aware of
each month and partial recovery was observed. The
this interaction and do not prescribe these drugs
patient had complained strongly of hyperphagia and
simultaneously. More studies are suggested to find the
overweight. So Topiramate 25 mg/daily was started and
after two days was increased to 50 mg/daily. Twelve
hours after increasing the dose of Topiramate, the patient
mentioned that has experienced a series of symptoms: a
feeling of great strength and ability to perform every task
by her right hand, sense of depersonalization and
Antel J, Hebebrand J (2012). Weight-reducing side
derealization and feelings of all levels to the steeper
effects of the antiepileptic agents topiramate and
slopes and slightly angled. Also she noted that her mood
zonisamide. Handbook Exp. Pharmacol., 209: 433-466.
has improved. Patient had insight and knowledge about
Arias HR (2009). Is the inhibition of nicotinic acetylcholine
problems. All laboratory tests were normal. The patient
receptors by bupropion involved in its clinical actions?
had discontinued the drug due to unpleasant symptoms.
Int. J. Biochem. Amp. Cell Biol., 41(11): 2098-2108.
About one day after discontinuation, symptoms had been
Diagnostic and statistical manual of mental disorders
eliminated and did not repeat any more in two months
(2000). 4 ed. Washington, DC: American Psychiatric
José RJP, Cairns A, Babbs C (2008). Topiramate-
induced psychosis in two members of the one family: a
Khazaal Y, Zullino DF (2003). Depersonalization-
Topiramate is discovered by Maryanoff and Gardocki
derealization syndrome induced by reboxetine. Swiss
(1985) as an Anticonvulsant drug (Maryanoff and
Gardocki, 1985), gradually more effects and side effects
Kramer CK, Leitao CB, Pinto LC, Canani LH, Azevedo
of this drug was shown, including weight loss properties
MJ, Gross JL (2011). Efficacy and safety of topiramate
(Antel and Hebebrand, 2012; Verrotti et al., 2011). The
on weight loss: A meta-analysis of randomized
most common reported side effect of Topiramate in
controlled trials. Obesity reviews: An official Journal of
patients that use this drug for weight reduction was
the International Association for the Study of Obesity,
paresthesia in a meta-analysis (Kramer et al., 2011. But
our case experienced a rare side effect of Topiramate,
Mandal A, Chatterjee S, Bose S, Ganguly G (2008).
feeling of great strength and ability to perform every task
Ocular adverse effects of Topiramate: Two case
by her right hand and feelings of all levels to the steeper
reports. Indian J. Pharmacol., 40(6): 278-280
slopes and slightly angled. In a case report by Sarwar
and colleagues a woman “talking like child” after
Anticonvulsant sulfamate derivatives. United States of
Topiramate started for her migraine headaches. In that
report the effect of Topiramate on serotonin levels
Miller AD, Prost VM, Bookstaver PB, Gaines KJ (2010).
described as a mechanism (Sarwar and McGinnis, 2011).
Topiramate-induced myoclonus and psychosis during
Our patient had Sertraline (Zoloft®) 50 mg and Bupropion
migraine prophylaxis. American journal of health-
75 mg/daily as two contributing factor when Topiramate
system pharmacy: AJHP: Official J. Am. Soc. Health-
started. The increased serotonin level can be a
justification for patient’s symptoms but alteration of the
Sarwar SR, McGinnis RA (2011). Topiramate-induced
norepinephrine system is one other mechanism as
Dissociative Disorder. Innovations Clin. Neurosci., 8(8):
reported in a case of Depersonalisation-derealisation
syndrome induced by reboxetine when added to
Singh T (2006). Topiramate and psychosis. Psychiatry
Citalopram that is a specific norepinephrine reuptake
inhibitor (Khazaal and Zullino, 2003). Bupropion is a
Stella F, Caetano D, Cendes F, Guerreiro CA (2002).
Acute psychotic disorders induced by topiramate:
interaction between Topiramate and Bupropion can occur
report of two cases. Arquivos de Neuro-Psiquiatria,
(Arias, 2009). Another drug that our patient consumed
was Metformin with no report of resemble side effect.
Verrotti A, Scaparrotta A, Agostinelli S, Di Pillo S,
Chiarelli F, Grosso S (2011). Topiramate-induced weight
RA (2006). Topiramate-induced psychosis in patients
loss: a review. Epilepsy Res., 95(3): 189-199.
with essential tremor: report of 2 cases. Clin.
Zesiewicz TA, Tullidge A, Tidwell J, Sullivan KL, Hauser
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