April 21, 2008

Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

Silly me for missing this bit of news out of the University of North Carolina's Prescribing for Better Outcomes Center, but last week the center issued its findings concerning the use of anti-seizure drugs in bipolar disorder, types I and II. What the center's researchers found was stunning:

"No scientifically acceptable clinical trial evidence supports use of either gabapentin or topiramate in bipolar mood disorder, either as monotherapy or as an adjunct to other therapies."

Researchers also found that:

"There is limited evidence showing that gabapentin is no more, and perhaps less, efficacious than placebo in the treatment of bipolar I disorder with recent mania and rapid cycling bipolar disorder. No acceptable evidence was found to support use of gabapentin in achieving remission or preventing relapse in bipolar disorder."

Another top-selling psych med beaten by placebo? Say it ain't so! Both Neurontin and Topamax are widely-used and in fact I know someone in Seattle who was recently put on the former as a first line drug for dealing with bipolar disorder.

The center found evidence supporting the use of Depakote, Tegretol and Lamictal in treating bipolar disorder and even goes so far as to say they perform as well as Lithium. I'm not sure I buy the latter assertion, but I'm not a researcher so what do I know?

The irony in all of this is that the center is supported by funding from the big off-label settlement reached over Neurontin a few years ago in which Pfizer admitted to committing fraud. There's some evidence-based medicine for you.

Via WSJ's Health Blog and Soulful Sepulcher.

Posted by Philip Dawdy at April 21, 2008 12:05 AM
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Comments

I'm afraid you'll believe that I'm lying. But I've been on Neurontin, Topamax, Depakote, Lamictal. Lamictal was just a trial. Depakote for 3 months and I felt terrible. Neurontin and Topamax for a one year.
I withdrew from both at the same time. Topamax was hard. I cried but felt that it was not because I was sad. Just cried. If I took the crying stopped.
I would really love to be live to see all of these uncovered.
But after reading the DSM-5 draft I realized that things can go worse.
I'll ask the stupid question:
Why is it impossible to gather all people that are on Internet to make a campaign?
(I know, I know this is impossible but I would like to hear the explanations.)

Posted by: Ana Lima at April 21, 2008 04:03 AM

Hi Philip:

For me, Lithium was toxic and it didn't even work. Tegretol has managed to prevent my major manic episode for 20 years and it seems innocent so far. I have it monitored carefully. I lost a kidney to Lithium in 1991 after taking it for 16 years to manage my mania. After that, I had to go on dialysis and have a transplant.
Now, I take nine different drugs, and they have lots of side-effects, believe me. But without them, I'm dead.
Keep up the great work.
Sandy Naiman

Posted by: Sandy Naiman at April 21, 2008 05:35 AM

I thought as far as neurontin goes that this is really really old news...why is it resurfacing now...?? because no one listened the first time around?? I heard studies about this way before I was even following this crap.

The Last Psychiatrist, if I recall correctly claims that depakote and lamictal have similarly ridiculous failings, but I heard that there first.

I wouldn't be surprised at all though if we're all running around on toxic placebos as they've showed with antidepressants.

Posted by: Gianna at April 21, 2008 08:32 AM

Where can I find this DSM-V draft? I'd like to see it.

Posted by: Garth at April 21, 2008 10:46 AM

Garth,

Here's my idea - draft the dsm v, send it to the front line and let it die in combat. The DSM accurately portrays the impressions single observers of behavior made of others at a single moment in time but has neither internal nor external reliability. Using it to base a system of medical treatment, criminal justice and punishment and bulild a huge bureaucracy of education, "treatment," and punishment is a crime. Better we use King Lear, David Copperfield, or Pride and Prejudice, but I don't hear good things about the DSM V. The dsm seems to gain credibility as it loses reliability.

http://www.dsm5.org/

Posted by: Sally at April 21, 2008 11:20 AM

And here I thought I was asking an innocent question.

As far as I can tell, the draft DSM won't be available until next year.

Posted by: Garth at April 21, 2008 12:09 PM

Garth,
I've downloaded a .pdf from here:

http://appi.org/book.cfm?id=2292

Posted by: Ana Lima at April 21, 2008 02:54 PM

Thank you, Ana - but just to note, that document isn't a draft of the new DSM, only a "research agenda".

Posted by: Garth at April 21, 2008 04:07 PM

Garth,
I'm sorry. The word "agenda" in Portuguese does not have this sense. So I used the word that first came into my mind.
Terrible choice.:-}

Posted by: Ana Lima at April 22, 2008 04:01 AM

I had topamax prescribed to me in the blink of an eye, for social phobia.

I had asked about mood stabilizers because a doctor tried to place me on one eons ago. "All I had to say I was thinking of trying this class of drug...."

I was handed a scrip in the blink of an eye.

Topiramate is shown to cause mania in even non-bipolar people.

It was suspected I had hypomania from this drug, and have had doctors try to place me on all sorts of medication unsuccessfully since then.

Posted by: Lee at August 26, 2009 01:41 PM
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Lee on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

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Ana Lima on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

Garth on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

Sally on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

Garth on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

Gianna on Report: No Scientific Evidence For Using Neurontin Or Topamax In Bipolar Disorder

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