Pharmacopsychiatry 2007; 40(2): 85-86
DOI: 10.1055/s-2007-970139
Letter

© Georg Thieme Verlag KG Stuttgart · New York

Rebound of Weight Gain Following Topiramate Cessation

Y. Khazaal 1 , D. F. Zullino 2
  • 1University Department of Adult Psychiatry, Lausanne, Switzerland
  • 2Division of Substance Abuse, University Hospitals of Geneva, Geneva, Switzerland
Further Information

Publication History

received 31. 10. 2006

accepted 8. 1. 2007

Publication Date:
19 April 2007 (online)

Glutamatergic system plays an important role in compulsive and/or addictive behaviors [5], which are associated with environmental cues [1]. Topiramate notably blocks the AMPA/kainate subtype of glutamate receptors [4]. Diverse studies and case reports have recently raised the interest of topiramate in the treatment of addictive disorders [6], obesity, and weight gain associated with antipsychotic drugs [2]. Despite this promising treatment for obesity [3], duration of treatment and its modality cessation remain understudied till to date.

We report here a case of weight rebound following topiramate cessation. Mr. A, a 28-year-old, Caucasian, consulted for the treatment of obesity (BMI=32). He reported having received previously multiple dietary treatments, which was followed by weight gain and one unsuccessful orlistat treatment. Assessment of eating behaviors revealed no binge eating. The subject has 2 daily meals with 4-6 snacks equivalent to over half of daily caloric intake. Snacks were related to specific cues (such as specific food stimuli: sweets or chocolates and “small” sandwiches and chips…). He received four sessions in order to explore specific cues and determine their role in his obesity. When topiramate was started at a dose of 25 mg/day, he was advised to eat as usual, however, to observe his snacking and reducing it to twice daily as one of the treatment goals. Topiramate was then increased weekly by 25 mg, and by 50 mg/week from week 4 onwards, until changes were observed in eating behavior (snacking reduction ≥50%) at a dosage of 125 mg/day. Mr. A reduced food consumption within week 5, leading to a reduction in “snacking” to twice daily. He felt less attracted by food cues finding it easier to resist the temptation to snack, which was maintained at 1 to 2 times/day representing less than 1/4 of total daily caloric intake. He lost 5 kg by week 9. He then remained with that stable weight for a month. Topiramate dosage was increased to 175 mg/day. He experienced distressing, word-finding difficulties as well as ‘mental block’ sensations without further weight loss which led him to stop the treatment abruptly. Consequently, the distressing side effects disappeared within two days.

After 6 weeks, he consulted again describing a rebound of snacking (6-8/day) within the first week of topiramate cessation associated with weight gain (8.5 kg) and highest peak in body weight history. He then refused topiramate, afraid of a subsequent weight rebound and distressing side effects at higher dosages. A Cognitive Behavior Therapy (CBT) was then started leading to a moderate improvement during the four following months (3-4 snacks daily, weight loss 3.5 kg).

One can hypothesize that the observed weight rebound phenomenon could be prevented by more prolonged treatment, progressive discontinuation or adjunctive CBT. Topiramate discontinuation strategies should be studied. Furthermore, the addition of CBT in deconditioning the cues brought forth by topiramate and their potential in relapse prevention remains to be determined, especially in subjects with weight rebound histories.

References

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Correspondence

Y Khazaal

Département de Psychiatrie du CHUV

Echallens 9

1004 Lausanne

Switzerland

Phone: +41/21/643 14 14

Email: yasser.khazaal@chuv.ch

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