Confusion and dysphoria with low-dose topiramate in a patient with bipolar disorder.
BACKGROUND
Topiramate, a newer antiepileptic agent, may benefit several neurological and psychiatric states, including bipolar disorder.


METHODS
A physically healthy, stockily built, 47-year-old, hypomanic Asian male with a >20-year history of uneventful use of psychotropic agents received topiramate in a dose that was stepped up to 100 mg/day across 10 days. He developed dysphoria, confusion, word-finding difficulties, and difficulties in maintaining a train of thought; the symptoms vanished within a week of drug discontinuation, and reappeared 1-2 days after rechallenge at a dose of 25 mg/day.


CONCLUSIONS
It appears that, while confusion is usually a dose-dependent adverse effect of topiramate, certain patients may idiosyncratically develop this adverse effect at very low doses.
Andrade
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Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. andrade@nimhans.kar.nic.in
D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003221:Confusion / Q000139:chemically induced* / Q000175:diagnosis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology*; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose