title: Combination treatment of clozapine and topiramate in resistant rapid-cycling bipolar disorder.
abstract: 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.
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Chin-Kang
authors.initials: CK
authors.lastname: Chen
authors.forename: I-Shin
authors.initials: IS
authors.lastname: Shiah
authors.forename: Chin-Bin
authors.initials: CB
authors.lastname: Yeh
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Mao
authors.forename: Chuan-Chia
authors.initials: CC
authors.lastname: Chang
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003024:Clozapine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D000077236:Topiramate
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D000077236:Topiramate; D005632:Fructose; D003024:Clozapine