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Topamax For Ptsd


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#1 Wooster

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Posted 06 October 2007 - 04:21 PM

Here's some published studies found on pubmed about treating ptsd with topamax and some other antisiezure meds/mood stabilizers including and especially topamax:


Berlin (2007)--metanalysis
Tucker et al (2007)--randomized double blind with some statistically significant improvements
Berlant (2004)--"nonhallucinating" pstd

And a couple of case studies:
Aalbersberg & Mulder (2006)
Tucker, Masters & Nawar (2004)

So for those of you who take topamax, I'm guessing not many of you are taking it for ptsd specifically. But would you consider it? Pros and cons? Considerations? Other Thoughts?

Thanks in advance

Peace,

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#2 Silver

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Posted 06 October 2007 - 05:52 PM

I think the pros/cons of TPM are well outlined elsewhere, so I won't belabor those.
It's a big drug for a problem that has a better track record of responding to CBT/prolonged exposure/etc.
I'd have some concerns about the additive cognitive effects with any benzodiazepines.
If you have a comorbidity, such as migraine or seizure disorder, that would benefit, I'd look longer at it.

I can't hunt it down right now, but go hunt for the "NICE" recommendations on PTSD and see if they came up with anything. That's the UK evidence-based panel. They're not driven by pharma money. If you can't find them, I'll chase it down when I'm home tonight. Carlat had something on this, too.
There's some evidence, I think you have most of it already.
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#3 Wooster

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Posted 06 October 2007 - 05:59 PM

That would be the guidelines available here:
http://guidance.nice.org.uk/CG26

Very helpful and informative.

Thanks again.,

Wooster

Edited by Wooster, 06 October 2007 - 07:15 PM.

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#4 Jerod Poore

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Posted 07 October 2007 - 03:04 PM

I wasn't taking it specifically for PTSD, but Topamax did have some unexpected results regarding the PTSD I've been dealing with.

Pros: I found out one of the main sources of my PTSD, which explained some very puzzling symptoms given my known history at the time. Many of the PTSD symptoms were toned down before the breakthrough.

Con: Four years on I still don't know which sucks less, remembering or not remembering.


Topamax: you'll forget what you want to remember and remember what you may rather want to keep forgetting.


Ha-ha. My little joke.

I found Topamax good for those repetitive, intrusive thoughts. And one does have to open up those black vaults of repressed memories to get to the heart of many a PTSD issue.
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#5 Mrs. Singer

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Posted 17 October 2008 - 04:09 PM

This is really interesting.

I was diagosed with PTSD when I was 16. I was hsopitalised for it, and the only time I was medicated for it was while I was in the hospital.
I've had chronic PTSD my whole life, but the past few years have been pretty great actually. No nightmares, no flashbacks.

But, lately, I've just been thinking about things that have happened. Still not flashbacks.
I started on my 4th week of Topamax today. I wonder if that could have anything to do with it...
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#6 BIMBO

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Posted 13 December 2008 - 11:19 PM

I wanted to bring this topic back up. I'm having alot of memories of my abuse since being on Topamax, since going up to 200mg stuff with my PTSD has been coming up alot. I don't think it can be a coincidence because nothing else has triggered it.

It's not really distressing me or anything, it's just memories keep coming back to me and I'm not sure why. I am a little worried if really represssed memories are going to surface like what seemed to have happened to Jerod.

Any others out there that it's happened to?

How strange that it can do that to your brain... bring out repressed memories. Like a key to a pandora's box.
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#7 Anna

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Posted 14 December 2008 - 08:36 AM

There was a thread on this awhile back.

I forget the name of it.

It was about the fact that sometimes, once one becomes stable, one can get to thinking and reminiscing about one's crazy past in a non-flashback type of way. And that it may actually have to do with increased stability, etc., leading one to think about it more, because one may be psychologically ready to do it.

You had better bet that now I am better, I have been thinking about/processing the past 18 months. They were largely awful! I've had some rough moments with it, but I don't think it's being caused by my meds, it's just my brain trying to fit the pieces back together.

Therapy can be helpful for this, or writing, or other forms of self expression, but don't be too quick to blame the meds in terms of cause/effects. You know?

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#8 BIMBO

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Posted 14 December 2008 - 05:13 PM

Well I get what you're saying, but I'm not actually any more stable in terms of my illness with BP & with PTSD, well I thought I pretty much had that beat.

I guess it could just be a coincidence, but when I read this thread I thought I'd put the feelers out & ask around.
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#9 Anise

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Posted 14 December 2008 - 09:08 PM

YES, YES, YES, YES!!!! YAY FOR TOPAMAX!

Ahem. I mean, it seems to be helpful so far for my PTSD issues. :) It's too early to really tell for sure, I guess, and yet.... The funny thing is that I didn't start taking it for PTSD, because I hadn't told my pdoc about my PTSD even I though I knew perfectly well that he'd written that I had severe PTSD in my diagnosis. I then "forgot" that he'd written it, "forgot" my constant flashbacks, "forgot" the re-experiencing and depersonalization and nightmares and flashbacks, forgot I'd forgotten anything, forgot I'd forgotten that I forgot that I forgot that... well, you get the idea. That seems to have happened to me a lot. It's strange... I almost feel as if I'm just starting to wake up from the trance of all this forgetting... but it's a good feeling. :) I've been so overwhelmed by all the re-experiencing, I think, that there's been no room to really *see* it for what it is. As early as this is, though, a lot of people in the PTSD studies *did* start seeing *something* changing in the re-experiencing area at 50 mg. of Topamax after only a week and a half. So it is possible.

Personally, I was very impressed by the PTSD studies. I have copies of them all if anyone wants to see the original studies themselves. Topamax had the most remarkable effects when it was added on to other meds, which seems to be true when it's used for bipolar too. In one study, 94% (!!!) of the participants experienced a complete remission of PTSD-related nightmares. Those and re-experiencing were the symptoms that consistently improved the most.

Another thing that I like so much about Topamax, though, is that it has improved my concentration and attention abilities so much, an effect that started after only a few days. I don't know if this has anything to do with PTSD, though. This effect seemed quite unusual to me, but I researched it and found that it maybe wasn't as bizarre as it sounded. Dr. Bankole Johnson has done a series of studies on topiramate/methamphetamine interactions (I have those too, if anyone wants to see them. I also emailed him.) He thinks that some people with ADHD who are already taking a stimulant drug may actually get this paradoxical effect with Topamax, although not everyone will. Nobody really knows why-- it doesn't seem to be that the stimulant is just canceling out the cognitive effect of the Topamax; something is happening through this interaction that enhances cognitive functioning in a different way. This is REALLY cool stuff. :mad: Anyway, I think that if Topamax keeps going the way it has for me, I'll NEVER want to go offr it. I don't know if I can exactly say that I've had any of the mood stabilizing effect yet (and certainly not the weight loss effect yet!), but what I HAVE had is worth it many times over even if I never do get that part of it.
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Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#10 Sasha

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Posted 17 December 2008 - 12:31 AM

I don't have PTSD, but when I started Topamax, I was really amazed by how well it just shut down a lot of obsessive/intrusive thinkking I'd been having about past events (nasty, nasty breakup). So, given my understanding of PTSD, I'd think it would definitely be worth considering. I could see it working to make memort/flashback type stuff somewhat less overwhelming, so that one's better able to actually deal with them in therapy, if that makes sense.
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#11 lostanddelirious

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Posted 17 December 2008 - 07:13 PM

I take 75mg topamax for weightloss counteraction.
Not sure if it works for my ptsd since I am on a bunch of other meds.
The only thing I notice that it does it forget things I have done during the day or earlier. Maybe that's a component to blocking out memories and flashbacks.
Hmmm...
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#12 Anise

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Posted 17 December 2008 - 09:10 PM

I take 75mg topamax for weightloss counteraction.
Not sure if it works for my ptsd since I am on a bunch of other meds.
The only thing I notice that it does it forget things I have done during the day or earlier. Maybe that's a component to blocking out memories and flashbacks.
Hmmm...

It wil be interesting to see how Topamax ends up working (or not, or whatever, or who knows!) for PTSD for me, because it has had *exactly* the opposite effect on my cognitive functioning. My working memory and short-term memory have both improved noticeably. Gee, they might end up being close to normal, considering where they started out from after that temporal-lobe-through-the-windshield thing. :) I also seem to be less likely to need to search for just the right word, or to lose my train of thought and not remember what the entire conversation was about in the first place, or to go into a room and completely forget why I was there or what I was doing. (These things have happened all the time since my head injury.) My concentration and attention abilities have improved the most, though. Even Focalin has never done this much for me. While most people certainly don't get any of these effects, I do have to say that people in the PTSD studies don't really seem to exactly report very many cognitive problems at all. My gut feeling is that this is not the mechanism by which the PTSD effects are happening. However, as always, YMMV, and these kinds of things will always be different for each individual person. I would say that there's no way that I'm up to a therapeutic dosage yet, so I'm not going to say anything about effects besides the cognitive ones yet, because I'm only sure about those. Who would have guessed?:mad: Maybe this is what Topamax does if you have brain damage to start out with!! Seriously... I really wonder if that's it. Has anybody studied this??? What happens if you give Topamax to the brain-injured? This could be really valuable in head injury programs! Could I be a test case? :)
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If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#13 BIMBO

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Posted 18 December 2008 - 12:04 AM

Can I ask how long you've been on Topamax & what dosage your on at the moment Anise?

I've only started having cognitive problems now at 200mg. They're not as bad as what others have complained of though, I have a feeling they'll go away once my brain gets adjusted to the new dosage. My concentration span is very short at the moment. I can't read as much or convey what I want to get across. But then... I'll have moments of clarity in between the fog & be able to talk well for awhile, then i'll go back to not being able to find words.

But for some reason my long term memory is better. It's all very strange at the moment.
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#14 In_Remission_bof

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Posted 18 December 2008 - 08:37 AM

Aptly put by Jerod,

"Topamax: you'll forget what you want to remember and remember what you may rather want to keep forgetting."

and

"I found Topamax good for those repetitive, intrusive thoughts. And one does have to open up those black vaults of repressed memories to get to the heart of many a PTSD issue."


When I started taking it 7 months ago, I found it stopped me from getting stuck in these recurring obsessive daily thoughts that really had no importance whatsoever other than to occupy my mind with number crunching. Which, ultimately kept my brain from taking break, sidling up to bar and ordering a nice cold beer to "reminisce" about my past.

I've also found that the combination of methylphenidate and topiramate, wake up frontal lobe! chill out temporal lobe, gave me some balance that I was missing.

#15 Anise

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Posted 18 December 2008 - 03:02 PM

I've also found that the combination of methylphenidate and topiramate, wake up frontal lobe! chill out temporal lobe, gave me some balance that I was missing.

Maybe that's it... I'm taking Focalin (dexmethylphenidate) and Topamax. For me, Focalin has been a lot cleaner in its effect than Ritalin, which I could NOT stay awake on for anything.

But it really is so odd. It seems (subjectively of course) that everything cognitive which was negatively affected by my TBI has improved. Everything I've read about TBI survivors and Topamax had led me expect the exact opposite (that it should exacerbate cognitive problems even more.) My TBI wasn't mild, either; because of the length of time I spent unconscious and in amnesia, and the degree of my deficits in working memory and visual-spatial tasks, it was considered moderate-- not severe, but moderate. My verbal and problem-solving abilities were largely spared; still, I've always been able to look and sound less disabled than I actually was and am. And yet the positive cognitive effects of Topamax SEEM to have increased, anyway, with each dosage increase (25-50-75). (I may yet become as dumb as a bag of hair as the dosage ranges upward, I guess, but it does seem that if such were the case, things wouldn't have been getting better each time I took more.) I first noticed the cognitive effects after the 5th day (it's been two weeks on Topamax as of today). So I can honestly say that I haven't noticed any mood-related effects yet. I do have a lot of anxiety, but personally, I think that's because my cognitive issues have improved so much but my mood-related ones *haven't* yet been affected at all. (claps hands in a random happy improved-concentration moment) Oh! This is so cool! I can sit here and type out this whole thing and go back and read it, and I don't feel like I want to jump up and down and bounce off walls and run around the house 80,000 times!!! Yay! Focalin all by itself never worked this well!

BTW, when did people start to notice mood-related effects?

For me, anyway, the effect of Topamax on my PTSD so far has been interesting *because* of the way it's improved my cognitive abilities but not my mood as of yet. It kind of makes me think of those drugs that Lakota people would take at the beginning of a vision quest to bring them face to face with their inner selves. :mad: It's like I SEE the reality of the PTSD... maybe that's where the anxiety is coming from, actually... but you know, I'm embracing it, because from my POV, losing memory-- which I sure did after my car accident and TBI-- only made my PTSD much, much worse even as it hid its clarity and details from me. I've wanted to know the worst all along; I'd RATHER feel the worst than feel numb and detached and fuzzy; I almost feel like I've been struggling to wake up and I'm finally starting to... and it's painful to wake up, but I'm doing it! It's hard to explain, but I'm actually glad I'm having this time with Topamax and PTSD *before* it's doing anything for my mood, for all that the experience is not always pleasant.
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#16 NOS

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Posted 19 December 2008 - 05:41 PM

Anyone have any experience with being on Topamax and Adderall? I've been giving some thought to trying the Topa for migraines, but had ruled it out due to cognitive effects and cost. I've also got PTSD, which is how this thread caught my eye. Any thoughts?
-L
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Pertinent and probably some not so pertinent info:

DX: Not sure which of these are current or accurate anymore, but my money's on the last one to account for the symptoms...Generalized Anxiety Disorder, ADD, Depressive Disorder NOS, Bipolar Disorder NOS, Possible Fibromyalgia/Chronic Fatigue Syndrome (doc has suggested this, prescribed accordingly, but has yet to do any sort of evaluation to determine...I'm uninsured), PTSD

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#17 Anise

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Posted 20 December 2008 - 05:18 PM

Well, all I can tell you is that with Topamax and Focalin, the cognitive effects for me have been positive and positive ONLY. My concentration and attention abilities have not been better in many years. Adderall is really nothing but mixed amphetamines, and Dr. Bankole Johnson's studies were also done with Topamax and amphetamines, when you get right down to it... and all that Topamax did in the cognitive realm for those participants (the same ones throughout three studies) was to consistently support the positive cognitive effects of the stimulants. I admire Dr. Johnson for not succumbing to the circular-file syndrome, because the results were the opposite of what he expected to find. There is so much that isn't known about how these drugs work, but Topamax actually has very positive effects on cognition for a small percentage who try it; that much is known to date, although it has been very little publicized for some weird reason. IMHO and YMMV and blah blah, but just based on my experience and on what has been found in studies, I wouldn't be so fast to rule T out just yet. :mad:
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I think everybody should like everybody. -- Andy Warhol
If you bring forth what it within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you. -- Jesus, The Gospel of Thomas.

Basically, I think that means that if you have PTSD and take Topamax, you had BETTER be ready to have the doors of perception opened!!!!

#18 In_Remission_Hell0

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Posted 04 April 2009 - 09:08 PM

YES, YES, YES, YES!!!! YAY FOR TOPAMAX!

Ahem. I mean, it seems to be helpful so far for my PTSD issues. :) It's too early to really tell for sure, I guess, and yet.... The funny thing is that I didn't start taking it for PTSD, because I hadn't told my pdoc about my PTSD even I though I knew perfectly well that he'd written that I had severe PTSD in my diagnosis. I then "forgot" that he'd written it, "forgot" my constant flashbacks, "forgot" the re-experiencing and depersonalization and nightmares and flashbacks, forgot I'd forgotten anything, forgot I'd forgotten that I forgot that I forgot that... well, you get the idea. That seems to have happened to me a lot. It's strange... I almost feel as if I'm just starting to wake up from the trance of all this forgetting... but it's a good feeling. :mad: I've been so overwhelmed by all the re-experiencing, I think, that there's been no room to really *see* it for what it is. As early as this is, though, a lot of people in the PTSD studies *did* start seeing *something* changing in the re-experiencing area at 50 mg. of Topamax after only a week and a half. So it is possible.

Personally, I was very impressed by the PTSD studies. I have copies of them all if anyone wants to see the original studies themselves. Topamax had the most remarkable effects when it was added on to other meds, which seems to be true when it's used for bipolar too. In one study, 94% (!!!) of the participants experienced a complete remission of PTSD-related nightmares. Those and re-experiencing were the symptoms that consistently improved the most.

Another thing that I like so much about Topamax, though, is that it has improved my concentration and attention abilities so much, an effect that started after only a few days. I don't know if this has anything to do with PTSD, though. This effect seemed quite unusual to me, but I researched it and found that it maybe wasn't as bizarre as it sounded. Dr. Bankole Johnson has done a series of studies on topiramate/methamphetamine interactions (I have those too, if anyone wants to see them. I also emailed him.) He thinks that some people with ADHD who are already taking a stimulant drug may actually get this paradoxical effect with Topamax, although not everyone will. Nobody really knows why-- it doesn't seem to be that the stimulant is just canceling out the cognitive effect of the Topamax; something is happening through this interaction that enhances cognitive functioning in a different way. This is REALLY cool stuff. :) Anyway, I think that if Topamax keeps going the way it has for me, I'll NEVER want to go offr it. I don't know if I can exactly say that I've had any of the mood stabilizing effect yet (and certainly not the weight loss effect yet!), but what I HAVE had is worth it many times over even if I never do get that part of it.


Before Topamax I was taking Dexamphetamine. Since the Topamax I stopped the dex because I felt as if my concentration and restlessness had improved enough.

I never started to eat less, I started to eat more if anything [breakfast].

Edited by Hell0, 04 April 2009 - 09:13 PM.



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