Frågedatum: 2008-06-16
RELIS database 2008; id.nr. 23604, DRUGLINE
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What is the evidence of using topiramate as treatment of obsessive compulsive disorder (OCD)?/nThe



Fråga: What is the evidence of using topiramate as treatment of obsessive compulsive disorder (OCD)?

The question concerns a 30-year-old woman who has insufficient effect of citalopram 60 mg daily.

Sammanfattning: The evidence of effect by topiramate on OCD is anecdotal. There are no randomized controlled trials. None of the studies referred to had any controls, emphasizing that there is no solid evidence for any effects compared to placebo or spontaneous recovery. Theoretically, a positive effect which could be synergistic to serotonin reuptake inhibitors can, however, not be excluded. Adding topiramate when a patient does not respond sufficiently to the established treatment options is an alternative which should be evaluated within a clinical trial, if tried in more than a single exceptional case.

Svar: Potentiation of GABA has been suggested to be the mechanism by which anticonvulsant drugs may have anxiolytic effects. Topiramate increases brain GABA-levels, which is supposed to account for psychotropic effects of the drug (1).

Topiramate is not approved for the indication OCD in Sweden. Concerning topiramate as treatment of OCD, two studies were found. The first (2) was a retrospective analysis of 16 OCD-patients who were partially or non-responsive to serotonin reuptake inhibitors. Some patients were treated with antipsychotics and bensodiazapines concomitantly. Effects were measured by two psychiatrists at 3-4 week intervals using the rating scales Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I). Baseline results were compared with results after 12-16 weeks of co-treatment. Eleven of the 16 patients were considered responders with much improved or very much improved CGI-I. In the whole group, CGI-S scores also decreased significantly (p<0.001). The mean dose of topiramate was 253.1 +-93.9 mg/d. There was no control group.

The other study (3) included 12 OCD-patients with insufficient effect of SSRI. Topiramate was added for 16 weeks and they were seen approximately every 2 weeks. Effects were measured using the rating scales Global Assessment of Function (GAF) and Yale Brown Obsessive Compulsive Scale (Y-BOCS). There was no control group. The primary efficacy measurement was >30 % decrease in Y-BOCS score. Ten of the patients were considered responders. The mean dose was 237.5 mg/d (range 200-300 mg/d).

There are also three cases of successful treatment of kleptomania with and without concomitant SSRI (4) and a case-report of successful adding of topiramate to paroxetine to an OCD-patient (5).

In two cases, OCD has been reported as a side effect of topiramate in the literature (6, 7). The manufacturer has listed depression, metabolic acidosis, kidney stones and side effects of the eyes in the SPC (8).

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