Uniqueresearchjournals.org

Unique Research Journal of Medicine and Medical Sciences Vol. 1(4), pp. 031-033, October, 2013 Available online@http://www.uniqueresearchjournals.org/URJMMS Unique Research Journal of Medicine and Medical Sciences
Dissociative disorder induced by topiramate in an
obese young woman: A case report
Omid Rezahosseini and Reza Bidaki*
Rafsanjan University of Medical Sciences, Rafsanjan, Iran. *Corresponding author. E-mail: [email protected], [email protected]. Tel: +03915230584. Topiramate is an antiepileptic drug and uses to induce weight loss. We introduce a case of Topiramate
induced Dissociative disorder with non common presentation. The patient was 27 year old obese girl.
Because of depressed mood, increased sleep and slow psychomotor she was treated with Sertraline
(Zoloft®, Pfizer, United states of America) 50mg and Bupropion 75 mg/daily. The patient had
complained strongly of hyperphagia and overweight. So Topiramate 25 mg/daily was started and was
increased to 50 mg/daily. The patient experienced a feeling of great strength and ability to perform
every task by her right hand, sense of depersonalization and derealization and feelings of all levels to
the steeper slopes and slightly angled. About one day after discontinuation of Topiramate, symptoms
had been eliminated and did not repeat any more in two months follow up. Our patient had Sertraline
(Zoloft®) 50 mg and Bupropion 75 mg/daily as two contributing factor when Topiramate started. The
increased serotonin level can be a justification for patient’s symptoms but alteration of the
norepinephrine system is one other mechanism. Physicians should be aware of this interaction and do
not prescribe these drugs simultaneously. More studies are suggested to find the exact mechanism for
these symptoms.

Key words: Topiramate, dissociative disorder, weight loss, sertraline, bupropion.

INTRODUCTION

Topiramate is an antiepileptic drug that use in
is defined as an experience of individual feeling unreality management of epilepsy and migraine prophylaxis. The and detachment from him/herself and derealization, common side effects of this drug include: dizziness, which defined as an alteration in the perception of one’s ataxia, somnolence, headache, tiredness, slow reasoning surroundings and consequently sense of the reality of the depression and cognitive impairment such as mental external world is lost (Diagnostic and statistical manual of confusion, paresthesia and hypoesthesia and speech difficulty. More over Topiramate induce weight loss in We report a case which perceived Topiramate for patients, especially whom with high baseline Body Mass weight loss and experienced symptoms related to Index (BMI) (Antel and Hebebrand, 2012; Verrotti et al., 2011; Stella et al., 2002). There are case reports of discontinuation. To our knowledge this is the first case with this symptom and can be interesting for physicians presentations like visual hallucination and paranoid delusions (Stella et al., 2002; José et al., 2008; Miller et al., 2010; Zesiewicz et al., 2006; Singh, 2006) but there are just limited reports of Dissociative disorder as a side CASE REPORT
effect of this drug (Sarwar and McGinnis, 2011). Dissociative disorder include Depersonalization that The patient was 27 year old obese girl (BMI = 29.2 kg/m2); she was a college student with a history of In other hand various ocular adverse effects like acute pathological grief following the death of grandmother. onset myopia, glaucoma is reported for Topiramate, but She was dependent to her sister and lived separated there is no report of feelings all levels to the steeper from her family. She did not mention a history of mania slopes and slightly angled (Mandal et al., 2008). and organic illness. Because of depressed mood, In conclusion it seems that concomitant use of increased sleep and slow psychomotor she was treated Serotonin Secretion Reuptake Inhibitors (SSRIs) or with Sertraline (Zoloft®) 50 mg and Bupropion 75 norepinephrine reuptake inhibitor and Topiramate can mg/daily and Metformin 500 mg/daily. Patient was visited lead to adverse effects. Physicians should be aware of each month and partial recovery was observed. The this interaction and do not prescribe these drugs patient had complained strongly of hyperphagia and simultaneously. More studies are suggested to find the overweight. So Topiramate 25 mg/daily was started and after two days was increased to 50 mg/daily. Twelve hours after increasing the dose of Topiramate, the patient mentioned that has experienced a series of symptoms: a REFERENCES
feeling of great strength and ability to perform every task by her right hand, sense of depersonalization and Antel J, Hebebrand J (2012). Weight-reducing side derealization and feelings of all levels to the steeper effects of the antiepileptic agents topiramate and slopes and slightly angled. Also she noted that her mood zonisamide. Handbook Exp. Pharmacol., 209: 433-466. has improved. Patient had insight and knowledge about Arias HR (2009). Is the inhibition of nicotinic acetylcholine problems. All laboratory tests were normal. The patient receptors by bupropion involved in its clinical actions? had discontinued the drug due to unpleasant symptoms. Int. J. Biochem. Amp. Cell Biol., 41(11): 2098-2108. About one day after discontinuation, symptoms had been Diagnostic and statistical manual of mental disorders eliminated and did not repeat any more in two months (2000). 4 ed. Washington, DC: American Psychiatric José RJP, Cairns A, Babbs C (2008). Topiramate- induced psychosis in two members of the one family: a DISCUSSION
Khazaal Y, Zullino DF (2003). Depersonalization- Topiramate is discovered by Maryanoff and Gardocki derealization syndrome induced by reboxetine. Swiss (1985) as an Anticonvulsant drug (Maryanoff and Gardocki, 1985), gradually more effects and side effects Kramer CK, Leitao CB, Pinto LC, Canani LH, Azevedo of this drug was shown, including weight loss properties MJ, Gross JL (2011). Efficacy and safety of topiramate (Antel and Hebebrand, 2012; Verrotti et al., 2011). The on weight loss: A meta-analysis of randomized most common reported side effect of Topiramate in controlled trials. Obesity reviews: An official Journal of patients that use this drug for weight reduction was the International Association for the Study of Obesity, paresthesia in a meta-analysis (Kramer et al., 2011. But our case experienced a rare side effect of Topiramate, Mandal A, Chatterjee S, Bose S, Ganguly G (2008). feeling of great strength and ability to perform every task Ocular adverse effects of Topiramate: Two case by her right hand and feelings of all levels to the steeper reports. Indian J. Pharmacol., 40(6): 278-280 slopes and slightly angled. In a case report by Sarwar and colleagues a woman “talking like child” after Anticonvulsant sulfamate derivatives. United States of Topiramate started for her migraine headaches. In that report the effect of Topiramate on serotonin levels Miller AD, Prost VM, Bookstaver PB, Gaines KJ (2010). described as a mechanism (Sarwar and McGinnis, 2011). Topiramate-induced myoclonus and psychosis during Our patient had Sertraline (Zoloft®) 50 mg and Bupropion migraine prophylaxis. American journal of health- 75 mg/daily as two contributing factor when Topiramate system pharmacy: AJHP: Official J. Am. Soc. Health- started. The increased serotonin level can be a justification for patient’s symptoms but alteration of the Sarwar SR, McGinnis RA (2011). Topiramate-induced norepinephrine system is one other mechanism as Dissociative Disorder. Innovations Clin. Neurosci., 8(8): reported in a case of Depersonalisation-derealisation syndrome induced by reboxetine when added to Singh T (2006). Topiramate and psychosis. Psychiatry Citalopram that is a specific norepinephrine reuptake inhibitor (Khazaal and Zullino, 2003). Bupropion is a Stella F, Caetano D, Cendes F, Guerreiro CA (2002). Acute psychotic disorders induced by topiramate: interaction between Topiramate and Bupropion can occur report of two cases. Arquivos de Neuro-Psiquiatria, (Arias, 2009). Another drug that our patient consumed was Metformin with no report of resemble side effect. Verrotti A, Scaparrotta A, Agostinelli S, Di Pillo S, Chiarelli F, Grosso S (2011). Topiramate-induced weight RA (2006). Topiramate-induced psychosis in patients loss: a review. Epilepsy Res., 95(3): 189-199. with essential tremor: report of 2 cases. Clin. Zesiewicz TA, Tullidge A, Tidwell J, Sullivan KL, Hauser

Source: http://www.uniqueresearchjournals.org/urjmms/pdf/2013/October/Rezahosseini%20and%20Bidaki.pdf