Topiramate and emotional overeating?

[sunlioness]

Does anyone have any experience/success with using topiramate in folks with emotional/stress overeating (though not straight up bingeing) or night eating?

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[milesed]

I used it in past for kids- had about 30% rate of patients who'd eat less. Rates are very low for adults so never used it with them. I think it's to be released in combination with another medication for wt loss.

 

[Ibid]

Emotional over eating..... what about logical over eating..... isn't over eating just over eating??

 

[Ceke2002]

Emotional over eating..... what about logical over eating..... isn't over eating just over eating??

Not always, some people do use the 'I'm an emotional eater' as an excuse not to make any healthy lifestyle changes and remain stuck in their poor nutrition choices, but actual emotional over eating, or over eating (such as bingeing) that has become a compulsive behaviour, that's a whole 'nother ball park.

 

[PikminOC]

I have the primary care start Topamax if they want to and the patient wants it. It makes people dopey and can cause lab changes that I don't want to deal with.

 

[Ibid]

Not always, some people do use the 'I'm an emotional eater' as an excuse not to make any healthy lifestyle changes and remain stuck in their poor nutrition choices, but actual emotional over eating, or over eating (such as bingeing) that has become a compulsive behaviour, that's a whole 'nother ball park.

No behaviour is the result of anything purely emotional or just logical..... rationality is a myth. Humans are not rational beings..... five minutes watching the six oclock news will prove this to anyone who doubts this simple fact of life.

As to compulsion..... well a habit is a habit..... calling a habit compulsive adds nothing.

The psychiatric assault on free will goes on......

 

[xlithiumx]

I prescribe a lot of topiramate in borderline pd patients with addictions and self injury. I have seen quite good response in terms of emotional reactivity, self injury urges, and substance cravings. It also tends to be an easy sell for women as it clearly doesn't cause weight gain and often leads to weight loss.

 

[whopper]

Binge eating does have data showing that SSRIs could work. Topamax, could it work? I see people give it out for weight loss despite that it's not indicated for it. While I don't fault them for it because it does seem to work, there don't appear to be any established guidelines.

I'd recommend people look into all the data they can amass on the topic before proceeding on such. E.g. get a bunch of articles, see how long the benefits last, is there a rebound effect, etc.

Unfortunately what I see are docs noticing it cuts weight so they give it for that reason without really trying to understand the nature of the beast or Pandora's box they are opening.

 

[Ceke2002]

Binge eating does have data showing that SSRIs could work. Topamax, could it work?

I see anecdotal evidence from Bulimic and AN (subtype purging) patients on the support forums that it's either a miracle cure that was the only thing that stopped them binging (but inevitably they were forced off it due to side effects), or it has worked but only to reduce the frequency of the binges (and the side effects eventually became too intolerable) or in a minority of reports it hasn't worked at all and the binging has actually gotten worse (although factors like med compliance and dosage would have to be taken into account, I'd think).

Be careful though of AN patients with restricting subtype falsely presenting as having purging subtype in order to obtain Topomax.

 

[MLT2MT2DO]

I used it in past for kids- had about 30% rate of patients who'd eat less. Rates are very low for adults so never used it with them. I think it's to be released in combination with another medication for wt loss.

Already released. Topiramate and naltrexone. Of course the pill is only in dosages you can get in the combo pill, and I'm sure seperate prescriptions of the "wrong" dosages wouldn't work.

In theory this combo should actually be fairly effective, all sarcasm aside.

 

[splik]

Already released. Topiramate and naltrexone. Of course the pill is only in dosages you can get in the combo pill, and I'm sure seperate prescriptions of the "wrong" dosages wouldn't work.

In theory this combo should actually be fairly effective, all sarcasm aside.

No you're confusing two different combo weight loss pills! There is topiramate and phentermine (Qsymia) and there is another pill of bupropion and naltrexone (contrave)

but you could probably market that combo too haha

 

[MLT2MT2DO]

You're right I was thinking contrave. Qsymia seems like overkill. Hmmm...when in doubt prescribe both combo pills? You'll never look skinnier than when you're a corpse.

 

[OldPsychDoc]

You're right I was thinking contrave. Qsymia seems like overkill. Hmmm...when in doubt prescribe both combo pills? You'll never look skinnier than when you're a corpse.

Augment with Adderall. And nicotine.

 

[MLT2MT2DO]

Augment with Adderall. And nicotine.

If only I could con the wife into a Wisconsin residency

 

[Ceke2002]

You're right I was thinking contrave. Qsymia seems like overkill. Hmmm...when in doubt prescribe both combo pills? You'll never look skinnier than when you're a corpse.

Augment with Adderall. And nicotine.

Holy ****, I think you guys might have just invented a new 'Ana' diet. Quick, think up a name, this could potentially be as legendary as the ABC, 2468 diet or the chocolate fast.

 

[vistaril]

Does anyone have any experience/success with using topiramate in folks with emotional/stress overeating (though not straight up bingeing) or night eating?

you see people out there using topomax for all kinds of stuff(one of them being eating d/os).......no good evidence it works above placebo imo though-For anything we should be treating(I'll defer to the neurologists for the stuff they may use it for)

It's yet another one of those psychiatric practices that are so common in the community that give us a bad name imo.

 

[HarryMTieboutMD]

Hey if you ask a certain, "reputable" addiction psychiatrist (dept chair even), it is a panacea for addiction. Nevermind the 74 disclosed financial conflicts of interest or the fact that meth addicts did not have to even stop using in a 12 week period to be counted as a positive outcome... But hey, maybe just load alcoholics/addicts with topirimate, and they'll be so cognitively disabled that they will forget how to use!

 

[MLT2MT2DO]

.
Meant to edit previous post autocorrect

 

[Merovinge]

you see people out there using topomax for all kinds of stuff(one of them being eating d/os).......no good evidence it works above placebo imo though-For anything we should be treating(I'll defer to the neurologists for the stuff they may use it for)

It's yet another one of those psychiatric practices that are so common in the community that give us a bad name imo.

It's pretty undeniably effective for seizure disorders (hopefully not being treated by a psychiatrist) and chronic migraines (which could very rarely be treated by some psychiatrists). Its awfully scary when prescribed as monotherapy for someone actively manic however, not a highlight of my pgy-1 year seeing that for a pt.

 

[PikminOC]

If only I could con the wife into a Wisconsin residency

Explain.
And I started someone on Topamax today because of this thread.
What doses do you see helping the most???

 

[sunlioness]

Thanks for your thoughts, everyone.

 

[F0nzie]

I do not know much about Topiramate but I have had success with SSRIs in conjunction with therapy.

Right now I have an alcoholic + binge eating d/o patient on Naltrexone that swears by it for food cravings. There are some studies, but not a whole lot of evidence for it.

 

[saudades]

For what it's worth, I personally took topamax for a few months for anticonvulsant effects and I lost probably 15 pounds from 130-something. I definitely became something of a stress eater in med school, and when I was on topamax I just didn't care about eating. Not necessarily that my appetite was supressed as much as food was just not appealing to me. I also noticed it changed the way some foods tasted and also kind of changed my palate. For example, I used to have a HUGE sweet tooth, and now, even being off topamax for a long time, I can take or leave dessert. I haven't seen it used for that reason in patients, but if my reaction is a common one, I would think it would be effective. Though I will say it turned me into a ridiculously stupid zombie (which is why I stopped taking it).