Topiramate Treatment for SSRI-Induced Weight Gain in Anxiety Disorders

Background: Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), have been associated with significant weight gain, a problem that frequently leads to noncompliance and premature discontinuation of treatment. Topiramate is a novel anticonvulsant that has also been used as a mood stabilizer and augmentation agent in mood disorders. Topiramate has been observed to have an interesting side effect of weight loss in some individuals. In this study, topiramate was added to the treatment regimen of patients with a primary DSM-IV anxiety disorder who had experienced substantial SSRI-induced weight gain, in an attempt to induce weight loss.

Method: Topiramate was added to SSRI treatment in 15 anxiety disorder patients, starting at a dose of 50 mg/day and titrating up to a target daily dose of 100 mg/day, with a maximum dose of 250 mg/day. Subjects’ weight was measured at baseline and after 5 and 10 weeks of treatment.

Results: Before topiramate treatment, SSRI-treated subjects in this sample had gained a mean of 13.0 ± 8.4 kg (28.6 ± 18.5 lb). After the addition of a mean dose of 135.0 ± 44.1 mg/day of topiramate for approximately 10 weeks, subjects lost a mean of 4.2 ± 6.0 kg (9.3 ± 13.3 lb).

Conclusion: Topiramate may have a role in managing SSRI-induced weight gain in anxiety disorder patients.