The Effectiveness of Anticonvulsants (Topiramate) to Treat Eating Disorders

There is no medication that conclusively supports treating eating disorders on their own. This does not, however, mean that medication cannot have an impact on eating disorder treatment and recovery.

Many medications can support symptoms which may be triggering or mediating eating disorder behaviors.

One of these medications that is becoming more popular in aiding eating disorder treatment is Topiramate, also known by the brand name of Topamax. For the remainder of this article, we will refer to this medication by this name.

What is Topamax?

Topamax is a medication that impacts the brain. It is approved by the U.S. Food and Drug Administration (FDA) to treat seizures (epilepsy) in adults and children (in combination with other anticonvulsants) and also to prevent migraine headaches in adults [1].

According to the National Health Service (NHS), Topamax reduces the bursts of electrical activity in your brain, restoring the normal balance of nerve activity [2].

Topamax for Binge Eating Disorder

You may have noticed that, thus far, there has been no mention as to what Topamax could possibly have to do with eating disorder treatment. This is because Topamax was not initially developed for this purpose, however, researchers have begun to explore how it might be helpful in treating eating disorders, namely bing eating disorder (BED).

Studies have found that Topamax shows some success in supporting reduction of BED episodes.

Research

One theory on the mechanism behind this success is that it supports reduction of food intake “mediated by its antagonism to glutamatergic transmission in the lateral hypothalamus.” [3]

Additionally, Topamax can lead to weight loss by [3]:

  • Stimulating energy expenditure
  • Decreasing binge eating by altering the rewarding properties of food
  • Reducing the general impulse to binge eat

Regardless of the mechanism of change, Topamax is proving to be effective in treating BED.

Results of one study indicated that Topamax-treated patients noticed a 94% reduction of binge eating compared to placebo-treated patients who only had a 46% reduction[4].

Topamax Side Effects

It is unlikely for any medication to not have side effects. After all, each body works differently, therefore, how the chemicals of medications will react with an individual will look differently as well.

The following side effects of Topamax occur in, at minimum, 1 in 100 people [2, 5]:

  • Nausea
  • Fatigue
  • Dizziness
  • Diarrhea
  • Loss of appetite
  • Weight loss
  • A prickling or tingling sensation in the extremities
  • Change in the way food tastes
  • Brain fog
  • Lack of coordination
  • Difficulty concentrating
  • Difficulty speaking clearly

According to the NHS, these side effects are often mild and will go away by themselves [2].

Serious Side Effects

Serious side effects include:

  • Blurred vision/difficulty seeing and/or eye pain
  • Pain in your back, belly, and/or side.
  • A burning sensation when you pee
  • Cloudy or smelly urine
  • Irregular heartbeat
  • Not sweating when the weather and environment would typically cause sweating.

The NHS recommends an individual call 911 or see a doctor immediately if experiencing any of the above symptoms [2].

Topamax has also been linked to metabolic acidosis, a potentially life-threatening condition that is the result of too much acid in the blood. Symptoms include [5]:

Fatigue

It is also important to know that the FDA has issued a warning on seizure medicines, like Topomax, and the risk of suicide and suicidal thoughts. [5]

“The FDA does not recommend that people stop using these medicines. Instead, people who take seizure medicine should be watched closely for warning signs of suicide.”

The safest way to engage with a new medication is to have consistent contact with a doctor when experiencing any side effects of medication at all.

Benefits of Topamax for Eating Disorder Treatment

As the above information makes clear, there are benefits and risks to taking Topamax at all.

Even with these risks, however, many researchers are saying that the benefit of Topamax in treating BED is substantial enough to be considered.

One study found that Topamax is a viable option along for treating binge eating disorder, when combined with cognitive behavioral therapy (CBT), interpersonal therapy, and SSRIs [4].

Regardless of the presence of Topamax, individuals should always continue therapeutic work in relation to their BED behaviors as medication alone does not effectively eradicate eating disorders.

Ultimately, one should consult with an eating disorder informed medical professional if they are considering Topamax as a supportive medication for treating binge eating behaviors.

Resources

[1] Unknown (2022). Topiramate (Topamax). National Alliance on Mental Illness. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Topiramate-(Topamax).

[2] Unknown (2022). Topiramate. National Health Service. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Topiramate-(Topamax).

[3] Leombruni, P., Lavagnino, L., Fassino, S., (2009). Treatment of obese patients with binge eating disorder using topiramate: a review. Neuropsychiatric Disease and Treatment, 5.

[4] McElroy, S. L., et al. (2007). Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biological Psychiatry; 61:9.

[5] Romito, K., Stewart, W. (2017). Topiramate for binge eating disorder. Kaiser Permanente, Retrieved from https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=ty7109.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 7th, 2022
Published on EatingDisorderHope.com

Author: Margot Rittenhouse, MS, LPCC, LPC, NCC