Abstracts

Rationale: AEDs are indicated for the treatment of epilepsy, yet are prescribed primarily for psychiatric and pain disorders. Five AEDs (carbamazepine/divalproex sodium/lamotrigine/pregabalin/benzodiazepines) are FDA/EMA approved for psychiatric disorders leading to almost all AEDs being studied for the majority of psychiatric disorders. Topiramate is no exception and, though not having regulatory approval for psychiatric indications, has been studied and clinically utilized in the treatment of affective, psychotic, anxiety, obsessive-compulsive, trauma-related, somatic, impulse control, eating, substance-related and addictive, neurocognitive, neurodevelopmental, paraphilic, and personality disorders. With, such broad off-label use, clinicians require a better understanding of pertinent studies and related efficacy. Methods: PubMed literature review and analysis. Results: Utilizing DSM-5 categories, topiramate intervention was studied for 32 diagnoses within 13 major diagnostic categories. Fifty-four representative papers addressing topiramate use for these diagnoses are summarized. Research ranged from case reports to case series, open-label un-blinded studies, small active comparator studies, placebo double-blind studies, and pivotal studies. Significant methodologic limitations included sample size, short-duration, unclear randomization/blinding, and non-adjustment for potential confounders including comorbidities and polypharmacy. Nonetheless, literature reviewed is suggestive that topiramate may be effective in subpopulations within specific diagnoses. Further, literature supports off-label use of topiramate in eating disorders, weight control secondary to psychotropics in different psychiatric diagnoses, and alcohol use disorders. Conclusions: Topiramate has no regulatory psychiatric indications but is used for refractory cases. Principal off-label psychiatric uses include eating disorders, weight control, and alcohol use disorders. Appropriately powered, well-controlled studies are required to better determine the use of topiramate in psychiatry. Funding: No funding support was received in support of this abstract.