Topiramate effective as add-on therapy for weight loss in schizophrenia

South Asians are prone to more metabolic disorders and thus the effects of schizophrenia per se and its therapy on metabolic profile of an individual is significant for this population.   Topiramate, which helps in weight reduction, can be useful add on drug in this regard as has been recently shown by Chandradasa et al in their recently published study in Asian Journal of Psychiatry.

A significant proportion of early deaths in SCZ are found to be due to cardiovascular diseases and related complications. Atypical antipsychotics are associated with more metabolic complications, including weight gain than the typical antipsychotics. Topiramate has been previously used to counter the weight gain induced by olanzapine. The present study was conducted to determine the effectiveness of topiramate in reducing the weight of overweight/obese persons with schizophrenia and to assess the potential change in psychiatric symptomatology as measured by the brief psychiatric rating scale (BPRS)

In this double-blind randomised control trial, 50 patients (each) were compared taking topiramate 100 mg/day with a placebo in overweight/obese adults with schizophrenia who have been on antipsychotics for at least a year. A monthly anthropometric measurements and assessed the symptomatology using the brief psychiatric rating scale (BPRS) was obtained.

It was found that out of total 100 patients, the one's with Topiramate add-on therapy led to significant weight/Body Mass Index reduction and improved symptomatology as measured by the BPRS compared to the placebo. The mean weight difference in 3 months was -3.02 kg for the topiramate group and 0.30 kg for the placebo group.

The topiramate group had significantly more reporting of loss of appetite. The number needed to treat (NNT) to have a 5% reduction of body weight was 4 with topiramate compared with the placebo.

This is the RCT with most participants assessing the use of topiramate in schizophrenia and only the second in South Asia. Topiramate was shown to be useful for weight reduction and symptomatic improvement in persons with schizophrenia.

Source: Asian Journal of Psychiatry: doi: 10.1016/j.ajp.2021.102963.