Topamax isn’t approved to treat depression or bipolar disorder with depression, but it may be helpful for people who have not found relief with other medications.

Topamax is the brand name for the drug topiramate. Topamax is approved to treat seizure disorders, like epilepsy, and to prevent migraine in adults.

Some people use Topamax to treat other conditions, like anxiety, depression, bipolar disorder, or post-traumatic stress disorder (PTSD), but Topamax is not approved by the Food and Drug Administration (FDA) for these purposes.

Though a few small studies have shown promise for using Topamax to treat depression or bipolar disorder with depression, there have been no large, peer-reviewed studies that show definitively that Topamax is safe and effective for these conditions.

In one small 2002 study of 16 women with treatment-resistant depression, 44 percent treated with Topamax reported improvement after 18 weeks.Carpenter L. (2002). Do obese depressed patients respond to topiramate? A retrospective chart review.

A more recent double-blind, placebo-controlled clinical trial was composed of 42 patients with major depressive disorder (MDD) who failed to respond to at least eight weeks of treatment with a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine, citalopram or sertraline.Mowla A, et al. (2011). Topiramate augmentation in patients with resistant major depressive disorder: A double-blind placebo-controlled clinical trial. DOI: 10.1016/j.pnpbp.2011.01.016

The study found that the participants taking Topamax in addition to their prescribed depression medication significantly improved depressed mood, suicidality, insomnia, agitation, and anxiety symptoms compared to those taking a placebo.

In another randomized, single-blind study, individuals with bipolar disorder in the depressive phase showed a significant improvement of symptoms in 56 percent of patients treated with topiramate.McIntyre RS, et al. (2002). Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study.

This was compared to 59 percent of patients who received another common anti-depressant known as bupropion (Wellbutrin). However, like the other studies mentioned above, this study was small, including a total of 36 patients.

Larger clinical trials will be needed to confirm Topamax’s use in treating depression or bipolar depression before the drug can be approved for this condition.

Still, some doctors may choose to prescribe Topamax off label. Your doctor may decide to do this if several other antidepressant or mood-stabilizing drugs fail to control your symptoms.

Since one of the side effects of Topamax is weight loss, a doctor may also decide to prescribe Topamax alongside another antidepressant as an adjunctive therapy to help offset any weight gain that may have been caused by the antidepressant.Mahmood S, et al. (2013). Effect of topiramate on weight gain in patients receiving atypical antipsychotic agents. DOI: 1097/JCP.0b013e31827cb2b7

There have been a few reports of Topamax causing or worsening depression in people taking it for other conditions, such as seizures, migraines, or bipolar disorder.Klufas A, et al. (2001). Letters to the editor: Topiramate-Induced Depression.

Topamax may increase a person’s risk of experiencing suicidal thoughts or behavior (thinking about hurting or killing yourself). About 1 in every 500 people who took anticonvulsants like Topamax during clinical studies became suicidal.Topamax (topiramate) medication guide. (2018).

symptoms to report if you take topamax
  • new depression or worsening of depression
  • suicidal thoughts
  • attempts to commit suicide
  • new or worsening anxiety
  • irritability
  • trouble sleeping
  • panic attacks
  • an extreme increase in activity and talking (mania)
  • withdrawing from friends and family
  • unusual changes in mood or behavior

Topamax is a prescription drug that belongs to a class of drugs called anticonvulsants or antiepileptic drugs (AEDs). It’s described on its FDA label as a “sulfamate-substituted monosaccharide.”Topamax (topiramate) label. (2017).

Topamax tablets come as 25 milligrams (mg), 50 mg, 100 mg, and 200 mg round tablets that are taken whole by mouth. The drug also comes in sprinkle capsules that can be broken open and sprinkled onto soft food.

The exact way that Topamax works in the body isn’t fully understood. Topamax is thought to decrease abnormal excitement in the brain. Among other actions, Topamax affects the activity of the neurotransmitter gamma-aminobutyrate (GABA).

GABA is involved in the excitability of the nervous system. Problems with the GABA system has also been thought to play a role in the development of psychiatric disorders, including anxiety and depression.Cryan JF, et al. (2010). GABAB receptors and depression. Current status. DOI: 1016/S1054-3589(10)58016-5

There are many potential side effects of Topamax.

topamax side effects

These symptoms can be very serious:

If you’re pregnant, you should speak to your doctor before taking Topamax. Topamax can cause harm to the fetus. Infants exposed to Topamax in utero have an increased risk of cleft lip, cleft palate, and low weight.

In 1996 the FDA approved Topamax for the treatment of partial onset or primary generalized tonic-clonic seizures and for people with seizures associated with Lennox-Gastaut syndrome.

Topiramate was also approved in 2012 for use in combination with another drug called phentermine for weight loss. This product goes by the brand name Qsymia.Vivus Inc. (2010). Vivus announces FDA approval of once daily qsymia (phentermine and topiramate extended-release) capsules CIV [Press release]. (2012).

In 2014, the FDA approved Topamax for the prophylaxis (prevention) of migraine in patients 12 years of age and older.Janssen Pharmaceutical Inc. (2014). FDA OKs Janssen Pharmaceutical Inc. ‘s Topamax For Migraine Prevention In Adolescents [Press release].

The exact way that Topamax works to help prevent migraine isn’t known. One theory is that Topamax calms overactive nerve system cells in the brain that lead to migraine attacks.

Topamax is sometimes prescribed “off label” for other conditions. Off label means the drug is used to treat a condition for which it is not approved.

Prescribing a drug off label is not illegal, though it is illegal for a drug manufacturer to market the drug specifically for the off-label use. Your doctor will assess your symptoms and history to determine if he/she thinks that using Topamax off label will help you.

conditions treated by topamax
  • seizures
  • migraine
  • obesity/weight loss
  • PTSD
  • bipolar disorder
  • eating disorders, including binge eating disorder and bulimia
  • alcohol addiction
  • cocaine addiction
  • painful nerve conditions

For this reason, a doctor may decide, after careful evaluation, your doctor to prescribe Topamax off label for treating depression.

On the other hand, Topamax may also cause serious depression and suicidal thoughts in some people, so it’s important that you discuss this option carefully with your doctor.

If you’re thinking about using Topamax to treat depression, you should discuss whether or not the potential benefits outweigh the risks before making a decision.

If you’re already taking Topamax and you’re feeling depressed or you’re having thoughts of suicide or self-harm, call your doctor right away. Your doctor will help you figure out if need to adjust the dose or try a new medication instead.