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Paper text:
weight gain is one of the commonest and most distressing side effects of antipsychotics that can add to the morbidity and mortality of the disease being treated .
topiramate is one of the weight - reducing agents that has been used successfully in reducing antipsychotic - induced weight gain .
topiramate has been reported to reduce body weight in patients treated for seizures , bipolar disorder , schizophrenia , and binge - eating disorders with obesity.[25 ] studies have reported a significant body weight reduction with doses of topiramate ranging from 100 to 300 mg / day . in this case report
, we describe a patient of bipolar affective disorder ( bpad ) mania with psychotic symptoms who showed a significant body weight reduction with very low dose of topiramate .
ms c an 18-year - old woman , congenitally deaf and mute , educated up to high school , a case of bpad mania with psychotic symptoms ( international classification of diseases - 10 ) in remission , presented to us with a significant weight gain while on treatment with 6 mg/ day of risperidone , 200 mg / day of chlorpromazine , and 4 mg / day of trihexyphenidyl .
her parents complained of a significant weight gain of 18 kg over a span of 5 months .
then she was started on 25 mg / day of topiramate with a gradual increase in dose to 50 mg / day over 1 week . at the same time , chlorpromazine was withdrawn .
after 2 weeks of starting topiramate , her parents noticed reduction in her appetite . within 1 month
she had lost 2 kg . during this course , she also complained of amenorrhea , for which she was evaluated with serum prolactin levels and ultrasound abdomen .
her serum prolactin levels were elevated ( 48.3 ng / ml ) , and her ovaries showed features suggestive of polycystic ovarian disease ( pcod ) . she was started on 10 mg / day of aripiprazole . during her next follow 
up , i.e. , after 2 months , she showed a weight loss of 3 kg .
this time she was planned to gradually reduce risperidone dose while continuing other medications ( risperidone was gradually reduced and finally stopped over a period of 12 months ) .
she showed a gradual decline in weight at a rate of 2 - 3 kg every 2 months .
after 15 months of treatment with topiramate , she had lost nearly 18 kg , and had reached near pre - morbid weight without any adverse effects .
only pharmacological interventions were done , and no lifestyle or diet modifications were practiced inspite of repeated advice .
her serum prolactin levels also reduced gradually ( 33.07 ng / ml ) after 6 months of starting aripiprazole along with regularization of menstrual cycles .
this case report suggests the usefulness of topiramate as an adjuvant in reversing the weight gain caused by antipsychotics . in this case scenario ,
aripiprazole , an atypical antipsychotic with additional weight - reducing property , might appear to have contributed to the weight loss , ; but the clinical course clearly indicates the onset of weight loss even before the start of aripiprazole .
it also raises the question of whether withdrawal of chlorpromazine contributed to the weight loss .
but there was no increase in appetite when she was on chlorpromazine and her appetite decreased after adding topiramate .
topiramate , in addition to its weight - reducing property , also has mood - stabilizing properties , which can be an added benefit in the management of mood disorders . to summarize , our observation reports a significant weight loss with a very low dose of topiramate , i.e. , 25 - 50 mg / day , in contrast to other studies .
hence we conclude that topiramate can be used as a potential weight - reducing agent in patients on antipsychotics with significant weight gain .
antipsychotic induced weight gain is the most common and distressing side effect . 
 this also affects the compliance toward the treatment and hence the prognosis . 
 non - pharmacological interventions such as exercise and diet modifications alone might not be sufficient most of the times ; also ensuring compliance toward this is difficult in patients with psychiatric illness . 
 so , the role of weight - reducing drugs become important . in this case report 
 , we describe the use of low - dose topiramate as a weight - reducing agent , in a patient with a bipolar affective disorder - mania with psychotic symptoms , who had significant risperidone - induced weight gain .