Brief Answer:
Why remain on topamax when it clearly is causing side effects?

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I am sorry you have been going through this distressing experience, but I would like to explain a few things for your better understanding ma'am.

First of all, the headaches you have been experiencing are migraine headaches. Quite clearly from the description and the treatment provided (topamax is used for migraine headache prevention). Migraine headaches are very common in women, more than men especially because they are related to the female menstrual cycle (a hormonal factor seems to be the cause for the headaches).

That being said, I would first like to mention that migraine headaches slowly subside once a woman attains menopause and so you should not have to suffer from these headaches any longer. But it is also important to know that other than the hormonal influence there are other triggering factors as well, which once avoided can help to prevent migraine headaches to quite an extent (I should know, as I have had them since childhood). Factors include:

+Climate: Too much heat or cold (not necessarily extremes)
+Food: Certain types of food like oily food, fried food, etc.
+Long gaps between meals
+Over sleeping
and others.

So recognising the causative factor may really help you to prevent migraine headaches to quite an extent. Now coming to the main part of your query. Topamax is used to prevent migraine headaches, but is not the first choice of drugs used to prevent migraine headaches. There are other options like:

+Sumatriptan
+Propranolol
+Olmesartan
+Verapamil
+Divalproex sodium
+Clinodine
+Lisinopril
and many others.

Topamax does carry the risk of depression, and as you have been experiencing the depression quite often whilst on topamax, your doctor should have substituted topamax with another medication. Knowing that there are so many options, I wonder why he/she did not do this yet.

So please do consult your doctor and request for a change in prescription, topamax is not the only option and so you should be able to live without the headaches and depression at once.

I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.

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Brief Answer:
Permanent imbalance resulted from the topamax

Detailed Answer:
Hello once again ma'am.

I am sorry, you did not mention completely discontinuing topamax, so I assumed you were still on it and wanted you to discontinue it immediately.

I am sorry to learn that you are still experiencing depression, despite the discontinuation of topamax. I have come across a few patients with such a presentation ma'am. Let me explain what happens, and how with some basic information on depression first.

Depression has numerous causes, but the most common one is related to brain chemistry. The brain has numerous neurotransmitters which help in maintaining mood, and a balance between then help to maintain a happy and normal mood and state of mind. When there is an imbalance it can result in depression, anxiety, panic, mood disorders, etc.

You were normal before topamax was initiated, but topamax had a common side effect of depression which you experienced. Topamax caused some amount of imbalance in your neurotransmitters which caused the depression in you. Due to the on and off prescription of topamax and the effect it had on your neurotransmitters, it resulted in a permanent imbalance in your neurotransmitters. There have been numerous such instances in individuals who were on medications that interfered with their neurotransmitters, and despite discontinuing the medication has resulted in a permanent imbalance.

The anti-depressants prescribed should have help to at least a minimal amount to suppress the depression, but if they have proven to be ineffective then we may have to use higher dosages or different approaches to treating major depression like behavioural therapy, psychotherapy, transcranial magnetic stimulation and in some cases even electroconvulsive therapy (ECT).

I am sorry to hear about this, and hope your doctor can work towards understanding and better treating your depression ma'am. Please do not hesitate to write to me for any further information, I am always here to help.

Best wishes.

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Brief Answer:
I do not think it can do any more damage

Detailed Answer:
Hello once again ma'am.

I understand and truly have to say what you are experiencing is unfortunate.

Ma'am, topamax may be the suspected culprit in bringing about the imbalance in your neurotransmitters, and in my opinion the damage it could do has already occured (with the almost permanent imbalance in your neurotransmitters), so taking some amount of topamax now will not be too risky. If it does help you for a while (even if it is for 6 months), then why not. After 6 months, if your depression does return then we can leave a gap and reinitiate the topamax, a whole new cycle may give you another 6 months of happiness.

As a well-wisher, I want to see you happy and comfortable, and I do feel this is what we have gor now, and there is no reason why you should not go ahead with it. You deserve to be happy, and if anti-depressants are not getting the job done, and cycles of topamax is, then why not?

Your well wisher,

Dr. Shoaib Khan

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Brief Answer:
Yes here is; unlikely; yes you should

Detailed Answer:
Hello once again XXXX.

You could experiment with the amino acids as they do not really carry serious side effects with them, and if at all they do help, then Hallelujah!!

But yes of course, there is a chance that they may not work as all such supplements like L-tyrosine, L-carnitine, etc; only contribute mildly. Medications like anti-depressants were made to do the job, and if they have been ineffective then there is a very small chance of the above mentioned supplements being effective. But I really want you to get out of this, so I think you should try them.

As for the anti-depressants, honestly speaking the list of medications tried by you are all I would really recommend to treat even major depression.

I too feel that Topamax should be initiated and taken, but with very careful and close monitoring. 6 months is a long period of time, although not permanent I really think you deserve this break from symptoms of depression.

I look forward to hearing only good news from you. Please do not hesitate to keep in touch ma'am.

Wishing you truck loads of luck,

Dr. Shoaib Khan.

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