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in our mood disorders clinic are seen in regular intervals for long-term maintenance of their illness (some have attended for over 7 years now). As part of the service that we provide, patients have regular blood tests, reviews of medication and checks of weight, usually at intervals of 3 or 4 months. Topiramate was given to some obese patients as part of our normal clinical practice, rather than as an experimental intervention (therefore we sought no Ethics committee approval). We decided to publish our results only after the patients had taken topiramate for a considerable time, because we felt that we should share our experience with other health professionals, as the results looked so clear. The only difference to treatment as usual was that we checked the weight of these patients on a more regular basis than we would have normally done. All 12 patients included in this report had a pre-topiramate BMI of \u003e30 kg/m2, i.e. they were all obese according to the National Heart, Lung and Blood Institute guidelines [36]. According to the British National Formulary guidelines [37], an anti-obesity drug should be considered only for those with a BMI of 30 or greater (page 207), and we felt that this recommendation should be followed in the case of Topiramate, even if this drug is not licenced for this use. The mean BMI of patients at the start was 37.95 kg/m2, SD = 5.66 and the mean weight was 104.38 kg, SD = 21.46 kg. The patients had the following diagnoses: Bipolar Affective Disorder type I (BPI) = 5, BPII = 4 and Unipolar Depression (UD) = 3. Four of them were rapid cyclers. Two of the three unipolar patients had co-morbid epilepsy and the third one reached a BMI of nearly 45 (extreme obesity). We felt that it was justified to give her this medication on general health grounds, although benefits from topiramate on unipolar depression had not been demonstrated before. Our clinic treats chronic and treatment resistant patients, and 9 of the 12 patients could be described as treatment resistant or incomplete responders, who had either frequent relapses of mood disorder (more than 2 per year), or remained chronically depressed (i.e. had not reached criteria for remission for a period of at least several weeks over the previous two years) despite adequate treatment. One more overweight patient was prescribed topiramate. He did not like its effect and stopped treatment after one month. He is therefore not included in any analysis."}

{"project":"NEUROSES","denotations":[{"id":"T1190","span":{"begin":2361,"end":2371},"obj":"CHEBI_63631"},{"id":"T1191","span":{"begin":380,"end":386},"obj":"PATO_0000461"},{"id":"T1192","span":{"begin":600,"end":604},"obj":"PATO_0001309"},{"id":"T1193","span":{"begin":2228,"end":2234},"obj":"PATO_0001309"},{"id":"T1194","span":{"begin":600,"end":604},"obj":"PATO_0000165"},{"id":"T1195","span":{"begin":716,"end":721},"obj":"PATO_0000964"},{"id":"T1196","span":{"begin":1128,"end":1132},"obj":"CHEBI_23888"},{"id":"T1197","span":{"begin":1305,"end":1309},"obj":"CHEBI_23888"},{"id":"T1198","span":{"begin":1722,"end":1729},"obj":"PATO_0000390"},{"id":"T1199","span":{"begin":1934,"end":1941},"obj":"PATO_0001863"},{"id":"T1200","span":{"begin":1934,"end":1941},"obj":"PATO_0000498"},{"id":"T1201","span":{"begin":1956,"end":1965},"obj":"PATO_0000513"},{"id":"T1202","span":{"begin":2033,"end":2042},"obj":"PATO_0000513"},{"id":"T1203","span":{"begin":1956,"end":1965},"obj":"PATO_0001178"},{"id":"T1204","span":{"begin":2033,"end":2042},"obj":"PATO_0001178"},{"id":"T1205","span":{"begin":2046,"end":2056},"obj":"PATO_0000297"},{"id":"T1206","span":{"begin":2084,"end":2092},"obj":"PATO_0000380"},{"id":"T1207","span":{"begin":2298,"end":2306},"obj":"PATO_0001627"},{"id":"T1208","span":{"begin":2376,"end":2379},"obj":"CHEBI_52027"},{"id":"T1209","span":{"begin":1564,"end":1574},"obj":"PM3425"},{"id":"T1210","span":{"begin":1871,"end":1881},"obj":"PM3425"},{"id":"T1211","span":{"begin":1564,"end":1574},"obj":"PM3425"},{"id":"T1212","span":{"begin":1871,"end":1881},"obj":"PM3425"},{"id":"T1181","span":{"begin":81,"end":85},"obj":"PATO_0000573"},{"id":"T1182","span":{"begin":274,"end":280},"obj":"PATO_0000128"},{"id":"T1183","span":{"begin":789,"end":795},"obj":"PATO_0000128"},{"id":"T1184","span":{"begin":1418,"end":1424},"obj":"PATO_0000128"},{"id":"T1185","span":{"begin":321,"end":331},"obj":"CHEBI_63631"},{"id":"T1186","span":{"begin":570,"end":580},"obj":"CHEBI_63631"},{"id":"T1187","span":{"begin":922,"end":932},"obj":"CHEBI_63631"},{"id":"T1188","span":{"begin":1280,"end":1290},"obj":"CHEBI_63631"},{"id":"T1189","span":{"begin":1848,"end":1858},"obj":"CHEBI_63631"}],"text":"Patients\nPatients in our mood disorders clinic are seen in regular intervals for long-term maintenance of their illness (some have attended for over 7 years now). As part of the service that we provide, patients have regular blood tests, reviews of medication and checks of weight, usually at intervals of 3 or 4 months. Topiramate was given to some obese patients as part of our normal clinical practice, rather than as an experimental intervention (therefore we sought no Ethics committee approval). We decided to publish our results only after the patients had taken topiramate for a considerable time, because we felt that we should share our experience with other health professionals, as the results looked so clear. The only difference to treatment as usual was that we checked the weight of these patients on a more regular basis than we would have normally done. All 12 patients included in this report had a pre-topiramate BMI of \u003e30 kg/m2, i.e. they were all obese according to the National Heart, Lung and Blood Institute guidelines [36]. According to the British National Formulary guidelines [37], an anti-obesity drug should be considered only for those with a BMI of 30 or greater (page 207), and we felt that this recommendation should be followed in the case of Topiramate, even if this drug is not licenced for this use. The mean BMI of patients at the start was 37.95 kg/m2, SD = 5.66 and the mean weight was 104.38 kg, SD = 21.46 kg. The patients had the following diagnoses: Bipolar Affective Disorder type I (BPI) = 5, BPII = 4 and Unipolar Depression (UD) = 3. Four of them were rapid cyclers. Two of the three unipolar patients had co-morbid epilepsy and the third one reached a BMI of nearly 45 (extreme obesity). We felt that it was justified to give her this medication on general health grounds, although benefits from topiramate on unipolar depression had not been demonstrated before. Our clinic treats chronic and treatment resistant patients, and 9 of the 12 patients could be described as treatment resistant or incomplete responders, who had either frequent relapses of mood disorder (more than 2 per year), or remained chronically depressed (i.e. had not reached criteria for remission for a period of at least several weeks over the previous two years) despite adequate treatment. One more overweight patient was prescribed topiramate. He did not like its effect and stopped treatment after one month. He is therefore not included in any analysis."}