So For All You Heavy Drinkers That May Be Addicted And Want To Quit…? Get Yourself Some Topamax!


Oh.My.God. I just about had a Simple Partial Seizure when I read this, for which I do take this med (among other things…)

I don’t even know where to start. It must be my week (or a few days?) to get hit with a Big Pharma blast as yes (of course?) they were involved in this. Not to mention some rather overzealous researchers? Or ill informed ones? Granted, I am not a scientist, nor a M.D., nor a statistician…nor…nor…nor…

However.

Take a look at this article: Pill Helps Alcoholics Taper Off Drinking. Now, I usually link to msn.com as I think their links stay live but I’m not sure. I haven’t gone back and checked them from older posts and no one has told me that they ended up in error or you need to pay for subscriber services, archives or anything. Nonetheless, forgive me AP for drawing attention to some highlights. That maybe a naughty in the reproduction department but I did link to the original which is fine. And no one is making money from me so sue me for the “parts” I reproduce. I’m just a wee mental case blogger with an opinion. Not many people read me anyway?

But I really need to talk about this.

First off in this very tiny blurb about Topamax/Topiramate and it being used as a treatment for alcoholism, they refer to it as a “migraine med.” Okay, perhaps I am being picky but Topamax is primarily used to treat seizures. It is an Anticonvulsant.  For migraines, it is used in prophylaxis. It is not the same as an abortive. So skipping ahead, when people read this, will they say in the same vein with preventing alcoholism, “Gee, doc’…my migraines are killing me. Can I pop some Topamax when they get bad?” Then the doctors, neuros etc… have a bloody flip out as they can’t deal with uneducated patients asking for crap they know nothing about. Think of all the adverts you see on television now for this drug and that drug…

“Talk to your doctor if this is the right drug for you!” Again…thank you Big Pharma. I have read posts on doctors’ blogs who absolutely hate these ads!

Alright, time for some excerpts for those of you who have not clicked on the above link. And I will apologize here. This is going to be a long post.

Now, before I get into the AP stuff, there is a link there that will take you to the study published in JAMA (The Journal of the American Medical Association.) At the moment, the study is free to read but it will probably disappear in a week. Yes. If you are not a subscriber, you will have to wait six months to read it! And again, that is if the link on msn.com survives! So you’ll just have to take my amateurish word re: the JAMA stuff.

Okay, let’s have some fun! From the AP blurb on msn.com:

Experts said the drug is likely to appeal to heavy drinkers who would rather seek help from their own doctors, rather than enter a rehab clinic to dry out.

No fucking kidding! Rehab’s a drag! Let’s just pop a pill–even if it doesn’t work!

Addiction specialists not involved in the study said the findings are promising, although side effects such as trouble concentrating, tingling and itching caused about one in five people to drop out of the study.

I’ll tackle this when I get to JAMA. But I had the first two with Topamax and they went away with time. I still have trouble concentrating but that’s more to do with the ADD.

The study, published in Wednesday’s Journal of the American Medical Association, was funded by the maker of the drug, Johnson & Johnson Inc.’s Ortho-McNeil Neurologics. The researchers also reported financial ties to the company. Ortho-McNeil reviewed the manuscript, but did not change the results or interpretation, the researchers reported.

Well, good bloody god, I hope not!

“You can come in drinking a bottle of scotch a day and get treatment without detox,” said Dr. Bankole Johnson of the University of Virginia, who led the study, which was conducted at 17 U.S. sites from 2004-2006.

Bankole’s so positive you know. Despite that fact, I think he might have been just about the only one not mentioned on the Financial Disclosure of the JAMA study? However he was involved in The Lancet’s prior dalliance with this where the JAMA study got their “magic number” (as I call it) dosage of Topamax for this engagement. Again, why the hell people dropped out?

The study didn’t follow the drinkers long-term, so it’s unclear how many relapsed after they stopped taking the pill.

This is actually accurate reporting. The JAMA study states this. So, erm…who the hell knows? Addiction is addiction. Or, having problems with drinking, is simply that. People fall off the wagon all the time! How do you know if your study works if you don’t track your outcomes over time? Especially with something as tenuous as this?

But there were lasting effects for Tom Wolfe, 44, a carpenter from Earlysville, Va., who said he has been sober for two years thanks to Topamax. After years of heavy drinking, he took part in an earlier Topamax study. He felt “a little lightheaded” at first until he got used to the drug. Alcohol lost its enjoyment, strengthening his resolve to quit.

“It’s been a miracle to me,” Wolfe said. “It got the monkey off my back.”

Ah, nothing like a good testimonial to drive it home, right kids?

The drug works by inhibiting dopamine, the brain’s “feel-good” neurotransmitters that are involved in all addictions, said Stephen Dewey, a neuroscientist the Brookhaven National Laboratory, who was not involved in the study but does similar research.

It’s a new approach, he said, that “clearly did work on a very small subset in the population.”

Okay, Dewey. Were you misquoted here? Fair enough it does theoretically inhibit dopamine but lets not forget about GABA and glutamate? They are also possible neurotransmitters that are involved? It’s not just about knocking out pleasure seeking. Remember, this is primarily an Anticonvulsant and dopamine is not necessarily thought to be involved in causing seizures. Otherwise, we could throw people with epilepsy and seizure disorders on a bunch of Antipsychotics! Granted they generally hit the D2 receptors…theoretically.  Regardless…there is more to Topamax than dopamine.

As a matter of fact, if I may go on my typical little speech about Topamax, it is a Temporal Lobe drug. It hits your Temporal Lobe hard. That is why it is considered “hit or miss” for people with Bipolar. For seizures, it’s a little more interesting as they seem to know a bit more about them–possibly. Dependent upon what type of seizures you may be having, a better Anticonvulsant might work for you (i.e. there are usually preferred ones for absence seizures etc… or at least ones to try first.) And, you may even get lucky with a physiological issue during an MRI scan (well, usually that may not be so “lucky…”) or something might be caught on an EEG to help you along. For migraine prophylaxis, who the hell knows as even less is understood about them!

As for Dewey’s latter statement, broad and sweeping and of no relevance, thank you.

Willenbring, who wrote an accompanying editorial, predicts that a future pill, although probably not Topamax, will do for alcohol dependence what Prozac did for depression: Remove the stigma.

Prozac changed the nature of depression treatment 20 years ago by allowing patients to see their family doctors for help, Willenbring said. An effective drug with few side effects could do the same for alcoholism treatment, he said.

Oh.My.God (Part II) Who the hell is this guy?! Just exactly what did Prozac do to remove the stigma of Depression or mental illness? When has any drug done that? A lot of times, when uninformed people hear you’re on meds they can get totally freaked out! And when Prozac came out, it was one of the most overprescribed drugs on the market! And an “effective drug with few side effects.” Ohhhh…I’d like to see just one pharmaceutical company produce one of those–for anything!

And yes, here’s his finest moment:

“This is a huge market,” Willenbring said. “We’re approaching a Prozac moment.”

Ironically, on msn.com this was somehow posted under the url of http://news.moneycentral.msn.com.(etc…) That’s just too hilarious. Or not.

Okay, this is kind of weird:

But Topamax has big obstacles. With the drug maker’s patent expiring next year, there won’t be any big push to advertise it for alcoholism, Willenbring said.

Maybe I’m not up on my FDA patents but the Canadian patent expired a while ago and I have to take the generic due to my drug plan’s stipulations. Ah well…at this point, I’m too tired to bother looking it up and you still have to deal with me going through the JAMA article!

On Tuesday, Dr. Sidney Wolfe, director of Public Citizen’s health research group, sent a protest letter to the U.S. Food and Drug Administration questioning the promotion of Topamax for alcoholics by researchers funded by Ortho-McNeil.

“This is a very bad message to send out,” Wolfe said.

Well, Hallelujah! At least someone’s paying attention besides wee PA!

Are you all still with me or falling asleep yet? Alright, I’ll try to keep the JAMA stuff brief.

Alright, so JAMA at least touched upon a bit of the glutamate stuff so that’s decent. And again, they proposed the study as a hypothesis (hello?) so it wasn’t so ridiculously posed as the media spun it.

Okay, they ran the dosage up to 300mg of Topamax (my “magic number,” right?) According to the JAMA study (from what I can gather from a notation) this was derived from a 2003 study that was published in The Lancet. Recall, happy Bankole Johnson? He was in on that one.

Now if you can jump on the JAMA study before it disappears and look at the titration schedule, well ‘geez, it’s no wonder some of the people went a little loopy and started bolting before it was completed! I mean, wow, they were titrating everyone 25mg every week! What happened to the rule of a slow and steady titration! When I looked a the chart I was just…

*PA shakes head*

I’m trying to recall my titration and if it was that fast and I don’t think it was. I’m pretty sure I went up 25mg every two weeks? Or maybe I didn’t. Maybe I did initially do 25mg a week with Dr. Asshole my ex-GP and then slowed it down? Either way…woo! I was pretty out there. And I’m on 200mg now. Good enough for me doing triple duty: Bipolar, Seizures and Migraines (although I ended up needing an adjunct for seizures–well, for Bipolar too.) Regardless, everyone is different but that is my point. Slap, bang! Let’s just ramp everyone up to 300mg!

Understood, I get that you need to have some sort of gauge in your study but also, when I looked at the table as well to show the adverse effects of Topamax participants vs. placebo…interesting variance in some cases? Certainly more than what you might see on something more generic like rxlist.com? Wasn’t anyone paying attention to prior research? At least they admitted in their limitations that their titration rates were too high. Well, duh.

Other limitations that they excluded were a significantly(?) large population of people that might have addiction problems? Yes, indeed…they called their population “…relatively healthier and more homogenous…” Okay, so how do the rest of the sickos and those with comorbidities work out? Not so well?

And yes…no follow up, period. But they were quite happy with their study results nonetheless and concluded as such:

Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings.

Please…please…no.

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  1. You know…I’m so tempted to spam this but I just can’t. I got the Pingback immediately after I posted! It’s the power of the RSS! Like “Auto RSS!” Like, some kind of crazy “Scoop And Plop RSS!”

    I’ve certainly never found myself there before but perhaps it’s only because I’ve simply talked about my own personal boozing prior to this major spewage. Maybe this is more up “they’re” alley.

    But is there a “they?” Or again, are we just talking feed to feed?

    On their “About” page they invite you to comment to tell them if you think your post doesn’t belong there.

    Bizarre. Ah who cares?

    I’m going to bed. Completely knackered.

    Like

  2. Apparently they’re called “Sploggers”… spam bloggers. I just read the term myself a few days ago:

    http://www.tamba2.org.uk/T2/2007/10/09/nicholas-weinberg-of-kalamazoo-michigan/

    http://www.tamba2.org.uk/T2/2007/10/10/what-to-do/

    Basically they suck content from Real Blogs… or Reloggers I guess, and post it on their Splogs surrounded by Google Ads and the like. Then they use your content to sell shit without giving you your cut.

    I think Mark, the dude who runs tamba2, is getting ready to make a big deal about it so I gave him the address of your splogger.

    It’s a great post, by the way. I love the “approaching Prozac moment” quote.

    Like

  3. tracy

    Hummmmmm….Topamax…Red Wine….Topamax….Red Wine….(visiting mil likes the cheap Sangria, so, hey, I’ll go with that…everything else she likes is expensive…!). Well, ummmm, i am “taking” them both these days, ughhhh, can’t remember the Topamax dose, i t h i n k it’s 100 mg 2x/day. So, where is all this leading…? Not sure, except to say, thanks so much, wee PA, for an excellent article and 2 1/2 “medium” size glasses of the stuff still get me ahhhh, relaxed, whatever that means…

    be goood to PA, tracy

    Like

  4. tracy

    Ahhhhhhhh,
    “Doctor Fuking Patient”….what the..??????? My dear PA, you can be absolutely certian that whoever that is, it’s not moi!!!!! Certianly I have had the odd fantasy or 12, but that’s as far as it has gotten or as far as i would let anything get, i assure you. Actually, my fantasies run more like what actually happened the other day when my sweet, cute, yes, young, understanding Internest gave me a hug…awwwwwww…..The current resident i am seeing for therapy (ahhhh, today actually, oh no, i’m not nervous….not me…), is a real “touch me not ” type, still calls me “Mrs”, gotta get past that one, I feel old enough already…! So, any way, where were we…..nope, it’s not i…!

    take care little bunny one, tracy

    Like

  5. tracy

    Oh dera, that last post sounded kind of mean, didn’t it…i’m sorry. and as for “snail mail”, i just thought it might be fun to write “real letters” once in a while, if you and/or anyone else were interested, you know with funny cards or whatever (i like to use funky stationary and am a big sticker fan…will i e v e r grow up…? i doubt it…). Anyhow, that is all that was about. A-kay, i have taken up enough space for now,

    BIG LOVE, tracy

    Like

  6. Hi Gabriel…, thanks for sending it to Mark. We’ll see what happens and if can do anything?

    When I clicked on the IP, I was redirected to an Apache/cPanel, “you-might-as-well-be-talking-another-language-to-PA” page. I also tried what you mentioned to me before and nothing happened! I even tried my own from work and nada. Wha…? And ARIN/WHOIS isn’t working here (at work) and keeps timing out with every person’s IP that I’m trying so, oh, to hell with it!

    I guess this is the second that I’ve gotten now? Interesting to hear that you get “splogged” so much. But you know, I’ll tell you, return revenue from those Google ads isn’t that high–especially from a shitty ass site like that where no one is going to visit or pay much attention. I mean, the click through rates will be so low. At least, this I know.

    I should spam/delete the comment above so no one will go there! But you’ve got a link to it via Mark’s site above so well…who gives a shit.

    BUT IF ANYONE GOES THERE, DO NOT CLICK ON THE GOOGLE ADS!!! YOU WILL BE SUPPORTING A PIECE OF “FUCKMEAT!”*

    I’m glad you liked my post as well. Yes, “the Prozac moment.”

    * “Fuckmeat” – copyright Gabriel…

    I wouldn’t want to be wrapped on the knuckles for that you know–hell, didn’t I do enough of it in my post *laughing*

    Hi tracy, I’m glad you liked this post as well. I can attest to your situation, too. Topamax hasn’t done a thing to curb my drinking habits. Unfortunately, it’s just up to us, kiddo.

    Oh, tracy…I’ve had some great search terms. I should have a peek and see what’s come up lately. I haven’t really been paying attention. My all time best was, “how does a woman masturbate with a gourd”

    I kid you not. And of course I blogged about that one when I did up a “latest list” sort of post. I mean, I searched my blog and I might have said “out of my gourd” or something but I never wrote masturbate in a post. Never. Oh well… We had some fun in the comments with that one–well, a bit anyway.

    Interesting your Internist gave you a hug. Most professionals actually like to maintain personal boundaries for sure! Huh. I’m not sure what to say about that.

    I’ve never received a hug or anything from any “professional.” Although I did presumably misinterpret some minor physical contact from “Attractive Rec. Therapist” from my Outpatient Program this spring. I flirted with her all the time. I gave her my number for dinner once I was done and she said she would call me but hasn’t–and won’t? No.

    Can you believe it! What a tease! I’m just kidding…maybe she was playing along so mental PA didn’t end up going back inpatient if Attractive Rec. Therapist turned her down and I completely fell apart. Please. Like I haven’t been rejected by a woman before…like a bajillion times? Well, not that many as I’m hardly Ms. Superwoman in the Love Department.

    Your last post didn’t sound mean. Huh?

    Snail mail. Sure, it’s fun. Nice to receive something other than useless crap or bills. Although I can really suck at it. I used to be very good, very diligent when I was younger. Letters to family, pen pals and things but now?

    Well…perhaps I could try? I’m not quite sure…again, I may suck and you might be waiting a long while for me to get back to you!

    Like

  7. Topomax. Sigh. Point of contention for me. Just wrote a thing on it over at my bloggy. I titrate up very slowly (oh wait, i’m stuck at 80mg/day. not much of a titration!). Had S/E similar to toxicity at 100 mg/day. Would like to try and hit that dose again though. I think at one time or another I was at a much higher dose – 200 maybe? Don’t remember anymore. So what else is new, right?

    Like

  8. Hi Rach, I don’t know that much about the toxicity of Topamax. I could look further but I haven’t read anything up to this point where I’ve seen people getting ill from taking it in a significant population, if at all.

    I should look at your post? As far as what I’ve read and researched, there really isn’t really much of a biological toxicity issue. Just mostly hard hitting cognitive side effects, weight loss, orthostatic hypotension, taste perversion, tingling in the limbs and extremities…I think those are the major ones?

    That is not say that you might not have a sensitivity to the med. Sure, anything is possible.

    The “worst” is Lamictal/Lamotrigine…everyone has a big freak out about “The Rash” and SJS but in terms of the stats, it’s not that bad. It’s actually quite rare to get to the point of “dying” from that Anticonvulsant. Or getting SJS…that’s the biggie…

    Sorry, I’m being all acronym. If you or anyone else didn’t or doesn’t know, SJS is Stevens-Johnson Syndrome. It’s, again, really rare. Funnily enough, on Wiki’s page it lists Tegretol/Carbamapazepine as a possible Anticonvulsant where you might have a reaction! Now I have never seen that one before… Maybe I’m a bit lax on me reading…

    Interjection: I will say that most Anticonvulsants make you clumsy and stoopid. No, they do. It’s just the way they work. The side effects can dull over time and they have with me somewhat but I still have my “moments.” Shit, I have so many bruises on me I can’t even count them! And crap! Thank god for having online resources to look up words for definitions and to spell! Or if not at a computer–better have that Dictionary or Thesaurus nearby!

    Granted, all writers probably do that. But writers on Anticonvulsants just take more time… *rolls eyes*

    As far as you and Topamax? Well, hmmm. You said you got up to 200mg, right? How did that suit you? Did it seem to help? Remember, I said it was a Temporal Lobe drug and it’s “hit or miss” in Biopolar. It’s a real toughie.

    Another thing that it is fabulous for is Ultradian Cycling and that is me! If you don’t know what this is all about, go to Wiki and look it up. It basically means that you can cycle FAST! Days, Weeks, Hours… Yes. I ended up that way. And Topamax IS the drug for that.

    Email me if you would like and tell me about your hx, your meds that you’ve been on, your current cocktail and I’d be happy to talk…always.

    Like

  9. Well now, this seems to be my Pingback Post doesn’t it?

    I had a look at the above site and it’s a bit interesting. Yes, there are Google ads so it could it be another “Splogger?” I’m not sure. The name is “The Rejected,” not the first part–that’s the title of the post. Sorry, that might be obvious. And yes, by the date indicated they are done weekly.

    Within these posts, there are links to some popular med blogs. He doesn’t have a lot of commenters but of the ones that he has that I could link to and read their blogs, they also link to some rather prominent and popular med blogs. So, the commenters are authentic and “real” people. Some of their blogs I’d actually like to read and even have a look at a few items in their blogrolls.

    I’m not quite sure who this person is or may be–or from where he hails. I am also not sure of what he does. He speaks of attending medical school. Maybe the title of his blog reflects the fact that he didn’t make through medical school? I haven’t read the whole thing through. Or maybe he just feels…well, rejected!

    He offers his email address freely and a name but it could be a pseudonym *laughing* And at the bottom of his blog he states a copyright message. That would be kind of ironic if he’s a Splogger that’s poaching from other people?

    His blog states that it is is a WordPress blog but here’s a kicker? In checking the IP, I was directed to bluehost, a web hosting provider. But in delving a bit further, he’s with wordpress.org and it does offer bluehost as a hosting service–or suggests it. And easy to block an IP address?

    He’s also got all of these widgets for “social bookmarking” and linkety linkety stuff and with that kind of thing, you may need to do coding? I’m not sure…getting way out of my league and I don’t know exactly what they all are. Maybe you just plop them into the template of your post. Regardless, you can’t get into that sort of stuff with the free blogs here at wordpress.com Unless, perhaps if you paid for the upgrade and started monkeying around with the CSS.

    Boy, this detective work is kind of fun even though I don’t really know exactly what I’m taking about!

    So, I’m not really sure what else I can say. If this is a Splogger, the person sure seems to be putting a lot of effort into it? It’s not like that other piece of dung that first hit me with the Pingback. And he stated that we were all either in the industry or want to get into the industry. Well, considering my moniker, I guess I fall into the latter but it would be great if I was considered “in the industry.” What an ego boost!

    So, let’s see if I get any other Pingbacks for this one?

    Like

  10. Shawn

    just a little note…
    my doc put me on topamax for my Bi 2. he also wanted it to slow down my drinking and smoking. within 6 months i am smoking double what i was and now drinking at least double what i was. i finally stopped taking it yesterday after everyone telling me what the hell happened to me. the only thing good about this drug is weight loss. that’s it!

    Like

  11. Hi Shawn, nice to meet you and welcome to my blog. I can’t remember if you’ve been here before but if so…welcome back.

    Interesting to hear about your smoking and drinking increase. I have not come across that as any kind of side effect of the drug. Do you think it might have been due to the Bipolar and the fact that the Topamax wasn’t working for you? Sometimes (a lot of times!) we loonies tend to self-medicate for so many reasons. And for some, those reasons can increase if we’re not stable.

    That is not to say that it couldn’t happen. I’ve just never really heard of it before.

    Topamax is a tricky one as it’s a temporal lobe drug. That being said, it can be hit or miss. It can help you if that is where some problems exist or…?…zilch? And also due to its zeroing in on that part of your brain as opposed to spreading out everywhere, most people need adjuncts.

    I was on it as monotherapy for several years until my last wing out in the spring. Then we added Lamictal which I really like.

    It was the same situation with my seizures. I first tried Tegretol/Carbamazepine and nope (ditto with my Bipolar–didn’t help so much–but it was more evident with the seizure control.) I have to take an adjunct for the seizures with the Topamax.

    And yes, I lost weight too.

    Meds are funny. They’re different. Our heads are all different. It’s just hopefully finding the right ones that will work for us.

    Take care,
    PA

    Like

  12. Right now it looks like Movable Type is the top blogging platform out there right now.

    (from what I’ve read) Is that what you are using on your blog?

    Like

  13. Howdy very nice website!! Man .. Beautiful .
    . Amazing .. I’ll bookmark your website and take the feeds additionally? I’m
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    Like

  14. Hi sunshine. Good to see you and if you’re not the person I think you are, welcome to my blog if you’re here for the first time.

    I’m not sure about MT. Well, I have heard of it! I’m just not familiar of the workings of it. If it has anything to do with coding, forget it! I’m all about the content! Even if it’s crap like this blog.

    However, I can offer up design and layout tips for someone who wants something made. As if someone has something completely unnavigable with a million drop downs for the same thing everywhere and just signing on will blind everybody’s eyes. *laughing*

    Thanks for your suggestion, though. I’ll take a look.

    Take care,
    PA

    Like

  15. Hi carsracingcars. I’m not sure if you are Sp&m or an actual reader. I rarely edit what a commenter has to say on my blog as this is a free and open space. However, I do not believe you pose a threat, as I protect my readers and commenters as well.

    Due to possible Sp&m, I also delete any blog information from the commenter’s name. You might see that if you come back. It actually works well both ways as you may receive Sp&m from me.

    If you are an actual reader, thank you so much for your compliments. They do mean a lot. If you continue to reading, I hope you like what you find.

    Take care,
    PA

    Like

  1. 1 Alcohol Rehab » Blog Archive » So For All You Heavy Drinkers That May Be Addicted And Want To ...

    […] Find the link to this great post here […]

    Like

  2. 2 Best Medical Blogs - Week Ending October 12, 2007 | The Rejected | Where Real Life Meets Medicine

    […] Topamax Patient Anonymous […]

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