Q. . I am a 23 year old male that was diagnosed with BPD a little over a year ago by the psych department of the University of Alabama at Birmingham. This condition is very frustrating and even more frustrating is finding anyone who even knows what it is. I was being treated at one point with a form of Lithium called "Lithobid".....it caused horrible weight gain....so I discontinued use and the weight has come off.

I am interested in the Prozac and Topamax combination....I am aware that the most successful dosage of the Prozac is 80mg daily. What is Topamax and what is the recommended dosage for this application. Also, will this combo cause weight gain? I am very afraid of the weight gain because it causes intense psychological grief.

  A. Topamax is an antiepileptic medication (antiseizure) like Depakote, Lamictal, Neurontin, and Tegretol. All of these agents are either approved or have shown efficacy in mania or borderlines.

Topamax causes no weight gain and sometimes weight loss in a number of people, and it is the only one that does this of the above group. Prozac tends to cause a modest weight loss at the beginning, and mild weight loss as time goes on (6-10 months after starting) in some, but not all patients.

If you can get by with only one medication, Topamax or Prozac, it would be preferable to using both.