Weight mitigation and tolerability of adjunctive topiramate in acute pediatric psychiatry: a retrospective real-world analysis.

BACKGROUND/OBJECTIVE: Psychotropic medications are often associated with significant and rapid weight gain in pediatric populations, especially second-generation antipsychotics and mood stabilizers. This was a retrospective study assessing weight gain, and tolerability of adjunctive topiramate in hospitalized child and adolescent psychiatric patients. METHODS: A total of 285 inpatients were included in the study: an intervention group (n = 45) receiving adjunctive topiramate and a control group (n = 240) receiving standard care. Net weight, polypharmacy burden (chlorpromazine [CPZ] equivalent doses and other mood stabilizers) and psychiatric recovery (Global Assessment of Functioning [GAF] and Clinical Global Impression-Severity [CGI-S] scores) were measured. Hierarchical ANCOVA models were employed to disentangle the independent metabolic effects of topiramate from the confounding effects of polypharmacy. RESULTS: The mean weight gain in the control group was significantly greater than in the topiramate group (3.3 kg vs -0.1 kg, p < 0.001). This protective metabolic effect persisted with high statistical significance even after controlling for the concurrent CPZ equivalent dose (3.1 kg advantage). Clinical recovery, measured by equivalent improvement in GAF scores and reduction in CGI-S scores, was similar for both groups. CONCLUSIONS: Adjunctive topiramate is a highly effective and safe metabolic shield in acute pediatric inpatient settings. It reduces the risk of psychotropic weight gain and can substantially reduce the need for obesogenic polypharmacy, without impeding the course of psychiatric recovery.