Topamax - The Price of Loss

Over the last seven days, I've been involved in a deeply personal experiment. I've been taking Topamax, an anti-seizure medication, in order to take advantage of two of its well-known side effects: appetite suppression and weight loss.

On this site and in personal conversations with friends, I've stressed the very positive dimensions of this experience. Today, at the end of Week One, it's time to be equally frank about the downside to taking Topamax ... and to be brutally honest about why, just seven days into the experiment, I'm cancelling the experiment and coming off the drug.

Progress: My Weight Loss
At the end of one week on Topamax, I've lost six pounds. This weight loss required no effort whatsoever. Apart from intentionally drinking ten glasses of water per day, I did not alter my routine. Some of this weight loss was water loss -- Topamax dehydrates you aggressively, even when you're drinking water like a fish. Most of it came about because, while on Topamax, I lost all interest in food.

The First Four Days
My first four days on Topamax amazed me. I've written in detail about the shock of finding myself in a world where food and hunger were simply not factors in life. Other side effects, mostly pleasant, were also apparent within four days of taking the drug:

- I was mellow. Make that melloooooooooow. No highs, no lows -- nothing bothered me. I experienced the world at arm's length, through a kind of muted objectivity that was completely unlike my usual approach to life.

- I was focused. Normally, I have about twenty-seven things going on in my head at once. Right now, as I'm writing this, I'm thinking about an over-due proposal, a letter I need to write for a new client, a movie I want to see, the number of calories in a treat I might eat later on, whether I can squeeze in a viewing of Farscape this afternoon, and the plot line for a novel about a series of real and threatening events in my hometown. On Topamax, my head was silent. I thought about whatever was in front of me -- and nothing else.

- I lost all compulsions. As it turned out, Topamax didn't just curb my appetite for food ... it also curbed my appetites in general. That movie I'd been longing to see? Now I could take it or leave it. That Tarot deck I couldn't wait to buy? Suddenly, owning it meant absolutely nothing. That book I'd been dying to read? It could wait.

Hmmm. Weight loss. Mellow moods. Mental focus. No inclination to spend money. Sounds like paradise, right?

Trouble in Paradise
Though I wouldn't vocalize it until Day Five, I knew by Day Three that I was in trouble. Here's why:

- I didn't feel like myself. While on Topamax, I had the growing impression that I was an impostor -- someone brought in to play the part of Mark. I looked like Mark. I sounded like Mark. I knew a set of responses, of general rules, that made it possible for me to simulate Mark. But inside, I wasn't Mark. The things that gave Mark joy left me unimpressed. The things that irritated Mark didn't matter to me. In the end, my passions define me -- and without passion, I felt alien, unstructured, lost.

- I lost all interest in sex. In the giddy joy over my loss of interest in food, this one took some time to sink in. In fact, during my first day on the drug, a friend asked about this ... and I honestly replied, "I don't see any difference there." Four days later, though, I was shocked to realize I hadn't had a single sexual thought -- not even the slightest twitch -- in more than ninety-six hours.

No fleeting fantasy. No daydream. No appreciative glances at passing strangers. Nothing. Realizing this, I tried to muster up sexual energy by calling up a favorite fantasy or two ... and discovered, with something like horror, that I couldn't even maintain interest long enough to keep a fantasy in mind. As it turned out, Topamax curbed all my appetites -- and did so with such sly effectiveness, I didn't even notice my sexual passion was gone until four days after the fact.

- Morbid thoughts. This is the most difficult thing to write about, so I'll be brief and frank. While on Topamax, on Day Five, I began to think of myself as dead. The image of an animated corpse came to mind: passionless, slack-jawed, kept in motion by chemical magic. I fancied that I ate what little I ate in order to maintain the illusion of life -- to trick the living people around me into believing that I was still alive.

Worse than this: the idea of being dead didn't bother me. It was not upsetting or disturbing in the least ... because, while on Topamax, nothing was.

The Food Court Scene
For me, the breaking point came at Lenox Square Mall, in the Food Court.

Having had only bites of breakfast, I waited too long -- past 3:00 -- for lunch. I still wasn't hungry (on Topamax, I believe I could have starved to death without getting hungry), but I was faint and weak ... so Clyde and I made a beeline for the closest, fastest food option.

We ate in relative silence. While I was on Topamax, silence became more and more a part of our routine. Clyde's quiet anyway; normally, I'm chattering away. On Topamax, though, I would sit quietly in my seat, mellow and focused on the task at hand: trying to be interested in food.

Without warning, I burst into tears. My face contorted with the effort of concealing the emotion, but the force of the feeling was strong enough to break through. "I don't feel like myself!" I exclaimed. "I"m not myself! And I like being me. I want to be me! I don't want to live like this!"

As quickly as it came, it passed. I found myself sitting in a body with tears on its cheeks, but with little more than an intellectual awareness of why those tears were there.

"I don't know what prompted that," I said. My voice was level, unnaturally calm. "I don't know where that came from." I went back on auto-pilot, lifting a forkful of bad Japanese stir-fry to my mouth and chewing it without joy.

In retrospect, I think I do know where that message came from: I think the part of me I lost -- the part of me I love, the part of me that makes me who I am, managed to get one last, desperate message through the Topamax barrier.

Trapped in a nightmare, I was trying to wake myself up.