Brian -
I lost some weight that I needed to lose when I first got on it (though recently, due to some extra stress in my life, I found some of it creeping back on), and it helped me quit the Pepsi habit I’d been wanting to shake for years (it has made fizzy drinks taste “off” though I know it doesn’t do that to everyone). So not all side effects are necessarily bad.
But the “Dopamax” thing has been true for me - less now than at the beginning, but I still have some occasional word finding difficulty, mainly with regard to words I use infrequently. If I did public speaking or acting for a living, this could be a real deal breaker. I find I don’t think as fast as I used to in general, but if I get fired up about something (a real interesting discussion or something I feel strongly about) I think I’m just about as sharp as I was before.
Other side effects in the beginning were constipation (but I’m prone to that - it just made my tendency worse), tingling in my fingertips and sometimes my lips (I hardly ever get that now), and ghostly visual trails that only happened in the morning when I first woke up when the light was kind of dim.
The big problems came when I told my doc that I had stopped having the daily wobbliness, major dizzy spells, and tunnel vision auras - all good news - but was having some breakthrough mild episodes of dizziness and some mild to moderate headaches; he suggested I work my way up from the previous target of 100 mg to 200 mg. Not only did my husband think I was mentally more dull (I know I was worse, but he thinks I was WAY worse) - I could no longer have orgasms at 200 mg. I am willing to deal with breakthrough mild episodes of dizziness and some headaches! I’m now at 150 mg - didn’t have to go all the way back down to 100 to fix the main problem. I will say that at 200 mg I had fabulous symptom control, but I wasn’t willing to pay that price. I have pretty darn good symptom control now.
By the way - I don’t know if the awareness of heartbeat is in any way related to tinnitus, but I also had some strange percussive thumping episodes that also went away with Topamax; these were much more pronounced than the subtle tinnitus I have still (kind of like a distant power line buzz/whine sound). These episodes were short, loud, and in one ear only; they even started slow and increased in speed (really bizarre), and it felt more like a spasm in my eardrum and not at all like a pulse. I thought they might be a kind of tinnitus, but maybe they were a kind of aura.
As with all things, we weigh the costs and benefits. I was having such severe dizzy spells with tunnel vision auras that I was afraid I might have to give up driving, so trying Topamax even with all its possible side effects was a no-brainer for me.