Efficacy and Tolerability of Topiramate in Treatment of Bipolar Mania and Alcohol Use in Adolescents and Young Adults

Inclusion Criteria: 1. Ages 12-25 years; 2. DSM-IV-TR83 criteria for bipolar disorder, type I, manic or mixed episode; 3. Young Mania Rating Scale (YMRS)86-88 score of \> 16 at screening and baseline visits; 4. DSM-IV-TR83 criteria for current alcohol abuse or dependence; 5. Drinking \>8 drinks in 30 days within the previous 6 months while meeting DSM-IV criteria for alcohol abuse or dependence. One standard drink is defined as 0.35 liters of beer, 0.15 liters of wine, or 0.04 liters of 80-proof liquor; 6. Fluent in English; 7. Provision of written informed consent/assent; 8) If female and of child bearing potential, agrees to use one of the following method of birth control: complete abstinence, barrier (diaphragm or condom), or oral contraceptive containing \> 35 micrograms of ethinyl estradiol (because concomitant use of topiramate and lower estrogen oral contraceptives may lead to contraceptive failure). Exclusion Criteria: 1. Manic symptoms resulting from acute medical illness or acute intoxication or withdrawal from drugs or alcohol as determined by medical evaluation and rapid symptom resolution; 2. Clinically significant alcohol or drug withdrawal symptoms that have the potential to cause serious consequences as determined by vital signs, the CIWA-Ar,84 and medical evaluation; 3. Any unstable medical illness or laboratory abnormalities \> 3 times upper limits of normal; 4. A documented history of mental retardation or an IQ total score \< 70 as determined by the Wechsler Abbreviated Scale of Intelligence (WASI),154 administered by a trained psychometrician; 5. Any substance use other than alcohol, nicotine, or cannabis during the 30 days prior to study participation; 6. A positive urine pregnancy test or lactating; 7. History of nephrolithiasis. 8. Treatment with concurrent mood stabilizers, antipsychotics or antidepressants; 9. Treatment with antipsychotics or other mood stabilizers within 72 hours and antidepressants within 5 days prior to randomization; 10. Treatment with fluoxetine within one month; 11. A history of non-response or hypersensitivity to quetiapine or topiramate; 12. Serious suicidal ideation (\> 3 on the CDRS-R89 suicide item, or any serious suicide attempt within the prior 60 days as judged by the investigator; 3=has thoughts about suicide or hurting themselves usually when angry); 13. Treatment for substance use during 30 days prior to screening (excluding peer support groups); 14. Court-ordered to substance use treatment; 15. Acute intoxication; 16. History of a medication change during the prior 30 days that may have precipitated manic symptoms; 17. History of a partial response (any improvement) to any existing medications as reported by treating clinician, subjects or legal guardian.