I started Topamax 3 weeks ago and gradually worked up to a dose of 25 mg in the AM and 50mg at bedtime. After one week at this dose I have to start decreasing the dose again due to undesirable side effects. I expected the tiredness, stomach pains (which subsided eventually), diarrhea, numbness in hands & fits( the doctor said that if this happened I should eat a banana for the potassium)...but I wasn't expecting the slowed physical response time and "diminished mental capacity" to be as extreme as they were. It's a good thing that I was on a leave of absence from work because I wouldn't have been safe to be at work or drive to work for that matter. It was quite disconcerting. It was so bad, I laughingly said that I should pin a note to my shirt that said "If I am lost, please return to......." ;-). I am now back to 50mg at bedtime and although am still tired through the day at least I'm not walking around in a drug induced fog. I would like to try this dose to see if it controls my migraines....the residual side effects may be worth it....we'll see??