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Zonegran For Weight Loss And Depression


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#1 crazyinct

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Posted 27 September 2008 - 08:08 PM

I have been considering topamax for weight loss for a while. I asked my pdoc and she said I could try it but in her experience it makes people stupid, etc. I have since been researching zonegran. It looks pretty good. Can cause cognitive side effects but only at high doses. Most people who rated the drug on revolutionhealth.com (the new remedyfind) and a couple of other sites didn't complain of any cognitive side effects at all. I only want to go to maybe 200mg at night. I also have a little bit of depression right now and have read that it's good for that. Anyone tried it for either indication? What were your results?
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#2 dymphna

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Posted 28 September 2008 - 12:51 AM

I have been considering topamax for weight loss for a while. I asked my pdoc and she said I could try it but in her experience it makes people stupid, etc. I have since been researching zonegran. It looks pretty good. Can cause cognitive side effects but only at high doses. Most people who rated the drug on revolutionhealth.com (the new remedyfind) and a couple of other sites didn't complain of any cognitive side effects at all. I only want to go to maybe 200mg at night. I also have a little bit of depression right now and have read that it's good for that. Anyone tried it for either indication? What were your results?


My god, you're serious.

You're actually considering one of the most powerful drugs in the pharmacopea for weight loss.

From the Crazy Meds Main Page:

Zonegran (zonisamide). The only person we know taking this drug is an eight-year old girl who is taking it for epilepsy. It's been brutal on her cognitive functions and she's not gaining weight as expected, but it works as far as the seizures are concerned. So, like Topamax, it's another supermodel drug that will make you stupid and skinny[1].

Supposedly like Lamictal it is good for bipolar depression. It hits pretty much every neurotransmitter there is in attempting to achieve neural homeostasis. This is the latest anticonvulsant out of Japan, and I'd bet folding money it was developed in response to all those kids seizing while watching the one episode of Pokemon we'll never see in this country. Zonegran has a spectacularly high rate of SUDEP, 7 out of 991. Normally anyone taking an anticonvulsant for bipolar should not be concerned with SUDEP unless you have a history of tonic-clonic (grand mal) seizures, especially flopping around in the middle of the night.

Given Zonegran's heavy hit on cognitive functions, high rate of SUDEP, and relative novelty as a mood stabilizer, you're far better off exhausting all the other usual options before turning to this one. Yeah, Zonegran is better than the typical antipsychotics, Mysoline, Felbatol or relying solely upon benzodiazepines for mood stabilization. So if you're taking Zonegran for bipolar, you stand a small but significant chance of it failing on you with a spectacularly nasty rebound effect.

Zonegran has multiple mechanisms of action, including blocking sodium channels, reducing voltage-dependent, transient inward T-type calcium channels, increasing GABA release, blocking potassium evoked glutamate-mediated synaptic excitation, and weakly inhibiting carbonic annhydrase. It is in the sulfa family of drugs and therefore should not be used by patients allergic to sulfa drugs. Freakiest rare side effects: fecal incontinence and facial paralysis.



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#3 Serpens

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Posted 28 September 2008 - 02:33 AM

Concuring with Dymphna. All indication puts the Zonegran cognitive impact at substantially greater than our dear old friend dopamax. This is NOT a simple, easygoing med. This drug hits a half dozen anti-seizure MoAs, a couple side systems, and I believe that it hits carbonic anhydrase several times harder than any other seizure med out there. It hits cognitive functions like the angry fist of god.

This med has been around in Japan since the late 80s. Clinical trials for approval in the US got canned after there was a rash of SJS in people taking it in Japan (yes. The Lamictal Rash). Systemic review of the use of the drug in Japan revealed that it was majorly unlikely to do this, there was just a blip in the numbers due to the drug's small circle of use in Japan. Well, here we are almost a decade later with US approval. Still, this has never been a widely used med, and as seizure meds go it's an 800 pound gorilla wearing clown makup which may or may not have the ability to spontaneously combust after it's snuck under your bed at night in its full body neoprene stealth suit.

There's a whole lot of research focused on this med now because it does so many novel and bizarre things, but because it does so many strange confusing things, we have to be rather careful with it.

Also, keep in mind that weight loss with these drugs will get you at the absolute most an extra 5% BMI decrease between 32 weeks and 1 year, combined with a supervised diet at a minimum of 500 Kcal/d deficient and an exercise program. That's not a lot.

It may come out that this med is safe for this. Maybe. But it's only been tried in tiny studies so far. There's one study for weight loss in bipolar (PMID 17628595) that, while tiny, had almost 3/4ths of their participants drop out of the study, half because of weird psych screwups from Zonegran. This med may be safe, effective, tolerable and all that, but the current data does not imply that it is acceptable for this use, and unless we get some data from bigger trials.. well..

There's a bunch of work being done on this drug right now, more than I've seen on any drug I've looked into recently. This includes several phase II grade (~600 participant) for Zonegran/Zonegran+Wellbutrin just for obesity. Not for the crazy folks. Most are presently in progress. I'm certainly hopeful. Psychmed weight gain sucks and we don't have a lot to combat it.
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#4 bunnyrabbit

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Posted 28 September 2008 - 09:36 AM

My doctor wanted to put me on Zonegran to stop Zyprexa related weight gain. I refused because Topamax sprinkle was unbearable, there would be no way I could tolerate Zonegran. I can tell you there is a study that is recurting people for Zonegran and Zyprexa.

Here is the link--> http://clinicaltrial...036...e"&rank=2


After reading the replies above, it makes me want to try it even less. There are other options for weight loss.
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#5 In_Remission_crowly19

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Posted 28 September 2008 - 02:46 PM

Hi I'm on Zonegran. I feel pretty good with it, it brought me out of my "shell". The only side effect I had was memory problems, but I take ginko baloba and have not had anymore problems with that. I'm on 100mg in the morning and 200mg at night. I wouldn't recommend taking it just for weight loss though.

#6 StrungOutOnLife

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Posted 29 September 2008 - 07:13 AM

I think you should wait around for these guys to develop something based on that. Something that doesn't make you forget your own name when you have something important to sign.
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#7 Anna

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Posted 29 September 2008 - 08:42 AM

I am one of those crazy folks who would consider trying Zonegran to see if it helped my bipolar depression. If only because it seems to be a bit lamictal-ish in some ways. I don't care about the weight loss.

But, my doctor won't let me. He doesn't do the off label stuff. Fortunately, I seem to be doing pretty well on the AD/cocktail I'm on now, so it's not an issue. But, I do find those tiny studies sort of interesting....

If things ever got really terrible again and I was with a private Pdoc instead of a public program... I'd give it a whirl.

But, there's probably heaps of things to try first before going to THAT med. It's pretty harsh. I've tried pretty much every AED out there, and currently take depakote. And I'd probably still have to exhaust some things before heading to the Z.

And yeah, I gained some weight. But, you know what? I'm not gibbering on the couch. I think my family and husband prefer a slightly fatter, sane Anna than the mixed episode messed up version.

In any case, it's totally up to you and pdoc, I guess. But do be thinking about the fact that this is not a pansy med. It, uh, does stuff.

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#8 bunnyrabbit

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Posted 29 September 2008 - 02:18 PM

Thank you for the advice. I don't know why my pdoc is stuck on Zonegran. It makes me think my instincts are right about this issue.
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#9 In_Remission_vinnie

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Posted 29 September 2008 - 08:15 PM

FWIW, I was on Zonegran for approximately two years for migraine prevention. It was VERY effective but it made me the village idiot. I also got many other symptoms such as weight loss (actually appetite suppression) and kidney stones. I took doses ranging from 200 to 400mg per day to every other day (very long half-life). Side effects and effectiveness seemed unrelated to the dose.

The neurologist prescribed it because he had experience with it.

You may not have any side effects on the medication. But that also means it might not cause weight loss either....

#10 bunnyrabbit

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Posted 03 October 2008 - 04:57 PM

Dymphna, help me understand what you mean when you said it was one of the most powerful drugs. I see all the side effects, but tons of drugs have tons of side effects. I need some enlightenment about this.
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#11 dymphna

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Posted 04 October 2008 - 01:24 AM

Dymphna, help me understand what you mean when you said it was one of the most powerful drugs. I see all the side effects, but tons of drugs have tons of side effects. I need some enlightenment about this.


Zonisamide: review of its use in epilepsy therapy

Lennox-Gastaut is about as bad as you can get, and Zonegran treats it. That, in my book, counts as a powerful drug.


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#12 Serpens

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Posted 04 October 2008 - 03:18 AM

Lennox-Gastaut is about as bad as you can get, and Zonegran treats it. That, in my book, counts as a powerful drug.


Dymphna


It's also used for West syndrome. Ugly is a word that falls short there. The other treatment for West syndrome? Our dear old friend Acthar ACTH gel, $25,000 dollars a vial.
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#13 bunnyrabbit

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Posted 04 October 2008 - 05:34 AM

I think I understand a bit better. Well, I've got a trial of it to go with the Zyprexa to see if it will prevent Zyprexa induced weight gain. I got a low dose and will try it tonight. I want it to work, but I also don't tolerate anticonvulsants. I may tolerate it since it is different from existing medications. We'll see.
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#14 bunnyrabbit

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Posted 04 October 2008 - 07:32 AM

Jook, how much did you take? I do have a low dose, plus I am on Lithium and will take it with Zyprexa. Were you on Lithium or an antipsychotic at the time you took Zonegran? Makes me a bit nervous about it after reading your experience with it.

Schizophrenic behavior was listed under side effects. Does anyone know why or what exactly they are referring to?
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
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Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#15 Jerod Poore

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Posted 04 October 2008 - 10:23 AM

It's also used for West syndrome. Ugly is a word that falls short there. The other treatment for West syndrome? Our dear old friend Acthar ACTH gel, $25,000 dollars a vial.


And Sabril (vigabatrin). Which sucks less, a drug with over 50% chance of causing some sort of visual defect, all the way up to full blindness, or West syndrome?

Zonegran is considered potent because it is the most broad-spectrum anticonvulsant on the US market. Zonegran makes your brain do stuff like no other anticonvulsant on the market. Like Topamax Zonegran blocks sodium and some calcium channels, is a carbonic anhydrase inhibitor, and it decreases glutamate. The controversy is with GABA. Either it enhances GABA like every anticonvulsant, or it decreases GABA production, like the next generation of anticonvulsants. On top of all of that it enhances the release of serotonin and dopamine like some oddball version of Remeron. It might also be doing something with the potassium channels.

No wonder some people go batshit manic when taking it.

Mixing Zonegran with Zyprexa is tweaking almost everything in one's brain.



I haven't looked at Sabril's mechanism of action, as it's not yet available here other than as a mercy drug for kids with West syndrome with no other options. It's undergoing phase 3 clinical trials for short term, low-dosage applications for non-seizure-related conditions and going blind isn't all that likely. There are some head-to-head comparisons with Zonegran, so they're probably similar.
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#16 bunnyrabbit

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Posted 04 October 2008 - 11:12 AM

Do you know why they list schizophrenia behavior as a side effect? I get the mania, but they are different enough to be listed seperately.

I will try it tonght with a lower dose of Geodon. I take that now for fibromyalgia and not for any antipsychotic effect. It seems like a bad idea to mix the SNRI effect of Geodon with Zonegran. If Zonegran could help fibromyalgia and stall weight gain from Zyprexa, I'd be able to stop Geodon. Truth be told, the Geodon might be adding to my current mixed, psychotic state. But I like not being in constant pain.

Update tommorrow on Zonegran. It is the lowest dose.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
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#17 sorrel

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Posted 04 October 2008 - 11:23 AM

I will try it tonght with a lower dose of Geodon. I take that now for fibromyalgia and not for any antipsychotic effect.



Geodon helps fibromyalgia? I thought you said you took it to induce akathisia for the appetite suppressing effect.
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#18 bunnyrabbit

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Posted 04 October 2008 - 11:52 AM

I did start the Geodon with the Seroquel to help with appetite increase through akethesia. Seriendipidously, I discovered it helped my fibromyalgia. The SNRI effect is more pronounced at lower doses. My pdoc said it was the SNRI effect that is helping. I am allergic to Lyrica. I can't take Elavil, Effexor or Cymbalta because they induce dysphoric, psychotic manias and rapid cycling like a yo-yo. So, I thanked my lucky stars that I can kinda take something that greatly releaves my suffering.
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#19 bunnyrabbit

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Posted 04 October 2008 - 12:38 PM

When I tried Geodon as an antipsychotic last Winter, I got my first episode of akethesia after 3 days. I am lucky I finally realized what it was and had some Ativan left over from a PRN 6 mths previously. I recall thinking at the time it was such a shame because Geodon was an appetite suppressor. 2 months later, I tried it again with Ativan. My visual stuff and mood got worse from taking both drugs and I abadoned Geodon for an antipsychotic.

When I started Seroquel again, I got wilderbeast hunger. My pdoc wasn't completely against me trying a very small dose of Geodon to induce a little akethesia to control the antipsychotic induced rageful appetite.

I'm not getting the full blown take-me-to-hospital-b/c-bad-things-will-happen type of akethesia with 10mg of Geodon. It's liveable without needing Ativan. When I tried the Zyprexa, my itty, bitty Geodon was no match for that hunger. So hopefully the Zonegran will match the Zyprexa. I don't need to loose weight, but I do need to avoid gaining weight.
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Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#20 dymphna

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Posted 05 October 2008 - 02:02 AM

Bunnyrabbit,

You do not appear to be describing symptoms of akathesia, you seem to be describing symptoms of hypomania.


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#21 bunnyrabbit

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Posted 05 October 2008 - 05:56 AM

If you are talking about currently, perhaps. My pdoc is in no doubt that I have akethesia with low normal doses of Geodon, Abilify, and all conventionals. The flavor of akethesia is different with each drug.

Yes, my therapist and p-doc both know all the reasons I take Geodon. I had an 80lb weight gain with Lithobid, Mellaril and Tofrinil. I am very capable of putting on enourmous amounts of weight with psychotropics. My father has diabetes and heart disease. Weight gain is nothing to mess around with, and if I find something that prevents weight gain and helps me take medications that help me, they really don't care.

Geodon, I felt this level of anxiety I have never felt before (which is something when I can have many panic attacks per day). I couldn't generate that kind of anxiety for a million dollars. It got so bad, I was propelled to move constantly to help it. It was so bad I would have killed myself on the spot if I had available means. Akethesia is most certainly a medical emergency. I would not stay still long enough to go into a car. That's when I realized it was Akethesia. It could be treated with cogentin, ativan or a beta blocker. Since I was taking cogentin at the time, I took ativan. That produced rapid relief and adverted a hospitalization.

I took the Zonegran last night. I was very ambivelant about it, but took it anyway. I had a bunch of freaky experiences that come with taking some anticonvulsants. Zonegran isn't something that could help my fibromyalgia, in fact it makes it worse. It appears that I might actually tolerate the drug phsically, which would be a miracle. I can see how it could help appetite.

Bad part...Jook's description of taking Zonegran seems very plausible for me at higher doses or even continuation at this dose. It reminds me of Zoloft. My visual stuff is worse, which may defeat the reason for taking the Zyprexa. I haven't decided if what I am going to do with the Zonegran.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
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Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#22 bunnyrabbit

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Posted 05 October 2008 - 08:19 AM

No, Welbutrin is used for Bipolar depression. I've been on that and Provigil for years for bipolar depression, fatigue and ADD-type problems that occur after years of bipolarness. It's all about dosages. A little is good, more is bad. Bad things happen when those medications are altered. Lithium and Zyprexa Zydis are very Bipolar I. You really can't get more Bipolar I.

I've refined my view about Zonegran. It's like Lamictal+Tegretol+Zoloft. My appetite with Zyprexa and Zonegran is normal. It looks like I might physically tolerate the Zonegran. It's just 25mg, but it's enough to relieve my constant hunger torture from Zyprexa. I might have found a miracle pill. Without it, I would not be able to stay on Zyprexa. I really need my Zyprexa.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
Dosages are the daily total. Most meds are taken in smaller doses throughout the day.

Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#23 bunnyrabbit

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Posted 05 October 2008 - 10:46 AM

Jook, I totally know what you're saying now about the anxiety/keyed-upness of Zonegran. I feel like I'm having 5 panic attacks at once. I was so excited this morning when it started to feel Lamictal-ish. I felt like I was able to think clearly, and I haven't done that since taking Lamictal for about 1 1/2 years in 2003. It was a camelot period for me I would welcome back at any time.

I think I'll try the Zonegran again without the Welbutrin and see if that helps.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
Dosages are the daily total. Most meds are taken in smaller doses throughout the day.

Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#24 bunnyrabbit

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Posted 06 October 2008 - 08:32 AM

Okay. I flipped out yesterday. I had to move my lithium up just to calm me down. LiCo3 did bring me back to earth.

I'm a bit sensitive to all kinds of stimuli, and the visual stuff is through the roof. I will have to sort it out later when I have better capacities.

My pdoc is out of town and won't be back next week. She has someone covering, but I find them usless for detail problems than gross, emergent problems.

I think I've hit mania though. I've been laughing and smiling all morning at work. I can't stop and everything is amazingly funny.

Zonegran is most likely BAD idea for people in Bipolar I-land.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
Dosages are the daily total. Most meds are taken in smaller doses throughout the day.

Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#25 In_Remission_Dixie60

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Posted 18 December 2008 - 09:18 AM

I have been taking zonagran for over a year for depresion to treat BPII. It is really the only thing that has worked for me but it makes me sooo nervous. leg shaking up and down all day long and have to take klonapin just to get to sleep.
My pdoc now wants me to go off the zonagran due to the nervousnes and I am scared to go off of it as this is the first time i am not depressed. This is a new pdoc and I think she is not thinking to clearly. She wants to sub it for tegretol and take me off my geodon as well all at once.

#26 bunnyrabbit

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Posted 20 December 2008 - 10:16 AM

I have been taking zonagran for over a year for depresion to treat BPII. It is really the only thing that has worked for me but it makes me sooo nervous. leg shaking up and down all day long and have to take klonapin just to get to sleep.
My pdoc now wants me to go off the zonagran due to the nervousnes and I am scared to go off of it as this is the first time i am not depressed. This is a new pdoc and I think she is not thinking to clearly. She wants to sub it for tegretol and take me off my geodon as well all at once.


Tegretol is used to treat bipolar disorder, though the evidence isn't as robust for depression. There is no evidence that zonagran works for bipolar disorder, but there exists some antadotal type evidence and is tried when other meds fail.

I thought zonagran was like tegretol+lamictal+zoloft in one pill, so the tegretol might be helpful (I loved it). Taking you off geodon and zonagran together leads me to believe that pdoc thinks they might be making you worse and it's best to get them stopped ASAP. Have you asked pdoc for the reasoning behind going off two meds at once?
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
Dosages are the daily total. Most meds are taken in smaller doses throughout the day.

Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#27 Stacia

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Posted 20 December 2008 - 11:48 AM

Okay. I flipped out yesterday. I had to move my lithium up just to calm me down. LiCo3 did bring me back to earth.

Just for the benefit of other readers, Lithium increases take days to a couple weeks to be efficacious. Bunny, I suspect what you experienced was coincidental. Also, it is a bad idea for anyone at higher serum levels to mess with dosage w/o pdoc involvement because of potential toxicity. Actually, it's a bad idea to mess with dosing on your own regardless of serum level. Lithium is great medicine but it does need to be managed with care.
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#28 Stacia

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Posted 20 December 2008 - 11:52 AM

I have been taking zonagran for over a year for depresion to treat BPII. It is really the only thing that has worked for me but it makes me sooo nervous. leg shaking up and down all day long and have to take klonapin just to get to sleep.
My pdoc now wants me to go off the zonagran due to the nervousnes and I am scared to go off of it as this is the first time i am not depressed. This is a new pdoc and I think she is not thinking to clearly. She wants to sub it for tegretol and take me off my geodon as well all at once.

Tegretol has been good to me. I am more stable than I have been since being diagnosed. My other meds play roles, but Tegretol has made a real difference.

I would be reluctant to drop both meds at the same time. That's a big adjustment and you won't be able to tell what med d/c has what effect. Maybe talk to your doc about doing one at a time.

Oh, yeah, the whole time I was on Geodon, I had withdraws (shaking) as I neared my next dose. That's not common, but it was my experience. Also, the first time I took Geodon, I was cold with shivers the whole time at lower doses.

Edited by Stacia, 20 December 2008 - 11:54 AM.

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#29 bunnyrabbit

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Posted 20 December 2008 - 12:21 PM

Okay. I flipped out yesterday. I had to move my lithium up just to calm me down. LiCo3 did bring me back to earth.

Just for the benefit of other readers, Lithium increases take days to a couple weeks to be efficacious. Bunny, I suspect what you experienced was coincidental. Also, it is a bad idea for anyone at higher serum levels to mess with dosage w/o pdoc involvement because of potential toxicity. Actually, it's a bad idea to mess with dosing on your own regardless of serum level. Lithium is great medicine but it does need to be managed with care.


I wrote that ages ago. My lithium level at that time was .4. Pdoc told me over and over that she wouldn't mind if I increased my lithium. Even with an increase, I'm at .5. While it does take a week or so to get a steady state of a new lithium level, lithium carbonate releases quickly and can spike a level for a little bit. Long enough to help me at that time.

I write this to explain that I just did NOT take more lithium just because I had a whim and against pdoc's wishes and against my health and safety.
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Current Meds: Lithium Carbonate 900mg, Geodon 85-90mg, Artane 2.75mg, Klonopin 1-1.125mg, Adderral 20mg, Provigil 100mg, Prolixin .33mg.
Dosages are the daily total. Most meds are taken in smaller doses throughout the day.

Past meds: I've tried almost everything except MAOI's, half of the TCA's, Clozaril, Remeron and Serazone.

#30 leighwest

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Posted 20 February 2010 - 01:15 PM

Definitely agree with all the above! I have been using Topamax with good weight loss results...7 lbs over two months and holding it off even over Christmas. Also great migraine med! And I was not even too stupid. However, I got the one side effect no one EVER gets from Topamax- freakin hemorroids! Bad! Never had them before and they were gone within a week of stopping the Topamax. I didn't know what was going on, and I liked the weght loss so much I thought to just keep taking it anyways...but I digress...

Pdoc put me on Zonegran...she said it was similar to Topamax...the only way it is similar in my experience is, it still causes hemorroids hahaah! Zonegran=mania from hell for bipolars. My mania has been controlled for a long time so it totally freaked me out. I cleaned an entire office space out and started a painting in half a day. :mad: All in addition to home schooling 3 kids. I felt like I had been on speed when it finally wore off.

I do not know if it's worth it. It is a seriously strong drug with many side effects, and for vanity? Rethink.

Leigh
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