Q:  Zonegran As a Mood Stabilizer?

I Have recently started introducing Zonegran into my Med regime...which currently consissta of 3600mg neurontin and 4 mg Xanax.  The idea being to help the fadiding effects of the Neurontin. I am starting w/ 300mg Zonegran for 7 days then up to 600mgs; at the sane time phasing out the neuronti little by little.  What are your thoughts on Zonegran as a mood stabilizer, and this treatment plan?

Thanx,
Todd
 

Dear Todd -- 
Well, it could be that you've got a terrible version of bipolar disorder and you've already had all the mood stabilizer medications that have solid evidence for their effectiveness, and lots of experience regarding their risks.  There are at least 5 such medications (here's my working list).  

And it could be that you've had all the possible combinations of two of those 5 medications, which comes to 4 + 3 + 2 + 1 = 10 more "trials" of medications.  And it might even be that you've had at least one go at some combination of 3 different mood stabilizers from that list (e.g. the most standard such combination would be the highest doses you can tolerate of lithium, plus valproate, plus carbamazepine.  

Notice that neither Neurontin nor Xanax is on that list of mood stabilizers.  So I think it's also possible that rather than having arrived at this current pair of medications after the above 16 attempts, that instead you've got a doc' who doesn't go by the usual "algorithm" approach to bipolar disorder (e.g. the Texas Medical Algorithm Project, that you'll see linked from that page of mood stabilizers above).  Instead it seems more likely to me that your doc' is using a different logic to select your medications.  

You should ask her or him what that logic is.  If you get a clear answer, great.  If you're not clear, after that answer, why you're using a different map than the one mood experts generally agree on (e.g. TMAP, or the APA bipolar treatment guidelines, which are nearly identical -- both outlined on that page I linked), then you might gently wonder if getting on the standard map mightn't be a good idea (here are some thoughts on talking with doctors about things like this).  

Your doc' could have a solid reason for your current regimen (e.g. you also have a seizure disorder, and have taken all the anticonvulsant medications on the list and then some).  But you should understand that reasoning; in which case you probably wouldn't be asking your question?  

The few times I've used Zonegran I started with a lower dose and my patients still had pretty bad nausea.  I hope you don't have that already.  Some people have had some pretty good results according to blurbs I read in non-journals (where opinions get thrown around but no formal reports are being made).  Here's the rest of what I've heard so far about zonisamide. 

Dr. Phelps
 

Published May, 2004