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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Geezer on March 5, 2002, at 10:06:32
Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
1) Increase Dep. to 1250mg and increase Remeron to 30mg.
2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
Geezer
Posted by Ritch on March 5, 2002, at 12:35:24
In reply to Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 5, 2002, at 10:06:32
> Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
>
> This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
>
> Geezer
Hey, I would be interested in how you do on the Zonegran. But, that is just selfish curiosity. You would be the guinea pig not me. Zonegran got dangled in front of me by my pdoc about a year ago. But, I was put off by its potential for cognitive dysfunction and thought disorders (by reading the monograph on it). BUT, I think the population used included many with schizo-affective disorder, so dunno what to think. So, you can hang onto your present meds just add on the Zonegran?? I see my pdoc Thursday and we are going to have to talk about mood stabilizers-big time. I want to try something different. Maybe I will ask for a sample and check it out. I am worried about it boomeranging big-time, though. From what I understand they just make 100mg capsules (one at bedtime-then more). I am a little unstable right now and I am worried about rocking the boat too much (esp. with stressful full time-job to worry about). What do you think? Ya want me to ask for some Zonegran Thursday? I could be guinea pig I suppose. I wish anybody who is bipolar that has had experience with Zonegran would jump in here and mention something (good or bad), before I take the jump.Mitch
Posted by Ritch on March 5, 2002, at 12:38:14
In reply to Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 5, 2002, at 10:06:32
> Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
>
> This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
>
> Geezer
Geezer,What sort of thing have these pdocs told you about Zonegran, if anything? What sort of things are they trying to solve by adding it on-if you don't mind me asking? I am just trying to figure what the skinny is in their heads by offering the trial.
thanks in advance,
Mitch
Posted by Geezer on March 5, 2002, at 13:21:43
In reply to Re: Zonisamide or Modafinil-Dysphoric Hypomania?? » Geezer, posted by Ritch on March 5, 2002, at 12:35:24
> > Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> > 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> > 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> > 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
> >
> > This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
> >
> > Geezer
>
>
> Hey, I would be interested in how you do on the Zonegran. But, that is just selfish curiosity. You would be the guinea pig not me. Zonegran got dangled in front of me by my pdoc about a year ago. But, I was put off by its potential for cognitive dysfunction and thought disorders (by reading the monograph on it). BUT, I think the population used included many with schizo-affective disorder, so dunno what to think. So, you can hang onto your present meds just add on the Zonegran?? I see my pdoc Thursday and we are going to have to talk about mood stabilizers-big time. I want to try something different. Maybe I will ask for a sample and check it out. I am worried about it boomeranging big-time, though. From what I understand they just make 100mg capsules (one at bedtime-then more). I am a little unstable right now and I am worried about rocking the boat too much (esp. with stressful full time-job to worry about). What do you think? Ya want me to ask for some Zonegran Thursday? I could be guinea pig I suppose. I wish anybody who is bipolar that has had experience with Zonegran would jump in here and mention something (good or bad), before I take the jump.
>
> MitchMitch,
Thanks for the response. I guess the problem I have here is the "decision tree". Its not a problem to get the Zonegran (in fact I would get it for free as a study participant) but I would have to wait a month for my next appointment at the research center. I have an appointment with the treating pdoc on Mon. 11th; at that time I have to decide to take steps #1 or #2 above - #3 option can't come until next month. All very confusing I know (especially in my mental state) but the real issue is the possibility of mood destabilization with increased Remeron or Modafinil. In brief-do I run the risk of taking steps #1 or #2 now in hopes of relief or try to hold on until next month. I should have pointed out at the beginning the "treating pdoc" and the "research pdoc" are two different people. Any hopes they might talk to each other is probably beyond the realm of possibility.
Thanks Mitch-always appreciate your comments. If I get first-hand experience with Zonegran you will be the first to know.Geezer
Posted by TSA West on March 5, 2002, at 13:51:24
In reply to Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 5, 2002, at 10:06:32
I read somebody's post on Zonegran indicating that they took it for bipolar disorder at up to 300 mg without any side-effects. He said it didn't work for his bipolar depression though.
Posted by Geezer on March 5, 2002, at 14:07:45
In reply to Re: Zonisamide- one more question » Geezer, posted by Ritch on March 5, 2002, at 12:38:16
> > Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> > 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> > 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> > 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
> >
> > This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
> >
> > Geezer
>
>
> Geezer,
>
> What sort of thing have these pdocs told you about Zonegran, if anything? What sort of things are they trying to solve by adding it on-if you don't mind me asking? I am just trying to figure what the skinny is in their heads by offering the trial.
>
> thanks in advance,
>
> MitchHi Mitch,
Don't mind your asking at all......infact at this point I am beginning to ask the same question. The purpose, as stated, is to determine the effects the drug will have on mania and depression. Please forgive me for not giving names and places Mitch...I just can't publicly convey that information. I have been recording in a mood chart since November 1, 2001 -drugs taken daily, moods, changes, depressed, manic, dysphoric, etc.
I have been guilty of not holding drugs used at a constant level and the treating pdocs introduce new drugs that confuse the issue. I am disquaified from trial add on drugs (for the purpose of the study) for these reasons. To put it in simple terms "the left hand doesn't know what the right is doing". The last CHARGE leveled at me was "you have trouble trusting people". After 30 years of this I think its about time one of them "earned" some trust. The research pdocs have the answers but won't discuss the issues......the local pdocs should have been shoemakers.Geezer
Posted by Geezer on March 5, 2002, at 14:23:14
In reply to Zonisamide post » Geezer, posted by TSA West on March 5, 2002, at 13:51:24
> I read somebody's post on Zonegran indicating that they took it for bipolar disorder at up to 300 mg without any side-effects. He said it didn't work for his bipolar depression though.
Hi TSA West,
Thanks for the post. Its starting to look like the Zonegran might be a good "stabilizer" (understand it got plenty of use in Japan) but, as you say, I have read noting about help for depression. Possible appetite suppression may have an advantage - THAT has maintained my continuing interest.
Your input helps in making the decision.Geezer
Posted by Ritch on March 6, 2002, at 0:19:10
In reply to Re: Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 5, 2002, at 13:21:43
> > > Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> > > 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> > > 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> > > 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
> > >
> > > This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
> > >
> > > Geezer
> >
> >
> > Hey, I would be interested in how you do on the Zonegran. But, that is just selfish curiosity. You would be the guinea pig not me. Zonegran got dangled in front of me by my pdoc about a year ago. But, I was put off by its potential for cognitive dysfunction and thought disorders (by reading the monograph on it). BUT, I think the population used included many with schizo-affective disorder, so dunno what to think. So, you can hang onto your present meds just add on the Zonegran?? I see my pdoc Thursday and we are going to have to talk about mood stabilizers-big time. I want to try something different. Maybe I will ask for a sample and check it out. I am worried about it boomeranging big-time, though. From what I understand they just make 100mg capsules (one at bedtime-then more). I am a little unstable right now and I am worried about rocking the boat too much (esp. with stressful full time-job to worry about). What do you think? Ya want me to ask for some Zonegran Thursday? I could be guinea pig I suppose. I wish anybody who is bipolar that has had experience with Zonegran would jump in here and mention something (good or bad), before I take the jump.
> >
> > Mitch
>
> Mitch,
> Thanks for the response. I guess the problem I have here is the "decision tree". Its not a problem to get the Zonegran (in fact I would get it for free as a study participant) but I would have to wait a month for my next appointment at the research center. I have an appointment with the treating pdoc on Mon. 11th; at that time I have to decide to take steps #1 or #2 above - #3 option can't come until next month. All very confusing I know (especially in my mental state) but the real issue is the possibility of mood destabilization with increased Remeron or Modafinil. In brief-do I run the risk of taking steps #1 or #2 now in hopes of relief or try to hold on until next month. I should have pointed out at the beginning the "treating pdoc" and the "research pdoc" are two different people. Any hopes they might talk to each other is probably beyond the realm of possibility.
> Thanks Mitch-always appreciate your comments. If I get first-hand experience with Zonegran you will be the first to know.
>
> Geezer
Geezer,I would go with keeping *everything* the same and adding the Zonegran. I guess what I am saying is don't accept #1 or #2. That way you can be more objective with the Zonegran add-on. Don't your pdocs realize this?? Just tell him-"OK I will take the same Dep. and Rem. dosage and I will wait and try the Zonegran add-on next month". Pdocs whine about changing one thing at a time and being "scientific"-well..why can't he put his money where his mouth is??
Mitch
Posted by Ritch on March 6, 2002, at 0:30:27
In reply to Re: Zonisamide- one more question, posted by Geezer on March 5, 2002, at 14:07:45
> > > Mitch, John, and others may recall my adventure from the recent past. I am Bipolar II, was stable on 1000mg. Dep. and Remeron 15mg. (refractory TRD persists with this combo). The old pdoc (now fired) pushed the Remeron to 30mg. resulting in dysphoric hypomania (mixed-state ?). Options coming up next Tues. 11th:
> > > 1) Increase Dep. to 1250mg and increase Remeron to 30mg.
> > > 2) Increase Dep. to 1250, leave Remeron at 15mg. and add Modafinil slowly.
> > > 3) Leave Dep. at 1000mg, leave Remeron at 15mg., and add Zonisamide as part of a research study next month.
> > >
> > > This is all being done under the supervision of 2 pdocs, one a treating pdoc, the other in research and in control the Zonisamide part of the plan.
> > >
> > > Geezer
> >
> >
> > Geezer,
> >
> > What sort of thing have these pdocs told you about Zonegran, if anything? What sort of things are they trying to solve by adding it on-if you don't mind me asking? I am just trying to figure what the skinny is in their heads by offering the trial.
> >
> > thanks in advance,
> >
> > Mitch
>
> Hi Mitch,
>
> Don't mind your asking at all......infact at this point I am beginning to ask the same question. The purpose, as stated, is to determine the effects the drug will have on mania and depression. Please forgive me for not giving names and places Mitch...I just can't publicly convey that information. I have been recording in a mood chart since November 1, 2001 -drugs taken daily, moods, changes, depressed, manic, dysphoric, etc.
> I have been guilty of not holding drugs used at a constant level and the treating pdocs introduce new drugs that confuse the issue. I am disquaified from trial add on drugs (for the purpose of the study) for these reasons. To put it in simple terms "the left hand doesn't know what the right is doing". The last CHARGE leveled at me was "you have trouble trusting people". After 30 years of this I think its about time one of them "earned" some trust. The research pdocs have the answers but won't discuss the issues......the local pdocs should have been shoemakers.
>
> Geezer
I can understand them being secretive-not wanting to "spoil" the objectivity of the study by letting you in on too much. I am really NOT interested in their names or any of "their" research really. I just wondered what *they* told *you* about *why* they were wanting *you* to engage in the trial. I just wondered if they allowed *you* to pick *their* brains or not. Obviously not.I would bring up the objectivity question to them and then see what they (all) say.....
You could bug them about a conference between all of you to address *all* of these issues. Why not??hope you can fine some humour in this :-)
Mitch
Posted by Geezer on March 6, 2002, at 12:55:41
In reply to Re: Zonisamide or Modafinil-Dysphoric Hypomania?? » Geezer, posted by Ritch on March 6, 2002, at 0:19:10
Hi Mitch,
Thank you! The matter is settled - I will stay with Dep. 1000mg, Remeron 15mg. until Zonisamide can be added. Regarding your other post - not much open discussion going on I am afraid. I will keep you posted on coming events, appreciate you staying with this one.
Geezer
Posted by JohnX2 on March 6, 2002, at 18:21:10
In reply to Re: Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 6, 2002, at 12:55:41
Hi,I just locked onto this thread. Sounds like some interesting stuff
in the works. If I may ask, what kind of medicine is
Zonisamide, aside from a mood-stabilizer of sorts?
Or is this secret?Let me tell you a secret from my industry, maybe Geezer
can comment more on this or others.I'm wondering if I can draw a parallel. These are
my OPINIONS, not fact.I do high level research into novel microchip design for a major
semiconductor manufacturer, so I know what it is like to be on the "inside"
of WELL FUNDED research and I can see from the "inside" how misguided those on the
outside are (like people doing research at universities). Also from
time to time my company will allow individuals to make reports on
microchip design for pr reasons, but NEVER will the company do anything
to tip off the competition as to where our real capital and research is
sending us. This is just plain capitalism working. So after we release
a product to the market, we give out some technical specs, for marketing
mainly, but hold the rest to our chest. In the mean time after we release
the product, outsiders (non-well funded parties,press) will study
our product up the WAZOO and make little reports study our chip (kinda like
the little crud here on medicine) and I read these outsiders reports,
analysis, etc and being on the "inside" I know what is myth and
what is a joke, and where things are really going (some secret some obvious).
Sometimes I almost fall off my chair laughing at work when I read
people 2nd guessing decisions made in my industry.
Also, the brains at these well funded companies know
A LOT more about their competitors products than you may believe. I know
this because my company has gobs of money in R&D and when our product
doesn't stack up or we are planning a new product, we use our R&D technology to guess what "they" are
doing (legally, not espionage ;). The public is oblivious to all the realities
of the matter until many years later when the technology becomes outdated, loses patent, etc.So my ?feeling/hope? is that probably in the pharmaceutical/biotech industry
there are some REALLY WELL FUNDED, and REALLY SMART GUYS, who know a lot
more about where mental illness treatment is heading than any of us, and
also know better how it got here. So with that I have some hope that as patents
expire (and thank god these SSRI patents are doomed),
the capitalist system will help to innovate in these areas of
medicine in the same way good competition in the semiconductor industry
delivers little chips with 25+ million transistors on a thumb nail.I would also like to note that business with out much
competitive pressure will not always release to the public the
most advanced technology strictly for business reasons. Its always
best to try to drag out a products life span to recoup your
R&D costs. But it just takes 1 or 2 new competitors with good
ideas,products, to scare the crud out of these monoliths into
really getting their R&D into high gear (it's a miracle how quickly
innovation pops up again, strange). I've seen this happen
in my industry, I hope its happening in the biotech/pharmaceutical
industry.Thanks for any insights.
John
> Hi Mitch,
>
> Thank you! The matter is settled - I will stay with Dep. 1000mg, Remeron 15mg. until Zonisamide can be added. Regarding your other post - not much open discussion going on I am afraid. I will keep you posted on coming events, appreciate you staying with this one.
>
> Geezer
Posted by Geezer on March 6, 2002, at 21:03:37
In reply to Re: Zonisamide my perspective on research, posted by JohnX2 on March 6, 2002, at 18:21:10
Hi John,
No secret on Zonisamide (trade name Zonegran), it is under clinical trials for mood stabilization in Bipolar Disorder. It is my understanding it is FDA approved in this country for seizure control in epileptic patients. The current thinking is mood stabilization for Bipolars is the key to effective treatment. The problem comes in when the depression does not resolve with mood stability and the use of convential antidepressants, in turn, destabilizes the mood = dysphoric mania or mixed state (a dangerous situation).
Your comments on chip tech. and capatialism are well taken. I completely agree!
Geezer
Posted by Ritch on March 7, 2002, at 0:03:22
In reply to Re: Zonisamide or Modafinil-Dysphoric Hypomania??, posted by Geezer on March 6, 2002, at 12:55:41
> Hi Mitch,
>
> Thank you! The matter is settled - I will stay with Dep. 1000mg, Remeron 15mg. until Zonisamide can be added. Regarding your other post - not much open discussion going on I am afraid. I will keep you posted on coming events, appreciate you staying with this one.
>
> GeezerGeez,
Thanks for responding. I was getting a little worried that you were getting *cornered* somehow. Make sure that you are getting proper medical monitoring of any side-effects that might crop up using the Zonisamide OK? The two biggies are the cognitive stuff and the skin stuff (like Lamictal). It has a long half-life, so if things start going South it is going to take a while to get out of there. Speak up if things aren't working out, OK?
good luck (you *are* on a Mars mission of sorts),
Mitch
This is the end of the thread.
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