Wednesday, November 28, 2007

Can you Breastfeed on Lamictal?

Deciding to take Lamictal during my second and third trimester was a big decision, but at least when making the decision I could turn to the pregnancy registries to see what data existed -- and those numbers are based on hundreds of women who have taken Lamictal during their pregnancies.

Deciding to breastfeed while on Lamictal is almost as difficult of a decision except there is NO "registry" to turn to for answers. My psychiatrist requested the information about Lamicatal during lacation and the data is pretty skimpy.

Here's what they know:
1. Lamictal does pass into breast milk.
2. The effects of infants exposed to Lamictal through breastmilk is unknown.
3. The concentration in a breast-fed infant is somewhere between 16-60% of the concentration found in the mother's blood.
4. No siginficant adverse effects were reported in infants exposed to Lamictal through breastmilk.

Out of the 5 studies that have been done there have only been 41 women followed. That is not a typo the scientific data that exists is about only 41 women.

So the question is do the benefits of breastfeeding which are numerous -- outweigh the risks (which are basically unknown)?

Some doctors believe that because a baby has already been exposed while in the womb there is really no additional risk since the baby will get less Lamictal through breastmilk than she was getting while inside.

I discussed this with my OB/GYN who advice basically was do what you feel is right, my babies future pediatrician who pulled out a book and said "says here it isn't recommended" and my psychiatrist who has reviewed the current studies with me. My psychiatrist beleives that the benefits DO outweigh the risks especially since their isn't any data that shows it is bad for the baby -- just data that says it passes into breastmilk. Since my baby has been exposed to Lamictal in utero for the last 6 month I can't imagine that a little pass through in the milk is going to be anymore harmful than being exposed directly.

Here are some helpful links I found:
- Lamtical & breastfeeding message board post at Epilepsy.com
- Lamictal and breastfeeding question (towards the bottom of the page)
- Center for Women's Mental Health Blog Post on Lamictal & Breastfeeding

UPDATE: August 2011
I wanted to post a long overdue follow-up to this post. I did end up breastfeeding for 1 year while taking Lamictal. My daughter had no side effects from an exposure in breastmilk.

She is now a very healthy 3 1/2 year old who just started preschool. She has always been ahead of every developmental milestone from walking to talking to writing her name.

When we eventually have a second child, I do plan on taking Lamictal during the pregnancy and during breastfeeding.

26 comments:

Lamictal Prescription Medication said...

My name is Denise Simon and i would like to show you my personal experience with Lamictal.

I am 57 years old. Have been on Lamictal for 24 weeks now. Lamictal has worked well with no side effects other than the sleep problesm. My problems with other meds included constipation and depression. Lamictal also relieves my anger bouts...and settles me down which probably helps with seizure control.

I have experienced some of these side effects-
Following conversion from tegretol and Zonegran, I began on 400 mg Lamictal. Bad dreams followed with sleep talking and thrashing during dreams. This turned into more vivid short dreams in which I could not discern dreams from reality. I have contacted my Dr asking permission to take the meds earlier and he concurred to try them 4 hrs earlier. HE is leaning toward changing the meds. After laying out a lot of $ for a 3 month supply, I am reluctant to change meds as I am tight on $....

I hope this information will be useful to others,
Denise Simon

Rachael said...

Hi Denise,

Thanks for sharing. I know that every medication works differently for different people. For me Lamictal is a wonder drug. No side effects and it does the job better than any other medication I've been on.

Anonymous said...

I think Lamictal is a wonder drug. I have been using Lamictal for almost 12 years and I don't have any negative side effects.
I've used it primarily for depression and some sporadic manic episodes. I don't use any other medication in conjunction. If I stop taking it I plummett into a downward spiral, sometimes slowly and not always immediately but eventually I become very depressed. Within 5-10 hours I notice and have been observed by others to have an immediate positive reaction. Myself and others have claimed that it is "night and day", immediate difference. I'm worried that pregnancy will be difficult with out it. Thought I'd share.

Kel said...

I'm a mom that found out about my bipolar after my first pregnancy. I am now trying to concieve another child and I am very worried about the effects of Lamictal on a fetus. I'm confused as to whether or not it'd be best to ween off of the meds after conception or risk taking them throughout my pregnancy. Lamictal has been a wonder drug for me and the previous time I went off of it (about this time last year in order to try to concieve) I went off the deep end and had to nix my baby plans and get back on the pill. The last time I saw my Doctor, she said that I should be able to concieve while I'm taking my Lamictal. I'm just scared as to its effects on unborn children. Keeping my fingers crossed though.

Anonymous said...

Hello everyone,

I am a new Mom with a 2 month old baby, a miracle for us. I am WRACKED with indecision about breastfeeding my little one on this medication which has been a wonder drug for me.

When I got the surprise that I was pregnant, my dr. at the time wanted me off of it and switched me to Zoloft. I did my very best to stay off of the Lam. until the 2nd trimester, when I just crashed with horrible depression symptoms. My new psychiatrist (we moved) encouraged, rather urged, me to get back on the Lam, which was the only antidepress in the last 5 years that has worked for me.

At the time i was so depressed and knew that I needed to treat, so I reluctantly went back on it at 150mg daily. I did a bunch of research and tried not to worry too much about it.

My daughter so far seems perfectly healthy and thriving. Now I am faced with this horrible decision about whether to cont. breastfeeding her, which I have absolutely loved, and which I know is so much better for her than formula. My pediatrician has strongly encouraged me to cont., and the psych. basically does as well.

After 5 weeks of breastfeeding her, i decided against my every cell to stop because I could not stop worrying and feeling guilty about it. i weaned her off over a 10 period, and I anxiously watched to see what patterns of her behavior may have been affected by her exposure.

It is hard to say exactly, but since weaning her, she seems less "keyed up" during the day - like she has an easier time falling asleep during the day. I may be reading into it because Lam. affects my sleep, but my mom in law seemed to think so as well.

Since weaning her, she has had to go thru a lot of stomach pain with cow's milk formula, and has now been switched to soy. She's definetly better on the soy, but still is very gassy. Her stools from breastfeeding have gone from pristine oderless poops to a once a day green mess. It breaks my heart!

because i've been so ambivalent, I decided to pump once a day to just keep the door open should I change my mind. Surprisingly, after a week, I still have a good supply even though I am only pumping 1-2 times a day!

The other day I was holding the pill in my hand and marveling that that tiny amount of powdered stuff is keeping me from breastfeeding my baby.

I just HATE having to deal with depression - which is under control thanks to Lamictal. Why, why does it have to be excreted into breastmilk?

Any thoughts or feedback anyone? I'm so grateful for this blog and for others who have shared.

Theresa

Anonymous said...

Hello everyone,

I am a new Mom with a 2 month old baby, a miracle for us. I am WRACKED with indecision about breastfeeding my little one on this medication which has been a wonder drug for me.

When I got the surprise that I was pregnant, my dr. at the time wanted me off of it and switched me to Zoloft. I did my very best to stay off of the Lam. until the 2nd trimester, when I just crashed with horrible depression symptoms. My new psychiatrist (we moved) encouraged, rather urged, me to get back on the Lam, which was the only antidepress in the last 5 years that has worked for me.

At the time i was so depressed and knew that I needed to treat, so I reluctantly went back on it at 150mg daily. I did a bunch of research and tried not to worry too much about it.

My daughter so far seems perfectly healthy and thriving. Now I am faced with this horrible decision about whether to cont. breastfeeding her, which I have absolutely loved, and which I know is so much better for her than formula. My pediatrician has strongly encouraged me to cont., and the psych. basically does as well.

After 5 weeks of breastfeeding her, i decided against my every cell to stop because I could not stop worrying and feeling guilty about it. i weaned her off over a 10 period, and I anxiously watched to see what patterns of her behavior may have been affected by her exposure.

It is hard to say exactly, but since weaning her, she seems less "keyed up" during the day - like she has an easier time falling asleep during the day. I may be reading into it because Lam. affects my sleep, but my mom in law seemed to think so as well.

Since weaning her, she has had to go thru a lot of stomach pain with cow's milk formula, and has now been switched to soy. She's definetly better on the soy, but still is very gassy. Her stools from breastfeeding have gone from pristine oderless poops to a once a day green mess. It breaks my heart!

because i've been so ambivalent, I decided to pump once a day to just keep the door open should I change my mind. Surprisingly, after a week, I still have a good supply even though I am only pumping 1-2 times a day!

The other day I was holding the pill in my hand and marveling that that tiny amount of powdered stuff is keeping me from breastfeeding my baby.

I just HATE having to deal with depression - which is under control thanks to Lamictal. Why, why does it have to be excreted into breastmilk?

Any thoughts or feedback anyone? I'm so grateful for this blog and for others who have shared.

Theresa

Anonymous said...

Hi, I have a 7 month old baby. I was on 400mg of Lamictal for several years, and when talking about getting pregnant, my psych and i decided to lower the dose to 300mg, in hopes that if i had a mood episode i wouldn't have to increase it a lot.
So i had a health baby girl, still on the 300mg. She had no health problems, and after my psych, OB and pediatrician conferred they told me that while there's not enough data to definitively say that its harmful while breastfeeding, we know the MANY health benefits of breastfeeding.
So, I ardently wanted to breastfeed. So, I went ahead and the breastfeeding's gone very well! she's a healthy happy little girl.
i currently am struggling, so the Dr's are weighing out weather to increase my dose. We are in the process to getting the babies blood level of Lamictal to see if its safe to continue if they do increase the dose.
I hope this information may help anyone who's been told its not safe to breastfeed while on a medication. Do research, urge your Dr of your desire to breastfeed, and do what feels right to you!
And remember you need to think of formula as a drug as well.

JoAnne said...

I went off of Lamictal at 3 or 4 weeks pregnant and am currently 35 weeks. I have BiPolar II, although fairly mild, I am at huge risk for postpartum depression. When I first went off of the med, I was all over the place with my moods-- it was horrible. It's hard to say how much of that was first trimester hormones and withdrawal from the meds (I was at 250 mg a day which was working wonderfully for me), but I was only on the meds for about 5 months when I got pregnant and we upped the dosage very slowly due to the BC I was on as well...

So my psychiatrist has recommended that I go back on starting at 25mg a day for two weeks and slowly up the dose as we did when I first went on it... My OB/GYN thinks I should follow my psychiatrist's advice. I am really worried that the side effects combined with the last trimester of pregnancy will make it horrible for me-- I have to work up til the last possible minute. My younger sister and her 4year old daughter live with me. I don't know whether or not I can handle this without putting my job at risk. WE are also moving in two weeks. YIKES.

Anonymous said...

this post is very usefull thx!

Anonymous said...

Thank you very much ladies... I am 9 wks pregnant but I am only taking 100 mg a day. I tried going back to 25 mg after not taking it at all and crashing... I am now taking 50 mg twice a day... which is less than what I was taking... and it is true you really do have to weigh the benefits...

Rachael said...

I wanted to post a long overdue follow-up to this post. I did end up breastfeeding for 1 year while taking Lamictal. My daughter had no side effects from an exposure in breastmilk.

She is now a very healthy 3 1/2 year old who just started preschool. She has always been ahead of every developmental milestone from walking, to talking to writing her name.

When we eventually have a second child I do plan on taking Lamictal during the pregnancy and during breastfeeding.

Elizabeth said...

Thank you Rachel for posting your update. We are trying to get pregnant and I decided to not take my medication during the process so I could "clean my system". Big mistake!!! I moved to another country during that period and I had terrible episodes of depession. My new psychiatrist told me to get back on my medication and I feel much better. I´ve been worried whether I should continue the treatment once I get pregnant, even though my old doctor recommended I do. (I went off my medications because my old OBGYN said I should. My old psychiatrist said to keep taking them but I didn´t take her advice).

I´ve read posts about people asking for help regarding this matter but I have never seen a post actually saying "I did it and we are ok!!!"

I know every pacient is different but I feel reassured when someone finally writes a positive response to these questions.

Again thank you for your post. May God continue to bless you and your family.

Anonymous said...

I took lamictal during my pregnancy but I slowly weaned my from 300 mg to nothing over the course of my pregnancy. My daughter was born at 6 lbs and she was healthy despite a low apgar because she had the cord wrapped around her shoulder causing her to get stuck in the birth canal. She is my second child, I had not been diagnosed Bipolar II yet when I had my first child. I took absolutely nothing with my first pregnancy so I felt (and still do) really guilty for taking lamictal with my second child. On top of that the doctors around here are really conservative and did not support my decision, so I weaned, and I went through the worst case of post-partum depression that I could have imagined. I had anxiety attackes, heart palpitations, depression, exhaustion and so much FEAR, it was truly awful. Additionally I found out that I had a pregnancy realated thyroid condition, I was in bad shape and it took my body over a year to recover. There was no treatment for the thyroid condition, I just had to wait it out. I wanted so badly to breastfeed my baby that I refused to go back on the lamictal. I have been breast feeding my daughter for 20 months and she has never even had a cold. However, she is very small for her age (10th percentile)and other children her age seem to have a lot more language skills, but this may just be me looking for more things to feel guilty about because the doc says she is fine. I have not taken lamictal in 22 months and I have no plans to return to the meds at all, I wish I had not taken them at all during my pregnancy because the guilt eats me alive. I dont know if my daughter would be as small as she is or if she would have more language skills if I had not taken lamictal, I will always wonder. Especially since my first child super excelled at everything. :( I think it is important to note that I am still unsure as to whether or not I really had bipolar disorder or if I just have a really bad case of anxiety disorder. Lamictal worked great for me, I was so miserable before I started taking it and my life improved immeasurably. I would never suggest that anyone stop taking a drug that is beneficial to them. If you find yourself in the same position as me and you need some support about lamictal and breastfeeding please contact a la leche league consultant they have access to medical information that even my doctors didn't have... This really is a personal descision, best of luck to all.

Anonymous said...

Thanks for this article. I don't know how old this info is, but there is actually a new study that shows that 147 2 year olds -- 41% of which were breastfed had no negative side effects while the nursing mother was on lamictal. They are going to follow up with these children when they are 3, 4.5 and 6.

Ally said...

I wanted to share that I've been on Lamictal for 1.5 yrs (started the week I conceived - coincidentally). I had a great pregnancy and was monitored monthly for blood levels and had appts with my neuro each trimester.

I breastfed for 5 months with no issues (other than a low supply, which is why I stopped after returning to work). She's a beautiful, smart, calm and well-mannered 9 month old now.

I suggest you DO take the meds and breastfeed. Check with your doctors to make the best decision for YOU.

and I did participate in a Lamictal/AED registry, so there will be more data available soon.

Anonymous said...

Thank you everyone for everything you've written here.
I am an OB/GYN nurse who was diagnosed with bipolar II with recurrent major depression about5 years ago. I have struggled with MAJOR depressive episodes since I was a teenager. Over the last 10 years I have had success with some wonderful therapists and went through MANY trials of medication combinations- then several trials of going off of them.
My health care team and I have concluded that I am one of those people who has a true chemical imbalance and needs to be on medications.
THE BEST thing that happened to me was lamictal. I have taken it in combination with lexapro since 2008. I have a 22 month old girl- I did go OFF lamictal (but continued lexapro) during my pregnancy with her- though it was a rough pregnancy emotionally and physically. I did not start the lamictal back again until I stopped breastfeeding. The lack of studies on lamictal was the main reason I chose not to take it during pregnancy and while breastfeeding. I never felt quite my best until I started the lamictal again last fall.
Then we decided to try for another baby in January. I went off the lamictal and had a total emotional meltdown within 2 weeks. So I started it again... and got pregnant about a month later (by this time I had been such a mess that we weren't trying to get pregnant- but I didn't take any birth control). We had only been together one time so I was a bit unprepared for the possibility of it happening so fast.
OK. So off lamictal again. And here I am, about 6 weeks later, about to finish up my first trimester and I am a MESS. So totally depressed. I cannot live like this for the next 6 months and beyond...
I talked with BOTH of my OB/GYN's (who I also work for) and my therapist today. All agree that especially since I have made it through my first trimester they are all fine with me going back on my lamictal. Just having that "permission" lifts a huge weight off my shoulders.
I am not sure what I will do with the breastfeeding decision, but reading some of the posts here makes me feel much better about it. At any rate, that is a ways down the road.
As an OB/GYN nurse, I have a special place in my heart for women who struggle with depressive disorders, especially those who are ready to start having babies. I know firsthand that internal struggle of "Do I go off my meds for the baby and risk getting really sick?" or "Should I keep taking my meds and risk hurting the baby?" Depending on the med, my experience, personally and professionally, is that the benefits FAR outweigh the risks. I share my own experience with my patients so they know they are not alone in having to make this decision. And here I am, making it again...

Bipolar and Pregnant said...

I have been looking EVERYWHERE for a way to report any side effects or lack thereof of taking lamictal during pregnancy and breastfeeding so that i can help expand medical knowledge of lamictal use for future mothers, but I can't find ANY way to do so as there are no current studies being done. Do you know of any way I can contribute my experience with this drug to the medical field?

Bipolar and Pregnant said...

Any suggestions of a place where I can contribute my experience with taking this med during pregnancy and breastfeeding to the research field to help future mothers? I have looked EVERYWHERE and found no current research studies to contribute to.

Rachael said...

Hi Bipolar and Pregnant,

If you are still pregnant you can sign up for the North American Antiepileptic Drug Pregnancy Registry
http://www2.massgeneral.org/aed/index.htm

This registry covers anyone who is taking a drug that is used in the anti-convulsant category which includes Lamictal, Depakote, Topamax, Ativan, Xanax and others for any reason. You must enroll during your pregnancy - ideally before the 16th week. They are tracking birth defects, not any side effect info.

The second Lamictal registry which was done by GSK closed in 2010 as they received the number of participants that they wanted.

I don't know of any other organizations tracking Lamictal use during pregnancy. If you find one, come back and let us know.

Elizabeth Allen said...

Hey! I am 4.5 months postpartum, breastfeeding, and just started on 25 mg of Lam. My skin itches and I've noticed my daughter hasn't sleep quite as much during the last couple days, but does great at night (7 hours last night)! I have terrible anger issues at nighttime and also struggle with anxiety and fear. I'm not planning on stopping the breastfeeding until my daughter self-weens. I will post updates as to how we're doing. So far I don't feel much different on the Lam except my anxiety was slightly worse today. I do have trouble sleeping at night now, but it could be related to other things. I feel that breastfeeding even though I'm taking the medication is the best thing for me. As a breastfeeding educator I completely believe that the benefits outweigh the risks, however I do plan on monitoring my moods and my daughter's as well. I just want to be better and can't wait! I really hope this medication does wonders for me as it did you all! Thanks for posting!

leigh said...

I was on 200 mg of Lamictal throughout my entire pregnancy 4 years ago. My daughter was born beautiful & healthy with no complications. I went on to breastfeed her for 17 months. We had her Lamictal levels tested every few weeks to make sure she wasn't at risk. I understand that every pregnancy is different, but I highly recommed breastfeeding with continuous monitoring. Its well worth it!

Anonymous said...

Hi!

First of all... I wanted to thank you for this blog. I was very nervous at first about having a baby on lamictal but I believe it wouldn't be harmful after I talked to my embryologist. They agreed that it would be okay first off and now that I am reading this, I truly believe if I can still be on medication and prenant then I can do the breast-feeding.

Anonymous said...

I'm glad I came upon this post. I just came off of lithium almost a month ago. I am currently on 150mg lamotrigine daily. We want to start trying in a couple of months. I've come to the conclusion that pregnancy is ok, it's just breastfeeding that has me nervous. I talked to motherisk and there is a chance of apnea, skin rashes, and lethargy. These risks are depending on the dosage and how healthy the baby is. Is there more feedback from people who have breastfed on this med? If I can't breathed, I will be putting off getting pregnant.

Anonymous said...

Hi, I have been reading your comments, and while I am very glad that no one has had negative effects from the lamictal, i think i should share my experience with you.

I found out i was pregnant at 3 weeks. I was taking lithium and was urged to switch to lamictal asap. I was told that there were risks but they were minimal compared to the lithium so i went for it. My baby boy was born with a bilateral cleft lip, one of which goes into his cartlidge. this is one of the side effects of lamictal. Its really not that bad and can be fixed, ive been told they do really good surgeries now, but i just wanted people to know that complications ARE possible. my pediatrician wants me to stop breast feeding asap until they can ween me off and get me of zoloft, so i am mixing my breast milk with formula. I dont want to not breast feed even if its only for a couple weeks, I feel like if i took it while pregnant, then why cant i while i breast feed?

Anonymous said...

So glad I found this site. I was switched from Lamictal to Depokote while my second son was in utero, (I wasn't diagnosed with my first son)because Depokote is rated Pregnancy Category Risk D & Lamictal is rated Pregnancy Category Risk C, this means that Depokote is less harmful to the baby in utero than Lamictal. So, I tried to continue Deopokote while nursing. It worked for over a year. I noticed the medication wasn't working the way it had when I first started and my doctor was telling me how terribly bad it was for my liver because of my dose & size. I'm 5 foot 0 and 100 lbs with quarters in my pockets. lol Anyway, my son is now 14 months and I have been working on weening now for a couple weeks. He still nurses some, but it's not I'm his primary source of food anymore. This is how I have rationalized that it is alright to start taking Lamictal while still nursing because the Depokote had stoped working. All that being said, I'm very glad to have found this site and read all your very personal experiences. It makes me feel better about my making the decission to start the Lamictal while still nursing. Thanks to all

Rachael said...

I am so sorry to have missed the last comment. please consult a doctor about medication risks. Depakote is known to cause serious birth defects mainly with the heart. category D means it is known to cause birth defects.

lamictal is Category C. It has been shown to be associated with some birth defects, but the benefits may outweigh the risks.

depakote and lamictal pass into breast milk. careful monitoring is required.

Lamictal has less potential adverse outcomes (birth defects) than most other bipolar medications. The one of concern is cleft palate. there are ways to minimize this. Do not use during first trimester or use a low dose. Take a high dose of folic acid - up to 5grams or less of lmethylfolate.

Good luck to everyone.

Best, Rachael