Thursday, February 11, 2010

Safety of Polytherapy Anti-convulsants (mood stabilizers) During Pregnancy

The North American Antiepileptic Drug Pregnancy Registry is pleased to announce findings on the comparative safety of some combinations of anticonvulsant drugs. We have previously published our findings regarding phenobarbital, carbamazepine, valproate and lamotrigine taken alone as monotherapy. Since we have analyzed the rate of malformations in infants for each of these specific drugs when taken alone, we wanted to investigate the effect they might have on the prevalence of major malformations when taken in combination.

A common perception in prescribing anticonvulsant drugs during pregnancy is that the combination of two or more drugs harbors a greater risk of major malformations.

Read the full study on drug therapy during pregnancy

7 comments:

Anonymous said...

Hi Rachel - Can you point us in the right direction? My daughter who has Bipolar I & is on Abilify 30 mg. every day. She just found out she is pregnant - between 3 - 5 weeks & has stopped taking Abilify. I see the info re: tegretol & lamictal have the least amount of fetal "malformations" but this study refers only to pregnant women with seizures - is this something to consider for bipolar disorder? Any info you can refer us to would be greatly appreciated. Thanks - mom-mom

Rachael said...

Hi mom-mom,

Thanks for writing.

The Anti-epileptical Pregnancy Registry covers women taking anticonvulsants for any reason including: epilepsy, bipolar disorder, migraines, etc.

I was a participant in the AED registry.

The majority of mood stabilizers are either anticonvulsants or antipscyhotic medications.

VisionsForSam said...

Thank you for your time in writing this blog. I just stumbled upon it by chance today. This past week I was diagnosed with bipolar disorder. The doc prescribed lithium, but I know I cannot take that while breastfeeding. I know this post is about pregnancy, but do you know which med(s) would be best during breastfeeding? I know they all potentially pass into the breast milk - but what has the least potential risk? Any ideas? I'm not ready to wean him yet, but I do know I need help. Thanks in advance!

Anonymous said...

Hi Rachel- I just wanted to contact you and share a little bit of my story. I am a mother of two and I am 26 weeks pregnant with my third baby. I had my other two children before I was officially diagnosed with Bipolar type 2 ...I was told I had Severe Depressive Disorder.Anyways long story short is I am taking 400 mg of Seroquel and 20mg of Celexa along with a low dose of Adderall. The Seroquel has worked wonderfully for me and my OB/GYN says my benefits outweigh the risks. Still I am so very nervous about how this baby is going to turn out although everything is looking perfect so far. I cant find much in the way of research about my meds and the effects on the baby and I was curious if you knew of any resourses that could help me out. To add to the mix I also have had a gastric bypass so I guess you could say I am going against the grain in having another baby but I know I am strong and I have a great support system. Lately I have been experienceing some manic symptoms and I am struggling with them bc I dont want to adjust any of my meds right now...I am also worried because I have to stop all meds two weeks before I deliver..which I think is a good idea but it worries me. Anyways thanks for your time. Anything you can add would be helpful.
Thanks alot- Amanda in Louisiana

TamTam said...

I started taking Lamictal 6 months ago for my Bipolar NOS. Lamictal is the only psychiatric medication that I'm on. It has worked miracles for me without any side effects!

My husband and I plan on getting pregnant within a year. I discussed this with my Psychiatrist. He told me that there have been rare cases in pregnancies when the woman was on Lamictal during the first trimester, which resulted in the baby being born with cleft palate.

He said the risk is very minimal, but in my case he wouldn't want to me to risk that since my depression/manics haven't proven to be too extreme. He said that after the first trimester I should be fine to go back on Lamictal if I needed to. He said that I might be fine and not need to take it. He explained to me that in his experience with patients with mood disorders often stabalize significantly while pregnant. He said it's a mystery as to why, since "normal" women experience severe mood swings while pregnant. He thinks it's our bodies/minds way (in the form of hormones and brain chemistry)of protecting ourselves and our fetus from the stress of the extreme moods that we normally experience. I have to say that I witnessed this in action with my sister, who is Bipolar II. She was very even keel during her pregnancy, and not on any meds.

This is just the information/advice that my Psychiatrist gave me. Every Dr. has different knowledge/experience, and every patient has different chemical make-up and different degrees and types of bipolar/mood disorders. I plan to also discuss this with my OB GYN to get another opinion.

Anonymous said...

I'm very thrilled you took the time and wrote that..

Rachael said...

VisionofSam,

Sorry for the delay. I missed your post. I know this doesn't help you. But it might help someone else reading this.

I was on Lamictal while breastfeeding. My doctors thought the benefits of breastfeeding outweighed any risks.


Here is an article about antidepressants:
http://www.kellymom.com/health/meds/antidepressants-hale10-02.html

I couldn't find anything on mood stabilizers.

I recommend the book by Dr Hale Mother's Milk and Medications