Continuing to Treat Bipolar Disorder During Pregnancy is Vital to Avoid Postpartum Relapse
Restoring life to “normal” after having a baby is always challenging, but more so if you are at greater risk for postpartum illness. For women who have taken lamotrigine for bipolar disorder before becoming pregnant, it is natural that they are concerned about not only their own health, but that of their child.
Continuing to treat bipolar disorder when women become pregnant is vital since there is a risk of postpartum relapse if medication is stopped. In rare instances, women can experience episodes of postpartum psychosis, a psychiatric emergency that can have dire consequences for them and their newborn babies.
Lamotrigine instead of Lithium During Pregnancy
One major reason for ongoing lamotrigine research is to determine whether it can be as effective as lithium in managing bipolar disorder during pregnancy. Lithium is an effective tool for controlling bipolar disorder, but it has a number of potential side effects. Typically, medication doses need to be increased during pregnancy to maintain their effect, so medications with fewer adverse side effects relative to how well they treat a disorder are preferred. Lamotrigine has been approved for use in the US since 1994, and is used for a broad spectrum of seizure types. Many antiepileptic medications are also utilized in the treatment of psychiatric illness. Lamictal also has comparatively few significant drug interactions.
Recent research published by a team led by Richard Wesseloo studied a small sample of pregnant women being treated for bipolar disorder (Wesseloo, Richard, et al. “Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: A population-based cohort study.” Journal of Affective Disorders 218 (2017): 394-397.) Some of the women took lithium during their pregnancy, while others took lamotrigine. The study measured the incidence of psychiatric admissions in a period that spanned three months postpartum.
The study results noted that there was no overall difference in the incidence of postpartum admissions between women taking lithium or lamotrigine. The study also indicated that lamotrigine causes little or no risk for fetal deformations (oral cleft) or developmental delays in newborn infants. Another potential advantage is that while breastfeeding is not advised for mothers taking lithium, lamotrigine does not appear to impart any adverse effects to infants from mothers who breastfeed.
More Research on Lamotrigine and Neurodevelopment
A 2017 NEAD (neurodevelopmental effects of antiepileptic drugs) study by Meador, et. al. followed children for a period of six years after birth whose mothers took lamotrigine during pregnancy. The findings of the study indicated that there was not a correlation between taking lamotrigine and any neurodevelopmental delay in the children. Other studies, including Newport et. al. (Newport, D. Jeffrey, et al. “Lamotrigine in bipolar disorder: efficacy during pregnancy.” Bipolar disorders 10.3 (2008): 432-436) have demonstrated the efficacy of taking Lamotrigine during pregnancy for controlling the risk of bipolar episodes. Recent research appears to confirm that lamotrigine may be an effective alternative to lithium for some women with bipolar disorder during their pregnancies.
As is the case with any therapy, it is essential to speak to a Psychiatrist about your specific risks and treatment protocols. For general information, please feel free to email our office at Amanda.Itzkoff@gmail.com. To schedule an appointment, call our offices at 917-609-4990.