Anticonvulsants and Bone Loss
Anticonvulsants are not only used for the treatment of epilepsy but are now used with increasing frequency for the treatment of mood disorders, such as bipolar disorder. Recent studies have indicated that anticonvulsants may negatively affect bone mineral density, as well as increase fracture risk. This seems to be especially common with the older anticonvulsants (e.g., phenobarbital, carbamazepine, phenytoin, and valproate); however, the data regarding lamotrigine and other newer anticonvulsants is much more limited. While bone loss is more often seen with long-term use of these medications, several reports indicate that decreased bone density may also be detected within the first 1-5 years of use.
Lithium and Breastfeeding
Bipolar disorder (types I and II) affect up to 5% of the population in the United States. As the onset of this condition typically occurs during or before the reproductive years, the management of bipolar disorder in women is often complicated by pregnancy. There are concerns regarding fetal exposure to medication, the impact of untreated maternal illness, and data demonstrating that women are at increased risk for relapse during the postpartum period.
New Oral Contraceptive Approved
The US Food and Drug Administration (FDA) has approved a combination oral contraceptive (OC) tablet called Natazia (Bayer HealthCare Pharmaceuticals). It is a bit different from other OC preparations in that it contains 4 progestin/estrogen dosing combinations during each 28-day cycle (instead of being monophasic or triphasic), and it contains estradiol valerate (instead of ethinyl estradiol).
What’s Safer for Breastfeeding: Lithium or Lamotrigine?
After last week’s post, we received several comments regarding the use of mood stabilizers in breastfeeding women, specifically asking which is safer: lithium or lamotrigine.
Lamotrigine and Breastfeeding: An Update
Women with bipolar disorder are vulnerable to postpartum illness, and it is generally recommended that mothers continue treatment with a mood stabilizer throughout the postpartum period to reduce their risk of relapse; however, this recommendation is complicated by the all mood stabilizers are secreted into the breast milk, although their concentrations appear to vary considerably (Chaudron and Jefferson, 2000).
When Health Care Providers Say the Wrong Thing
With increasing frequency, postpartum women who have taken antidepressants during pregnancy have shared – usually in tears – that while in the hospital for their labor and delivery hospitalization, a health care provider at the hospital said something judgmental about their being on an antidepressant. For example, one woman said that a nurse told her, “I can’t believe you took that during pregnancy.” Or, “Don’t you know how risky that is?!” Or “How could you do that to your baby?” This is often in the context of women using other medications in parallel for non-psychiatric indications, of which less may be known about the reproductive safety profile, but not addressed by the health care provider.