Ruta Nonacs, MD PhD - MGH Center for Women's Mental Health

Anxiety During Pregnancy Predicts Worse Outcomes

In treating pregnant women with mood or anxiety disorders, we tend to focus primarily on the reproductive safety of psychotropic medications; however, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may carry some degree of risk. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that depression during pregnancy may negatively affect pregnancy outcomes (reviewed in Bonari 2004).

By Ruta Nonacs, MD PhD|2024-03-24T11:56:41-04:00July 14th, 2010|Anxiety Disorders, Outcomes, Pregnancy Outcomes, Psychiatric Disorders During Pregnancy|Comments Off

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.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:18-04:00May 18th, 2010|Anti-Epileptic Drugs, General, Mood Stabilizers, Outcomes|Comments Off

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.

By Ruta Nonacs, MD PhD|2025-06-26T09:07:09-04:00May 4th, 2010|Anti-Epileptic Drugs, Breastfeeding & Medications, Mood Stabilizers, Outcomes|Comments Off

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).

By Ruta Nonacs, MD PhD|2025-06-26T09:07:10-04:00April 27th, 2010|Anti-Epileptic Drugs, Breastfeeding & Medications, Mood Stabilizers, Outcomes|Comments Off

Clinical Question: Topamax and Seroquel in a Woman with Bipolar Disorder Planning to Breastfeed

A clinician asks: “I am a psychiatrist treating a patient with Bipolar Disorder on Seroquel and Topamax. I would like to know what information is available regarding the safety of these medications to the infant if used during breastfeeding.”

By Ruta Nonacs, MD PhD|2024-04-14T16:10:23-04:00December 1st, 2009|Anti-Epileptic Drugs, Antipsychotic Medications, Breastfeeding & Medications, Mood Stabilizers|Comments Off

Lamotrigine and Pregnancy: An Update

While anticonvulsants, such as lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin), are being used with increasing regularity for the treatment of women with bipolar disorder, we have limited information with respect to the reproductive safety of the newer anticonvulsant agents. In 2006, we reported on preliminary data indicating an increased risk of oral clefts among infants exposed to lamotrigine during the first trimester of pregnancy.

By Ruta Nonacs, MD PhD|2025-06-26T09:07:11-04:00August 25th, 2009|Anti-Epileptic Drugs, Mood Stabilizers, Outcomes, Pregnancy & Medications|Comments Off

Can We Identify Women at High Risk for Postpartum Psychosis?

Postpartum psychosis occurs in about 1 to 2 per 1000 women after delivery. While there appears to be a strong link between postpartum psychosis and bipolar disorder, it is estimated that about half of women who present with postpartum psychosis have no psychiatric history prior to delivery, making it difficult to identify those women who are at greatest risk for this illness. A recent study, using data from the Swedish Medical Birth Registry, has examined possible risk factors that may be used to identify women at risk for postpartum psychosis.

By Ruta Nonacs, MD PhD|2025-09-03T16:46:41-04:00August 3rd, 2009|Postpartum Psychiatric Disorders, Postpartum Psychosis, Prevention|Comments Off

Pregnancy May Lower Lamotrigine (Lamictal) Blood Levels

Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy. Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians. Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data on this relatively new anticonvulsant in pregnancy is limited, pregnancy registry data suggests that lamotrigine may pose less of a risk to the developing fetus than with older anticonvulsants, such as valproate (Depakote). With lamotrigine emerging as an effective and relatively safe treatment for pregnant women with bipolar disorder, more attention is now being paid to the effects of pregnancy on lamotrigine levels.

By Ruta Nonacs, MD PhD|2025-06-26T09:07:13-04:00May 5th, 2009|Anti-Epileptic Drugs, Bipolar Disorder, Mood Stabilizers, Pregnancy & Medications|Comments Off

Fetal Exposure to Valproate Associated with Lower IQ

There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart, limbs, and genitals. A recent report published in the New England Journal of Medicine indicates that in utero exposure to valproate may also result in lower IQ.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:20-04:00April 24th, 2009|Anti-Epileptic Drugs, Bipolar Disorder, Long-Term Outcomes, Mood Stabilizers, Neurodevelopmental Disorders, Outcomes, Pregnancy & Medications|Comments Off

Folic Acid Supplementation is Recommended for All Women Taking Anticonvulsants and Planning Pregnancy

Given recent discussions within our group and with our colleague, Lewis Holmes, MD, chief of the Genetics and Teratology Unit at Massachusetts General Hospital for Children and director of the North American AED (Antiepileptic Drug) Pregnancy Registry, I wanted to expand upon a previous blog post. In the initial post, I wrote that women who take certain medications, like mood stabilizers or antiepileptic drugs, are advised to take increased doses of folic acid before pregnancy and throughout pregnancy.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:21-04:00November 11th, 2008|Anti-Epileptic Drugs, Bipolar Disorder, Medication, Mood Stabilizers, Psychiatric Disorders During Pregnancy, Treatment|Comments Off

Ruta Nonacs

About Ruta Nonacs, MD PhD