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

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

Oral Contraceptives Reduce Lamotrigine (Lamictal) Blood Levels

Lamotrigine (Lamictal) has been effectively used for the maintenance treatment of bipolar disorder. Many women suffering from bipolar disorder are of childbearing age; therefore an adequate contraception is a major concern that needs to be addressed in this population.

By Ruta Nonacs, MD PhD|2025-06-26T09:07:14-04:00October 20th, 2008|Anti-Epileptic Drugs, General, Hormone Therapy|Comments Off

Post-Traumatic Stress Disorder (PTSD) Following Childbirth

Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.

By Ruta Nonacs, MD PhD|2026-01-11T11:58:13-04:00October 8th, 2008|Diagnosis & Screening, Postpartum Psychiatric Disorders, Prevalence & Risk Factors, PTSD and Stress Related Disorders|Comments Off

Medication Changes During Pregnancy

At our clinic we have the opportunity to see patients at various stages of pregnancy. When we evaluate a patient while she is still in the planning stages, we may recommend changing medications to those that have a better studied safety profile during pregnancy and see how she does on those medications prior to conception. If that same patient came into our clinic for an evaluation, but was already pregnant, we may make different recommendations than if she was in the planning stages.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:23-04:00February 28th, 2008|Anxiety Disorders, Depressive Disorders, Outcomes, Pregnancy & Medications, Psychiatric Disorders During Pregnancy|Comments Off

Treatment of Insomnia During Pregnancy

Most women experience some degree of sleep disturbance during pregnancy, and for a significant number of women sleep disruption may be quite severe. There are many different causes for sleep disturbance during pregnancy, and choosing the appropriate intervention relies on an accurate diagnosis of the problem.

By Ruta Nonacs, MD PhD|2025-12-11T09:41:07-04:00November 19th, 2007|Pregnancy & Medications, Psychiatric Disorders During Pregnancy, Sleep Disorders|Comments Off

Polycystic Ovarian Syndrome in Women Taking Valproate

Polycystic ovarian syndrome (PCOS) occurs in 4-7% of women and is characterized by irregular menstrual cycles and hyperandrogenism (facial hair, acne, male-pattern hair loss, acne, or elevated male hormone levels). The majority of women with PCOS also suffer from obesity and insulin resistance. PCOS has been associated with a spectrum of health problems including infertility, diabetes, and possibly heart disease and endometrial cancer. Recently there has been concern that women with bipolar disorder who are treated with the mood stabilizer valproate (VPA; brand name Depakote or Depakene), may be at higher risk for PCOS, although the data have been somewhat conflicting.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:24-04:00November 8th, 2007|General, PCOS|Comments Off

Link Found Between Anxiety and Preterm Birth

While there have been concerns regarding the reproductive safety of psychotropic medications, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may not always be the safest option. 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|2024-03-24T11:57:46-04:00October 22nd, 2007|Anxiety Disorders, Outcomes, Postpartum Psychiatric Disorders, Pregnancy Outcomes, Psychiatric Disorders During Pregnancy|Comments Off

Ruta Nonacs

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