• anticonvulsants

    What’s Worse for Pregnancy: Bipolar Disorder or the Medications Used to Treat It?

    In studies of pregnant women with unipolar depression, it has been shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight.  There is far less data on pregnancy outcomes in women with bipolar disorder.  A recent Swedish study analyzes pregnancy outcomes in treated and untreated women with bipolar disorder and attempts to distinguish between the effects of medication versus the effects of untreated psychiatric illness in the mother.

    More on Topiramate (Topamax) and Risk of Oral Clefts

    Earlier this year we reported on a possible association between first trimester exposure to topiramate (Topamax) and increased risk of cleft lip and palate.  In a recent study published by the American Journal of Obstetrics and Gynecology, researches drew upon data from two birth defect databases to further delineate the risks associated with topiramate exposure.

    Outcomes of Children Exposed to Antiepileptic Drugs in Pregnancy: No Good News for Valproate

    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. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.

    From the North American AED Pregnancy Registry: The Newer Anticonvulsants Appear to Be Safer

    While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). The North American AED Pregnancy Registry was established in 1997 for pregnant women in the United States and Canada at the Massachusetts General Hospital. The purpose of the registry is to obtain and publish information on the frequency of major malformations among infants whose mothers have taken one or more AEDs during pregnancy.

    Topiramate (Topamax) Associated with an Increased Risk of Oral Clefts

    Topiramate (marketed as a Topamax), in addition to its use for the treatment of epilepsy, is now being prescribed to reproductive aged women for a broad spectrum of indications, including migraine headaches, weight control, and mood stabilization.  Limited information is available on its reproductive safety; however, the preliminary data we do have raises some concerns regarding the use of topiramate in pregnancy.

    Valproic Acid and the Risk of Major Malformations

    Previous studies have indicated that infants exposed to valproic acid in pregnancy are at increased risk for a range of malformations, including neural tube defects.  While these studies have shown an association between valproic acid and various malformations, they have been limited in their ability to quantify the risk of certain, less common malformations.  To do this, large population-based case–control studies are more appropriate.

    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.

    Anticonvulsant Use in Pregnancy and Nursing: Differences in Recommendations from Psychiatrists vs. Neurologists

    There are strong parallels between the clinical management of bipolar disorder and epilepsy, and women with these disorders face significant challenges while pregnant or planning to conceive.  In this setting, treatment decisions must balance the risks of recurrence of severe illness with the risks of potential harm to the fetus when certain medicines are taken during pregnancy.

    Mental Health Parity in Massachusetts

    Recent changes expanded the scope of mental health parity in the Commonwealth of Massachusetts, which requires insurance companies to cover specified diagnoses on a “nondiscriminatory basis”. This means that copayments, deductibles, coinsurance, unit of service limits- such as hospital days and outpatient visits, and/or annual or lifetime maximums are no greater for mental disorders when compared to physical conditions.

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