We have an abundance of articles which address the impact of psychotropic medications on pregnancy. Much less research, however, has focused on how pregnancy may affect how these medications work. Physiologic changes take place during [...]
Autism spectrum disorders (ASDs), which include childhood autism, autistic disorder, Asperger syndrome, atypical autism, and other pervasive developmental disorders, are characterized by social and communication difficulties and by stereotyped or repetitive behaviors and interests. It [...]
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.
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.
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.
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.
Unfortunately the mood stabilizers most commonly used to treat bipolar disorder (including lithium and valproic acid) can increase the risk of certain types of birth defects or congenital malformations in children exposed to these medications during the first trimester of pregnancy. For this reason, many women with bipolar disorder choose to discontinue maintenance treatment during pregnancy. However, we have observed very high rates of illness during pregnancy among these women who discontinue treatment; over half of the women relapse, most frequently during the first trimester.
