Q:  Lamictal & Pregnancy

As a result of a stroke 4 yrs ago, I have bipolar.  I also have some myclonic symptoms as well.  Lamictal has saved my life!!  However I am now 8 weeks preg and after a miscarriage last Oct I have opted to not take my meds (Lamictal and Paxil) this time around if possible.  This is my 3rd day without med and I dont know if I can do this.  The Lamictal is the main one I need, but the info I find out there is so sketchy!  Without it I cannot function very well at all.  The myclonic clicking in my head makes me not be able to think or focus on anything.  Do I need  to just get through this, can I take lamictal (only need 25mg to function) or is there a class B med that I could suggest to my neuro to try?

                       
Dear Ms. H' -- 
You and your neurologist may already have had a discussion about your options, as she/he has surely had numerous patients needing antiseizure medications through pregnancy, but that is definitely the place to discuss your options, and their relative risks. Here's a summary from a Harvard doc' on the issue of medications during pregnancy, which includes some discussion of lamotrigine in the last paragraph (see page 3 of the pdf) of the section on medications and their relative risks. There is growing enthusiasm about lamotrigine (you'll see a hint of it in Dr. Viguera's comments), because the "registry" (record-keeping on as many women taking lamotrigine alone prior to and in the first trimesters, as well as through the pregnancy) is growing and still not showing evidence of risk of fetal malformations any greater than the background rate (2-4%). However, that registry is still very small, not really big enough to rely on firmly, and that's why you and your neurologist would have to discuss going back on it (and at what rate; don't forget, you can't just restart at your previous dose, you have to taper up again if/when you restart). 

There is no "Class B" (FDA classification system, where B means "appears to be safe for use during pregnancy") mood stabilizer; all are C or D (including verapamil, which you will see mentioned sometimes) -- unless you count fish oil as a mood stabilizer. The evidence for it is growing, but in general it appears that any mood stabilizer effects are relatively weak, certainly not to be counted on to provide the benefits you might have seen from lamotrigine.  

Dr. Phelps

Published April, 2006