Q:  Lamictal & Pregnancy

Dear Dr. Phelps,

I suffer from Bipolar depression and have been taking Lamictal for 2 years now.  I am 40 years old.  I am thinking about getting pregnant.  Last year, I tried to taper off Lamictal, but got severely depressed again and have since gotten back to taking 200 mg Lamictal daily.

My question is: what are the risks of staying on Lamictal while pregnant?

Thanks,
Annette


Dear Annette -- 
Fair question.  Almost no data.  Here's a link to the "lamotrigine pregnancy registry" maintained by the manufacturer, but your "healthcare provider" has to call them.  That database was cited by Dr. Lee Cohen, the Harvard "reproductive psychiatry" guru, a year ago when he said " The manufacturer of lamotrigine has a pregnancy registry, and preliminary data do not suggest that risk of malformations is increased when this drug is used as monotherapy, but it is too early to reach conclusions. "

A 2002 review concluded "risks for neonatal safety during lactation continue to appear substantial with lithium, are of potential concern with lamotrigine and clozapine, are quite likely minimal with valproate or carbamazepine, and are indeterminate with most other new anticonvulsants or atypical antipsychotics." 

I'm afraid that's about all we know -- not enough to say it's safe, but nothing clearly to indicate it's a terrible idea (except in principle when we know this little).  You might benefit from reading all the essays on this topic from the Harvard group, available at their "Women's Health Library". It will give you more background on this very complicated issue (complicated in terms of making a decision on the basis of very little information).  Good luck. 

Dr. Phelps
                        

Published October, 2003