Bipolar and pregnant - need advice on meds

[smeep]

I've been off of my meds, zoloft and tegretol (carbamazepine), for about a year now. I wasn't able to get them for a couple months and by the time I was able to I had learned pretty well how to manage my episodes (basically just high frustration that leads to screaming, yelling, etc.) without them. Now that I've got all these extra hormones I definitely need something. Geodon was HORRIBLE for me (massive "why bother to live? nothing will ever make you happy" depression, luckily I at least knew it was the meds), so I CANNOT do that again and I am weary of anything similar to it. I also want to avoid any that cause excessive weight gain. Any ideas? Many things seem to not be "approved" for pregnancy, but I need to know details on that because sometimes it's just something in the first or third trimester, so they give it a blanket "no" for the whole time...so knowing why it's not approved would help significantly. Thanks!

[angela1435]

I was on trileptal which is very similar to tegretal during pregnancy. I would advise you to see a maternal fetal medicine specialist. They are the docs that know all about the meds and the risks to the baby. The one that I saw really explained things in a way that I could understand. Good luck! I know it's hard.

[Carley]

Lamictal has a great history of use during pregnancy and breastfeeding & registry for pregnancy: http://pregnancyregistry.gsk.com/doc...nal_report.pdf

There's a rare rash side effect, but the percentages are low. If you get the rash you simply stop taking it.

SSRI's like Zoloft are not typically prescribed for Bipolar disorder as they can increase manic episodes. Are you comfortable with your psychiatrist?

In addition to Lamictal I also take Seroquel (before, during, and after pregnancy).

The hormonal effect on Bipolar disorder is pretty huge. My psychiatrist offered Klonapin to counteract the potential hormonal effects, but my medication kept me perfectly stable. If you're racing you might also ask for a px for the just-in-case.

After 4 years of treatment with Lamictal and Seroquel I'm totally stable & only visit my psychiatrist yearly to check in. I highly recommend them!

[angela1435]

Hey Carley, they were ok with the Seroquel while pregnant? I am on it now and had to stop breastfeeding. What did the doc tell you about that?

[painefaria]

I have seen Lamictal used(with great benefit), and Risperdal as a antipsychotic, but that is it. Most of the medications are limited by the LACK of research. Sadly, it really limits what is out there for you.

[journeymom]

I didn't know Lamictal is OK for pregnant gals. That's wonderful.

One way to mitigate the Lamictal rash is to dose up very, very slowly. Start at the lowest dose possible and stay with it for a while before you increase the dose. Increase very gradually.

[Carley]

Originally Posted by angela1435

Hey Carley, they were ok with the Seroquel while pregnant? I am on it now and had to stop breastfeeding. What did the doc tell you about that?

Yes, I took Seroquel during pregnancy and take it while currently breastfeeding.

I want to note here that which medications you take is your control. Nobody should be "Starting you on" or "Stopping you from" anything. Taking charge of your mental health your right, and some might say your responsibility. I do get your context & this isn't meant to offend - I just had to stand up on my soapbox of Internet real quick

My initial therapeutic dose of Seroquel was 100-200mg nightly (how's that for knocking out an elephant ). Seroquel serves two purposes for me - 1) SLEEP 2) antipsychotic effects. I have tried other means of sleep aids (including Geodon) and suffered psychotic symptoms, hence I take Seroquel.

After a few years at this dose I let my psychiatrist know that I felt comfortable experimenting with a lesser dose (long term high doses of antipsychotics like Seroquel can get pretty unsavory). I cut down to 25-50mg no problem. For the past year I've taken anywhere from 5-15mg nightly. I get sleep and the only time I felt symptoms start to emerge was after not taking it for a week after DD2 was born. I was afraid of sleeping too well when she was in the nurse 'round the clock phase of newbornhood.

For me the benefits of this slight dose outweigh not taking Seroquel at all, not becoming pregnant or not breastfeeding. You might come to a different conclusion. Since starting Lamictal I have always taken an additional 400mcg folic acid in addition to my prenatal vitamin (even when not actively TTC) to cover my bases should I become pregnant.

Here's some general information on Bipolar meds and pregnancy:

http://www.nami.org/Template.cfm?Sec...ontentID=84897

http://pn.psychiatryonline.org/content/43/2/26.full

Painefaria that's really the rub, isn't it? For those interested Lamictal has a pregnancy registry, hence it's often recommended for pregnancy & breastfeeding because there is data on it. It was closed during my pregnancies, sadly. If you're pregnant or breastfeeding while one is open do participate!