lamictal/abilify- nursing??

[nayma]

hi.  i'm a mama who was lucky to bf (and still does), but a friend recently confided that she may not have a baby bc she cannot bf due to her need to be on lamictal and abilify (for depression).  it sounds like it's not an option for her to go off of them, even briefly, and i'm wondering if anyone here has experience with these meds and bf'ing?  also, she spoke about getting bm from a bank.  is that even worth it?  how much does it cost?  thanks so much for your help!  if this is he wrong place to post, please redirect me...

[scottishmommy]

She needs to talk to her psychiatrist. Anecdotaly, I was on Lamictal and no one seemed to concerned about bfing or pregnancy. In the first trimester I had to take a ton of folic acid, but other than that it wasn't a big deal.

[myk]

she needs to consult her psychiatrist with regards to pregnancy and medication. i'm not familiar with amblify. i take lamictal. it was not a concern for the pregnancy but it is discouraged during breastfeeding. i consulted Motherisk (hospital for sick children in toronto) and they said that the drug passes through to breast milk in doses that are higher than they recommend.

personally, i did a lot of research and made an informed decision to go ahead and breastfeed. i'm on a low dose and there is a strong family history of allergy to milk, which factored heavily into my decision. my sister did so as well at first, but tapered down and made the switch to formula after a while. neither baby had any ill effects. i know this is anecdotal and again, CONSULT A PROFESSIONAL, but with most drugs it is possible.

if amblify is not recommended for pregnancy/bfing, it's possible to switch to another antidepressant. she's right in thinking it's often not favourable to go off medications entirely. if she does choose to have a baby, she will have to take additional folic acid if she's not already (i believe i took 4-5x as much as a standard pregnancy vitamin) otherwise there's a higher risk of neural tube defects. i didn't know this at the beginning of pregnancy and my baby turned out fine (i did start taking the folic acid when i found out but it was too late to affect spine closure). they recommend taking additional folic acid BEFORE you get pregnant, a few months at least. just in case. :)

good luck to her. it's a very personal decision and she deserves every support she can get to make her decision.

[smeep]

Have her call the Infant Risk Center: http://www.infantrisk.com/ (806)-352-2519 

That's Dr. Hale's hotline (THE leading expert in meds and mnothers' milk, in case you don't know). They can give her all the info and advise her of alternative options if necessary. They can also advise her on the meds during pregnancy. Most doctor's do NOT know and will say don't bf as a CYA measure. Or they go by the Physician's Desk Reference, Pregnancy Category, FDA, or manufacturer's info which are NOT reliable for determining the safety of breastfeeding on the medication.

I can vouch for lamictal. I'm nursing my 6 month old DD and take 150-250mg/day and no issues. I also took it during the last trimester of my pregnancy (I hadn't been on meds at all for a while before that) and she did end up with upper lip tie, high arch palate and recessed chin, which may or may not have been due to the lamictal, I can't say. If she wants to avoid the risk off palatal and related issues, she can consider a temporary change in meds or lower dose during the pregnancy or the "sensitive" months.

Remind her that when a med is "safe" it means that the risks of not breastfeeding outweigh the risks, if any, of breastfeeding on the meds. There ARE risks to not breastfeeding. Most meds are safe whilst nursing and most of those that are not do have acceptable alternatives.

[IwannaBanRN]

It's not an option to go off of my lamictal. I'm on a dose of 100mg a day and am 28 weeks pregnant. I am going to give breastfeeding a go while on lamictal. It's controversial wether or not it has a negative effect on the child while breastfeeding. I'm lowering my dose after I have this baby so there's even less of a chance of him being effected through breastfeeding. There were no visible defects on the anatomy scan at 20 weeks, so all seems well so far. As far as being on BOTH Abilify and Lamictal, I wouldn't recommend during nursing, but I'm also not a doctor specializing in mental health medicine.

[smeep]

100mg is a whole lot less than what they've studied (I believe about 800mg/day). We gotta remember that there are risks to not breastfeeding too, and weigh those against the risks of nursing on the meds. We also need to keep in mind that babies in utero are much more susceptible to meds, in part because they often get more through the placenta than through breastmilk, but also because they are at a much more developmentally fragile stage, so the vast majority of meds that are safe (i.e., better to take it than not) during pregnancy are safe during breastfeeding as well. :) 

If you have any nursing troubles, do get evaluated for palate, tongue tie or lip tie issues... I think those should be routinely checked for regardless (their impact on breastfeeding is SO underrecognized), but definitely look for it if you have latch or gain issues. And get it checked by someone who knows how to check for it and don't be afraid to get a second or third opinion. It can be resolved most often. 

Anyway... just so you're prepared! It took 5 people (including myself, with all my experience) to figure out her issues. It just never occurred to me to look for all that (and I found out about upper lip ties by mistake - there's almost no literature on those). 

Good luck. :) 
 

Originally Posted by IwannaBanRN 

It's not an option to go off of my lamictal. I'm on a dose of 100mg a day and am 28 weeks pregnant. I am going to give breastfeeding a go while on lamictal. It's controversial wether or not it has a negative effect on the child while breastfeeding. I'm lowering my dose after I have this baby so there's even less of a chance of him being effected through breastfeeding. There were no visible defects on the anatomy scan at 20 weeks, so all seems well so far. As far as being on BOTH Abilify and Lamictal, I wouldn't recommend during nursing, but I'm also not a doctor specializing in mental health medicine.

[IwannaBanRN]

Jeez louis! I didn't think anyone could need to take that much Lamictal in a day. lol I took Lamictal and Abilify together when I was 16 and it made me super manic. I'm going to be closely monitored by my doctor and baby will be watched closely by his pediatrician.

[smeep]

lol I know, right? I cannot imagine taking that much! But it's primarily a seizure med so I could see it being a necessary dose for severe seizure cases I suppose. But the most I've ever taken was 300/mg and that was a very stressful day coupled with the fact that my IUD decreases the effectiveness of the lamictal which has caused me to raise my dose 50mg until I can get the IUD out. It's also worth noting that they observed NO side effects in the studies. If I'm correct, the L3 (moderately safe) rating is simply due to the lack of further studies, but I discussed it with the Infant Risk Center recently (I was donating milk and the mom wanted to get their specific info) and the person I spoke with agreed it was definitely okay. 

Tegretol is also an alternative that's rated L2 (safer), though on your low dose I personally would not switch if the lamictal works well (I was previously on tegretol which worked relatively well but I was off it when I got pregnant and felt safer starting the lamictal during the pregnancy). 

[IwannaBanRN]

I wasn't put back on Lamictal until the beginning of my 2nd trimester, because the risks to baby in 2nd trimester are alot lower than 1st trimester.

[smeep]

Yeah, and that's one of the reasons why I went with lamictal over tegretol because, while tegretol isn't recommended during the first trimester, it's actually riskier to suddenly start taking it later on than if you were on it consistently prior to the pregnancy and through the first trimester (with extra folic acid to counteract that issue), but lamictal doesn't work that way and it's okay to just start up later on (well, safer than doing it with tegretol). I did some research and luckily I landed an incredible psych who totally trusts my judgement! Which is great because I feel like I can trust hers. Finally! lol

[IwannaBanRN]

Originally Posted by smeep 

Yeah, and that's one of the reasons why I went with lamictal over tegretol because, while tegretol isn't recommended during the first trimester, it's actually riskier to suddenly start taking it later on than if you were on it consistently prior to the pregnancy and through the first trimester (with extra folic acid to counteract that issue), but lamictal doesn't work that way and it's okay to just start up later on (well, safer than doing it with tegretol). I did some research and luckily I landed an incredible psych who totally trusts my judgement! Which is great because I feel like I can trust hers. Finally! lol

See, with me, I needed a psych AND an OB that trusted my judgment on the matter. I didn't want to go to one or the other doctor and have them be like "I don't think you should be on this drug". I got lucky with the OB I have because he saw how badly I needed to be on medication. He knew what risk not being medicated entailed for me and my baby. I have spent the last 3 years not being listened to by psych doctors who were convinced I just had depression because that's when things got the worst. I told them about my manic episodes over and over and they just wrote everything off as depression. I think some doctors don't believe in bipolar disorder and that screws their judgment of a patient's symptoms.
 

[Mom2M]

I posted in your other thread in ppd and now looked up abilify. here is the link to the page with abilify, it is in the top thread.
http://neonatal.ttuhsc.edu/discus/messages/47/47.html?1290115477
There is no data on it because it is new but lots of data on Lamictal/lamotrigine (generic)
Lamictal is a good choice.
I take it as an anticonvulsant and was on 400 mg/day both pregnant and nursing. DD1 I took it for pregnancy on a lower dose and then stopped for nursing for a while because I didn't need it.
DD2 I took it the whole time at 400 mg and there was no issue at all. (she's almost 2). There is a risk of sedation in an infant which only lasts until the baby is able to fully metabolize what little gets into the milk. At 9 months there should be no issue unless the baby has a metabolic disorder or something like that.
I really researched it carefully with DD1 and Tom Hale's site and book is a great resource.
Her pediatrician;'s office should have a copy of his book so that she can see the direct research but he answered questions from doctors on his forum about it also.