Lamotrigine in bipolar disorder: efficacy during pregnancy.
OBJECTIVE
Clinical management of bipolar disorder (BPD) patients during pregnancy is a major challenge. The high risk of bipolar depression during pregnancy encourages consideration of lamotrigine (LTG). We therefore compared recurrence risks among pregnant women with BPD treated with LTG to those discontinuing mood stabilizer therapies.


METHODS
We compared risks and weeks to new DSM-IV illness-episodes among 26 initially clinically stable pregnant women diagnosed with DSM-IV BPD who continued LTG treatment to those discontinuing all mood stabilizer treatment during pregnancy.


RESULTS
The risk of new illness-episodes with LTG was 30% versus 100% after discontinuing mood stabilizers, and survival-computed time-to-25%-recurrence was 28.0 versus 2.0 weeks (chi(2 )=17.3, p < 0.0001; hazard ratio = 12.1; 95% confidence interval = 1.6-91.7).


CONCLUSIONS
Discontinuing mood stabilizer treatment presents high risks of illness-recurrence among pregnant women diagnosed with BPD. LTG may afford protective effects in pregnancy, and its reported fetal safety compares favorably to other agents used to manage BPD.
Newport
D Jeffrey
DJ
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA. jeff.newport@emory.edu
Stowe
Zachary N
ZN
Viguera
Adele C
AC
Calamaras
Martha R
MR
Juric
Sandra
S
Knight
Bettina
B
Pennell
Page B
PB
Baldessarini
Ross J
RJ
D000328:Adult; D018692:Antimanic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000453:epidemiology; D037841:Pregnant People; D012306:Risk; D013375:Substance Withdrawal Syndrome; D016019:Survival Analysis; D014227:Triazines / Q000009:adverse effects*
D018692:Antimanic Agents; D014227:Triazines; D000077213:Lamotrigine