Lamictal in consideration of pregnancy

My husband and I are talking about expanding our family. While that sounds all well and good, I just have one issue:

Lamictal.

For most women, they think, “Well, I want a kid” and the most they have to do is probably get off birth control. Just finish off their contraceptives, maybe feel a little nauseous, and move forward with their plans.

(sigh) Not me. If I want to do this right, it might be a good 6 months or so before I can consider trying.

Here’s the thing: Despite the recent discovery that Lamictal performed no better than placebo, I can’t deny that the medication has worked wonders in my life. My mixed episodes are practically zero, my suicidal thoughts—for the  most part—have been kept under control, and I haven’t had any suicidal impulses. Just a lot of ideation. And for me, there’s a huge difference between the two.

I’m currently on 200 mg. Do I have any side effects? Probably. I’m not wholly sure but my best conjecture is that I often suffer from fatigue and blurry vision. If I look at a TV from a sideways angle, my vision gets blurry and crosses. I don’t remember that happening before. As for as I can think of, I haven’t had any other serious side effects other than those two.

Sometime last year, I dropped down to 150 mg in the hopes of getting off of the drug since I’d been doing so well. My doctor chewed me out over it and told me it wasn’t wise.

“You wouldn’t stop taking your blood pressure medication if you were doing well, would you? Lamictal’s a maintenance medication. You have to take it to keep doing well.”

And like I said, for the most part, I have been doing well. Two years ago, I mentioned my concern about being pregnant on Lamictal:

I’m currently wrestling with the idea of having a kid soon. My husband and I talked about it and we knocked all  of our concerns down to the medication issue. I’ve been doing really well on the Lamictal, but there are warnings all over the prescription that say “Do not take while pregnant.” My doctor’s pretty much, “You need to outweight the benefits vs. the risks.” He said there’s a slightly increased chance of my kid developing a cleft palate but not much more than the average population. … I’d like to nurse my kid and I don’t want it to nurse on Lamictal.

PregnantTwo years later, the concerns haven’t changed. My doctor will probably be resistant about it, especially when I expressed this concern and he said something about it being a Category C drug and the risk increases slightly but not by much and blah, blah, blah. I have to consider whether the benefits outweighs the risks and for me right now, it’s the opposite. I am adamant about not having a child while on Lamictal. Just like I’m adamant about not taking topical steroids while pregnant. (FYI, doctors say that it doesn’t go into the bloodstream but the patient safety information says “That it is not known whether the medication is absorbed into the bloodstream.”) If moms do everything they can to protect their children, I sure as hell will be part of that group.

According to epilepsy.com (remember, Lamictal [lamotrigine] is an anti-seizure medication), the risk of a child having a cleft palate while the mother is on the drug is 24 times higher than normal. Why expose a baby to that? Even GSK warns in its patient safety information:

“Lamictal should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus”.

Not only that, I’d like to breastfeed my child and studies have shown that indeed the medication does pass through the breast milk. To be honest, the main reason for it is quite silly.

“Every mom in my church does it.”

After being at my church for 2 years, several women have had a baby and every one of them has breastfed their child. I’d feel like an oddball sitting there, feeding my kid formula. I was raised on formula and I guess there’s nothing wrong with but I think that breastfeeding is better for a child anyway. And there’s no need for a healthy child to be ingesting medication that it does not need.

So this is what I’m currently facing. I have an appointment with my doctor in February and I’m going to drag my husband along with me for moral support. I know it took Gianna at Beyond Meds 2 years to come off the drug but—and I know she’ll tell me this isn’t wise!—don’t plan on taking that long to withdraw. I plan on taking 4-6 weeks, depending on the severity of side effects, to come off of the drug. From 200 mg to 150 mg to 75 mg to 50 mg to 25 mg. I expect the 150 mg to 75 mg drop to be a doozy. And lately, I’ve been obsessed with the idea of suffering from seizures, a problem that I’ve never experience, but the idea scares me. Apparently, I have good reason:

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. This appears to be particularly true for Lamictal. (epilepsy.com)

Rachael over at My Bipolar Pregnancy said that she decided to take Lamictal during her second and third trimester and it turns out she had a healthy baby daughter. While at the hospital, a nurse told her that her daughter had been on Lamictal without any issues:

She also told me that her daughter used Lamictal while breastfeeding and had no issues. Which was nice to hear since I too am now breastfeeding.

I’m happy that things are working out for Rachael and the nurse’s daughter but it’s not a chance I’m willing to take if I can help it.

16 Comments

  1. Gianna said,

    January 12, 2009 at 11:17 am

    if you’re breastfeeding a baby a drug…you don’t know if there are issues necessarily until years later and even then you won’t know for sure even if an “issue” appears…no one knows how it plays out in long-term development…
    I chose not to have children because I didn’t believe it was a responsible thing to do for me or a child…my psychiatrist was always pushing me to have kids because I wanted them and he pissed me off in doing so…I was barely functional on all the crap he had me on…
    and now it’s too late…
    it’s not too late for you to make the life-style changes that can heal you and then you won’t have to take lamictal during your pregnancy or after..
    you would have to make a commitment to lots of changes…unfortunately there will be no motivation to try if you don’t believe it’s possible.
    Our bodies and minds were designed to heal.

  2. Gianna said,

    January 12, 2009 at 2:02 pm

    I’m sorry if I sounded harsh Marissa.
    I find it so frustrating that people are willing to put faith in toxic crap that pharma pushes with little evidence of value, while poisoning themselves at the same time when nature makes all we need to heal us and God put it there for us to find and use—this comprises nutrients, foods, and behaviours/habits.
    Sometimes it hurts when I watch people I love going down the path I went and I can’t do a damn thing to stop them…
    I know I don’t know everything and that I can’t possibly have the answers for everyone, but I love you and I want you to be happy—I’m sorry if I was pushy in the above post…
    in the end you can only trust your own gut…not mine or anyone elses..
    peace to you during this difficult time of decision making.

  3. Marissa said,

    January 12, 2009 at 2:22 pm

    Hey Gianna,
    I’m not offended at all. I know that you care and you’re right. It’s tough. I think everyone has different experiences with things and I can’t tell someone to come off a drug if they think it’s working for him or her. I know of a friend who has a sister who has been on Paxil for the past 7 years. She says it’s worked wonders for her even though we know the hoopla surrounding Paxil/Seroxat and the effects it can have. But again, it’s different for everyone. Only each person can determine whether the benefits outweigh the risks of horrible and debilitating physical (and possibly mental) side effects.
    Personally, a child who is developing and doesn’t have any inkling of mental illness doesn’t need to be exposed to a drug that does. It’s bad enough that mental illness runs through my family; a drug isn’t necessary to bring it on any sooner!!

  4. Gianna said,

    January 12, 2009 at 2:44 pm

    thank you for being so generous Marissa…I am so frustrated now…I’m so sick and angry about being sick and the drugs made me this way…5 minutes on my feet make me sick…
    anyway…I was on a ton more crap than you were and for a much much longer time…our experiences are not in the least bit identical..
    peace to you…

  5. Stephany said,

    January 12, 2009 at 7:38 pm

    Personally, I was not on any drug, not even caffeine 3 months before and all during pregnancy and breastfeeding. Though, I did not have a psych med dilemma, I know I would go off of it, but that is just me.
    I can safely say that all things pass thru the milk, because if I ate garlic or zuchinni the baby’s stomach complained within hours!
    I understand the anxiety you must have, the worry over mental health stability and the safety of you and the baby re: the Lamictal.
    But…life has no guarantees Marissa. I ate perfectly, was in tip-top shape, took no drugs(not even pain medication during labor) with all 3 kids and my youngest is deaf in one ear, autistic and schizophrenic….
    ((HUGSS)))

  6. Stephany said,

    January 12, 2009 at 7:43 pm

    Oh, and my point about life having no guarantees–is to take a chance, there are risks with everything we do. But that is what life is about, having the courage to risk and accept the outcome, and life as it happens.

  7. January 12, 2009 at 9:32 pm

    This is such a difficult issue. I know a woman who adopted because she knew she wouldn’t get enough support while she was off the meds if she went through a pregnancy.
    What frustrates me is natural remedies seem to never be the first-line treatment for depression in the US. Meds are almost automatic, and they cause their own issues.
    Good luck, either way, and I don’t think it’s a coward’s way out to do whatever you need to do to take care of yourself, even if that means taking Lamictal, even during pregnancy.

  8. Stephany said,

    January 13, 2009 at 3:31 pm

    I agree with Alison, make sure you do what is best for you. It’s a personal decision.

  9. Niki said,

    June 30, 2009 at 4:26 pm

    I am Bipolar II taking Lamictal and currently 5 weeks pregnant. I went off Lamictal the month we started trying, and my dr. said I probably wouldn’t feel any different for a few months. Four months later I started to crash. I had been very stable for many years – I had forgotten how bad it can be. No offense to anyone on this board, but if you haven’t had the experience, you have no idea what we go through. If I were you, I would only seek advice from others who have been there. It’s kinda like asking someone who is blind to pick out paint colors. I’d try going off Lamictal and cross your fingers you get pregnant right away. It shouldn’t take that long to ween yourself. If you start to slip, see your doctor.In fact, I’d make an appt. for 3-4 months after you are med free just in case. If you don’t see it he/she will. Funny, I just got back on Lamictal a week before I got a positive test, but once you start to slide you gotta get back on the meds. BTW, I was SET on being med free for this experience, but things don’t always work out like you plan.

  10. Savannah said,

    July 16, 2009 at 9:19 am

    Hello! My name is Savannah and I have been on Lamictal for the last 10 years and I have been thru two pregnancy’s and both of my children are perfect! None of my doctors ever prepared me for anything different! I even saw a genetic doctor during my pregnancy’s. However I did choose not to breast feed the baby. Due to directly passing the drug and its not necessary. Its a very personal choice. If you would like to talk to me further my email is smanhold@aol.com
    Good Luck!

    • Rose said,

      March 10, 2012 at 11:18 am

      I am replying to an old post, but I thought I’d give it a shot. I just found out I’m pregnant. I am 41 years of age and currently on 175 mg of lamictal. I am weening myself off the drug with my doctor’s supervision. The combination of my age and the risks of Lamictal has me very concerned. I have a healthy 5 yr. old boy, but wasn’t on any meds during that pregnancy and was younger. Did you find during your pregnancy or thru research any information that made you feel better about the situation? I would love to hear back from you. Thanks. Rose

  11. Amy said,

    May 23, 2012 at 3:38 pm

    Hello, my name is Amy. I’ve been on Lamictal for about 3 months now and Citalopram for approximately 8 1/2 months. After my last child (whom is now ten months, precious, loved and lucky to have me as a mom even though I have Bi-polar II to manage) I suffered from post-partum depression which is why I began the Citalopram. I also breastfed my son until he was about 7 months. At that time I was slipping into rage full, irrational, depressed wife and Mumma. Enters Lamictal- and weening to formula. Both decisions were hard- continue breastfeeding while on Citalopram and stop to begin usage of Lamictal.

    Now, I am 33 years young (keep it positive, right!) and my husband and I are eager to welcome a third child into our delightful family. my first (whom is equally adorable, adorned with love, and lucky) was nearly 4 years ago. I suffered from post-partum then too and began Zoloft or generic equivalent, which did nothing. So when I ran out at some point I stopped. I should have pursued a better fitting med but did not. I breastfed my little girl for a year largely without meds.

    Yay!, for breastfeeding for a year, but I was slipping…slipping…slipped. When she was 15 months, my irritability, rage, depression etc. was so bad I was fearful for my daughters safety and mine. I ended up in a behavioral center. Hard for me, my husband and my daughter.

    So what is the point to my rambling? Different strokes for different folks.Differnt reasons for Different seasons… And all that jazz.

    this time I am on a medication which I will ween from prior to conception. I sought help earlier. I expect to have no meds during pregnancy as the other two because I have an Aaamazing husband. And I also assume I am once again at high risk for post-partum depression. Though I loved breastfeeding I am thinking of seeking help as soon as needed and start formula feeding.

    Do I feel guilty for any of my decisions? Not anymore. Only when I was depressed and feeling worthless and a crap mom. But because of maintance medication I am guiltless. Except, I do wish I had sought help sooner after my first child. Perhaps a short stay in the behavioral center could have been prevented. No one likes an angry, depressed violent mom.

    Everyone’s situation is their own. your pain yankee only pain that you know. It is not weak; It is not trivial. and your journey is an isolated one. Yours and yours alone. You can have great support, and make sure you do. Trust your gut in the decisions you make, and be at peace with them. They affect you and the ones you love, yes, but you owe no explanation to “outsiders”.

    Dang, if you read all of this you will receive a ribbon in the mail shortly for all your hard work! 😉

  12. Amy said,

    May 23, 2012 at 3:44 pm

    “your pain Yankee only pain you know”? Geez, automatic spell check. 🙂

  13. Dee said,

    January 17, 2013 at 11:17 pm

    Oh my wow! I’m in the same boat. Did you get pregnant and is your baby healthy. I’m on 100 mg and if I miss a day or two, I’m a mess. My family and I would like another baby. I had a healthy baby girl without medications and breast fed for 6 months but I was a mess and almost filed for divorce. It was that bad! So here I go on the second round but am so afraid of going through the spirals. Please tell me how you did it and if your outcome was successful. Thank you. Dee

    • Nicki said,

      April 8, 2015 at 10:39 am

      It’s been a couple years since your decision, so I guess I’m asking how it went for you? I also am on 100mg of lamictal and have been researching to see if it is possible to go through another pregnancy. I was not on any meds before my first pregnancy and through out I ended up with depression during and even stronger after.I also almost ended up in a divorce and that scares me. I don’t know if it’s from the extra hormones due to having twins or just the stresses in life. I went through many meds until I found this one which really works for me, this being said I’m torn on what to do!

      • Dee said,

        April 8, 2015 at 1:02 pm

        Hi Niki. I went through my pregnancy and boy was it a ride of my life. I tapered off the first 2 weeks of knowing I was preggo with doctors supervision. It hit hard after I was off but once into my second trimester something interesting happened and I no longer felt in a dark hole. Mind you I had my husband on board asking how I was doing and making sure I wasnt isolating. Also I hung onto my faith and talked to my baby when I felt lonely or sad. I did have my moments but when I felt the feelings coming on strong I reminded myself why I am doing what I’m doing without meds to let a human grow inside. I took pleasure feeling every move inside my body and looking at sonogram pictures of my boy gave me hope. On April 26, 2014 I gave birth to a perfect little boy. I then breastfed him for 5 months but my mother in law suddenly died (unexpected heart attack). I fell into a deep depression but luckily my doctor was supervising me weekly. I was suggested to get back on meds, stopped breastfeeding and began back on meds. My heart hurts from the loss still but I’m able to maintain myself from falling apart through meds, an incredible support system and my faith! The key is getting your family on board with your pregnancy and all the changes your body will experience. Divorce must be out of the question with hubby and you will need to fight through your changes. It’s possible but you will NEED support from every angle. I hope this helped. Wishing you peace love and FAITH! D


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