Lamotrigine in bipolar disorder: efficacy during pregnancy

Authors


  • DJN has received research support from Eli Lilly & Co., GlaxoSmithKline, Janssen, Wyeth, NARSAD and NIH; and speakers honoraria from AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, and Pfizer. ZNS has received research support from GlaxoSmithKline, NIH, and Wyeth; has served on the advisory boards for Wyeth, Bristol-Myers Squibb and GlaxoSmithKline; and has received speakers honoraria from Eli Lilly & Co., GlaxoSmithKline, Pfizer, and Wyeth. ACV has received research support from AstraZeneca, a Harvard Medical School Fellowship, NARSAD, NIH, and the Stanley Institute; and has served as a consultant or received speakers honoraria from GlaxoSmithKline and Novartis. MRC and SJ have received NIH research support. BK has received research support from Bristol-Myers Squibb, Cyberonics, Eli Lilly & Co., Forest, Janssen, NIH, Novartis, and Wyeth. PBP has received research support from GlaxoSmithKline, NIH, and Pfizer; has served on the advisory boards for GlaxoSmithKline, SleepMed Digitrace, and UCB Pharma; and received speakers honoraria from GlaxoSmithKline and UCB Pharma. RJB has had research or consulting relationships but no equity holdings with the following companies: Auritec, Biotrofix, Eli Lilly & Co., IFI SpA, Janssen, JDS, Merck, NeuroHealing, Novartis, and Solvay, as well as NIH grant support.

Corresponding author: D Jeffrey Newport, MD, Department of Psychiatry, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6100, Atlanta, GA 30322, USA. Fax: +1 404 778 2535; e-mail: jeff.newport@emory.edu

Abstract

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 (χ= 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.

Ancillary