Richard Wesseloo1, Xiaoqin Liu2, Crystal T Clark3, Steven A Kushner4, Trine Munk-Olsen2, Veerle Bergink4. 1. Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands. Electronic address: r.wesseloo@erasmusmc.nl. 2. Aarhus University, National Centre for Register-based research, Aarhus, Denmark. 3. Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois, USA. 4. Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Women with bipolar disorder are at high risk for relapse/recurrence postpartum. Among all mood stabilizers, lithium has the largest evidence base for efficacy in the peripartum period, but lamotrigine is increasingly prescribed for bipolar spectrum disorders during pregnancy. The aim of this study was to investigate whether lamotrigine use during pregnancy is as effective as lithium in the prevention of severe episodes postpartum. METHODS: Danish national registries were used to identify pregnancies of women with a diagnosis of bipolar spectrum disorders at the time of conception who used lamotrigine or lithium during pregnancy. We compared the risk of inpatient psychiatric admission within three months postpartum between women who used lamotrigine (N=55) versus lithium (N=59) during pregnancy. A logistic regression model was used to calculate crude and adjusted odds ratios. RESULTS: We did not find a significant difference in the risk of postpartum psychiatric admission between women who used lamotrigine versus lithium during pregnancy (7.3% versus 15.3% respectively, adjusted OR 0.83; 95% CI 0.22-3.14). We adjusted for year of delivery, parity, previous admissions and antidepressant/benzodiazepine use during pregnancy. Other variables did not differ substantially between groups. LIMITATIONS: We used an observational design and therefore patients were not randomized to lamotrigine or lithium. The study has a small sample size. CONCLUSIONS: Lamotrigine was not inferior to lithium in the prevention of severe postpartum episodes. Our findings suggest lamotrigine could be a reasonable alternative treatment option for bipolar disorder during pregnancy in patients with vulnerability for depression and may prevent severe episodes postpartum.
BACKGROUND:Women with bipolar disorder are at high risk for relapse/recurrence postpartum. Among all mood stabilizers, lithium has the largest evidence base for efficacy in the peripartum period, but lamotrigine is increasingly prescribed for bipolar spectrum disorders during pregnancy. The aim of this study was to investigate whether lamotrigine use during pregnancy is as effective as lithium in the prevention of severe episodes postpartum. METHODS: Danish national registries were used to identify pregnancies of women with a diagnosis of bipolar spectrum disorders at the time of conception who used lamotrigine or lithium during pregnancy. We compared the risk of inpatient psychiatric admission within three months postpartum between women who used lamotrigine (N=55) versus lithium (N=59) during pregnancy. A logistic regression model was used to calculate crude and adjusted odds ratios. RESULTS: We did not find a significant difference in the risk of postpartum psychiatric admission between women who used lamotrigine versus lithium during pregnancy (7.3% versus 15.3% respectively, adjusted OR 0.83; 95% CI 0.22-3.14). We adjusted for year of delivery, parity, previous admissions and antidepressant/benzodiazepine use during pregnancy. Other variables did not differ substantially between groups. LIMITATIONS: We used an observational design and therefore patients were not randomized to lamotrigine or lithium. The study has a small sample size. CONCLUSIONS:Lamotrigine was not inferior to lithium in the prevention of severe postpartum episodes. Our findings suggest lamotrigine could be a reasonable alternative treatment option for bipolar disorder during pregnancy in patients with vulnerability for depression and may prevent severe episodes postpartum.
Authors: Torbjörn Tomson; Dina Battino; Erminio Bonizzoni; John Craig; Dick Lindhout; Anne Sabers; Emilio Perucca; Frank Vajda Journal: Lancet Neurol Date: 2011-06-05 Impact factor: 44.182
Authors: Crystal T Clark; Autumn M Klein; James M Perel; Joseph Helsel; Katherine L Wisner Journal: Am J Psychiatry Date: 2013-11 Impact factor: 18.112
Authors: Adele C Viguera; Theodore Whitfield; Ross J Baldessarini; D Jeffrey Newport; Zachary Stowe; Alison Reminick; Amanda Zurick; Lee S Cohen Journal: Am J Psychiatry Date: 2007-12 Impact factor: 18.112
Authors: Joseph Hayes; Philip Prah; Irwin Nazareth; Michael King; Kate Walters; Irene Petersen; David Osborn Journal: PLoS One Date: 2011-12-07 Impact factor: 3.240
Authors: Meera Viswanathan; Jennifer Cook Middleton; Alison M Stuebe; Nancy D Berkman; Alison N Goulding; Skyler McLaurin-Jiang; Andrea B Dotson; Manny Coker-Schwimmer; Claire Baker; Christiane E Voisin; Carla Bann; Bradley N Gaynes Journal: Psychiatr Res Clin Pract Date: 2021-05-04
Authors: Nina M Molenaar; Eline M P Poels; Thalia Robakis; Richard Wesseloo; Veerle Bergink Journal: Bipolar Disord Date: 2020-06-30 Impact factor: 6.744