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My sister is taking Tegretol for bipolar affective disorder (it's more commonly used for epilepsy and seizures).
She recently found out she's pregnant. I've read up on the increased risk of neural tube defects from using the drug (increases the risk to about 1% from .1%--possibly from the drug itself, possibly from the symptom it's treating), and was wondering if anyone here has any experience with other drugs for treating bipolar affective disorder.
On a lighter note, I'm going to be a new uncle twice in the same year. Well, I guess only a new uncle the first one...whatever. Both my little sisters are growing up. Wonder when it'll be my turn.
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My friend who is bi-polar hashed it all out with her doctor before she got pregnant. Certian meds she went off of, for a while, during critical development phases. Yeah, it wasn't as good for her mental heath, but in the long run it was better for her baby.
I believe she went off several of them as soon as she found out she was pregnant, and then started phasing some of them back in during the second trimester, after a lot of the critical organ developments had occured.
Though the question really is how stable is she off her meds. If the meds are absolutely crucial to her continued survival, then the stakes are much higher. She really needs to discuss it in depth with her doctor.
I have no experience with the teratogenicity of Tegretol, as that isn't much of an issue in pediatrics. Maybe Theca could help?
AJ's advice is really sound. She needs to have a long discussion with her physician. I'd also recommend making sure she gets the recommended amount of folic acid for a pregnant woman (another cause of neural tube defects), especially a concern if she can't hold down prenatal vitamins. Other than that, I'd be guessing.
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Tegratol is definitely something she might not want to be on during a pregnancy; it causes reproductive problems in women who aren't pregnant (it's been linked to PCOD), and does increase the risk of neural tube and other defects, at least last I heard. She really needs to talk to her doctor and see if she can change meds for a little while. Also, if she's on other meds, she needs to discuss them as well-- especially lithium, which can cause cleft palates and spina bifida.
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She obviously needs to talk to her doctor again, but I'm just looking around at other opinions, since her doctor advised her to really consider getting an abortion because of the serious risk of spina bifida.
And Tegretol is the only meds she's on, so if there's a possibility of another drug having a chance to do the same job with less harm to the fetus, it's something she should look into.
Thing is, the Tegretol messed up her cycle so much (it also supposedly makes you less fertile, heh), that she may be mostly through the first trimester, which is where most of the damage from Tegretol, if there is any, is done.
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Whoa. She got pregnant unexpectedly? I thought that all young women on Tegretol were supposed to be on some form of birth control, even if they weren't sexually active. And it may decrease the effectiveness of the BC pill, so if the woman was on the pill, she had to use a second form of contraceptive.
That was, like, drilled into me with a 2 by 4. We had to document this in the chart for liability protection.
[ November 18, 2004, 05:24 PM: Message edited by: Sara Sasse ]
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Eddie, there's a whole laundry list of meds that can be effective with bipolar disorder. Tegretol is one of the antiseizure meds (as you know). More of those are depakote, topamax, trileptal (another form of tegretol, causes less problems with the liver), gabitril. Lamictal, another antiseizure, was actually approved for bipolar therapy last year. Lithium is the gold standard. Also used can be the atypical antipsychotics: zyprexa, risperdol, abilify, seroquel, geodone.
I'm sure there's more.
So...yeah. Talking to her doc is good. Posts: 14745 | Registered: Dec 1999
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Nah, I'm sure the doctor will make the right choice for her and the baby...I'm just a little overprotective. Posts: 5264 | Registered: Jul 2002
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Ugh -- she should *not* have been on the shot. If she's planning on going back on birth control post-pregnancy, tell her to do a *lot* of research on Depo-Provera...although it won't take her much to realize how much it completely screws you up. I've read absolute horror stories, and mines not much better -- no shot! Shot bad!
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Tegretol is classified as Pregnancy Category D. This is bad. As you have mentioned, there is a definite risk to the fetus. The good news is that this risk is lower in patients taking only one drug (Tegretol) as compared to patients on combination therapy of multiple anti-epilepsy medications.
There have been women that have carried to term a healthy baby while taking Tegretol, however, I would encourage your sister to have that frequently mentioned talk (as mentioned above several times) with her doctors, for 2 very important reasons:
1. This use of Tegretol is off-label, meaning that it is not indicated for this use by the FDA. This is not always a bad thing. Countless drugs are used off-label for many different conditions or illnesses, but in this case, I would encourage her doctor who prescribed this for bi-polar disorder to find a more appropriate med that is safer during pregnancy, or to have your sister abstain altogether if at all possible while pregnant and nursing. But these are life-altering decisions that should be made by the patient and doctor. There is no easy answer.
2. Although you mentioned the damage has already been done, there are other secondary problems other than spina bifida that medication can cause to an unborn child. The sooner she changes medications, I believe, the better her chances for not damaging her baby.
P.S. Drugs are classified by the FDA as B,C,D, and X. No drug is safe during pregnancy, because drugs are all poisonous in the wrong dosage. Most safe drugs are classified as B, like Tylenol. Class C drugs have not been well studied and cannot be indicated as safe or harmful, and studies are impossible to conduct for ethical reasons and other reasons. Drugs that are class D are known to be harmful and should be avoided, and drugs that are X are contraindicated and should never be used during pregnancy, such as thalidomide.
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I second her not getting back on the shot. While I realize that it doesn't cause bipolar, I imagine it could easily make the symptoms a lot worse. I was on the shot for a short while after using the pill, to prevent ovulation not just pregnancy.
I went off of it for other reasons, but I had no idea how much it really had effected me until I did stop it. She's pregnant now, so she won't see the effects of getting off until perhaps even after she stops nursing. A lot of women like it, but for quite a few women it causes severe depression.
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She shouldn't be on lithium during pregnancy either, even if she didn't. Just in case anyone else in the same situation ever reads this.
If she may be past the first trimester, I think she should consider an amnio. There are all kinds of things that can go wrong from Tegretol besides those detectable by sonogram. Just make sure that it's by someone experienced in amnio, because if it's not, that ups the risk of miscarriage in itself. Even if she's committed to having the baby (as in, she doesn't want an abortion), she should have an amnio so she can be prepared. She may end up deciding that a special needs kid is too much while she's trying to keep her MD under control; she could consider adoption in that case. A genetic counselor could help her explore her options and know what to expect if the amnio comes back positive for any chromosomal abnormality, or if the sonogram shows an abnormality. I hope, of course, that all tests come back normal and she and her baby are healthy and happy, and her MD stays under control post-partum. Best wishes to her, you, and the whole family.
Posts: 21182 | Registered: Sep 2004
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Ketchup Queen I'm thinking by MD you meant Manic Depression, not the traditional meaning? I admit for a while I was trying to figure out why her doctor (MD) was going so out of control...
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Caleb Peter was born at 10:47 this morning, perfect in every way. Has these long, long, long fingers and toes. Gonna be a hit with the ladies.
21 and 1/4 in., 7lbs 5oz.
Sis is doing great, too. Went this whole time with no drugs at all, as it turned out. Well, until the epidural. She looooved that. Made my job of holding her leg a whole lot easier. No stitches or nothin', the lucky wench. Oughta be walking around by evening. Posts: 5264 | Registered: Jul 2002
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Well, I had freakishly long fingers as a newborn, but now they are unusually short, at age 30.
Posts: 3354 | Registered: May 2005
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Wow! You got to be in there with her as brother? That is so cool! Is this the first birth you've witnessed first hand, Frisco?
quote: Has these long, long, long fingers and toes. Gonna be a hit with the ladies.
See how different our minds are? You thought of long fingers as being a hit with the ladies. I read 'long fingers' and think "could be a great pianist". LOL
quote: I thought that all young women on Tegretol were supposed to be on some form of birth control, even if they weren't sexually active.
NONE of the friends I knew who took Tegretol were ever told this. And some of them were sexually active, but were not on birth control. I refused to take it because my cycle was messed up already and I personally knew so many people who got PCOS after taking it, but in the discussion in which I made this clear, birth control was never mentioned. :|
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Eddie you said uncle twice in a year is this the first one or the second one? Congrats anyway, hopefully (for all the little girls out there) he'll grow up to look just like you.
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Well, I guess only a new uncle the first one...whatever. Both my little sisters are growing up. Wonder when it'll be my turn. ![[Razz]](tongue.gif)
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Hard choices.
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