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Depression

Question
Posted by: Ash | 2018/06/15

Q.

Risks of taking Epitec during Pregnancy?

I have been on Epitec 100mg twice a day for the past year or so to treat my mood disorder, depression and anxiety. Recently I visit a new psychiatrist and was informed that Epitec can be 100% dangerous during pregnancy due to malformations and disfigurements of the child. On this website I read one of the experts say it is a safe option during pregnancy? I believe it is high risk to take epitec duing pregnancy, but would like some clarification on what the risk entails and the actual statistics. I have reduced my epitec intake to 150mg per day, with help from my psychiatrist, and fear that I may be pregnant. Obviously I haven't told anyone because i'm not sure, but I am terrified that the drug may cause serious defects in the formation of the (possible) baby. So my question is: what are the statistics of epitec during pregnancy? and for how long are you able to take the drug into your pregnancy before any deformation or harm may take place? also, on a scale of 1 - 10, how high is the risk and what would you recommend? Simply searching for a second opinion here.

Expert's Reply

A.

Depression expert
- 2018/06/15

Hi Ash,
Epitec is a trade name for the drug Lamotrigine.  I'm puzzled as to why, but some doctors seem to have become rather too fond of this drug, using it rather too often and too easily. It is meant for treating Epilepsy, and can also be used in treating Bipolar Disorder, though usually not alone.  I am much less convinced that it's sensible to use on its own for treating depression, as some do, where there are alternatives.
There was indeed concern about a potential for the drug to cause foetal abnormalities if taken in pregnancy, which was based on animal studies. But recent studies in humans have not found that effect, and it seems now to be considered probably safe in pregnancy. I'm not aware of the precise dose being considered relevant.  I would generally prefer to avoid prescribing or recommending any drug during pregnancy unless it is really needed to treat or prevent an illness which would probably cause significant risks in its own right. Also, one should assess the status of the condition for which the drug is being taken : is the medication needed NOW ?
Some experts have advised using high dose Folic Acid with Lamotrigine in pregnancy, but others advise against this, as the folic acid interferes with the actions of Lamotrigine. So we get back to re-evaluating whether the drug itself really is needed at this time.
As you can see, the issue is complex, and the available evidence is changing. Discuss this issue with your psychiatrist, and ask for him to explain his advice and to deal with your very sensible concerns.

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