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psychcns
psychcns, Nurse
Category: Mental Health
Satisfied Customers: 79
Experience:  Advanced Practice Psychiatric/Mental Health Clinical Nurse Specialist with Prescriptive Privileges
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stop lamictal b/c pregnancy

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I am 4 weeks pregnant and on lamictal 100mg. Can I just stop taking or do I need to wean off? I am worried about birth defects.  Forgot to add, Bipolar II mainly depression with some hypomania.  I am on nothing else but I just need to know if physically it is safe to stop cold turkey?

psychcns :

Hello. The package insert says to wean off gradually over a 2 week period. That being said, I have had clients stop it cold turkey at higher dosages and not have any problems.

psychcns :

You are not on a really high dosage, so, that's good.

psychcns :

I have some clients who are really unstable off their meds and the benefit outweighs the risk for them to continue it during pregnancy...Ideally, nothing during pregnancy, of course. I like my pregnant clients to come off meds when possible and just follow more closely with a therapist during pregnancy.

Customer:

Do you think maybe 50mg for a week and 25mg for 1/2 will be safe for baby?

psychcns :

I would tell a client of mine who was on 100mg to cut in half for a week then stop it.

Customer:

I have severe depression so I am going to ask to be put on an antidepressant or do you think fish oil would work as well?

psychcns :

If you remember, the starting titration was over a five week period....25mg daily for two weeks then 50mg daily for two weeks then 100mg for one week and then I usually go to 200mg week 6.

psychcns :

If you have severe depression, no, I don't thin Fish Oil will get it.

Customer:

What is the safest anti-depressant during pregnancy and what dose would your recommend

psychcns :

You should make sure you communicate between your psychiatrist and OB/GYN to get their take on which antidepressant they are most comfortable with during pregnancy and, if you plan on breastfeeding.

psychcns :

Zoloft and Prozac have a lot of studies....of course, all of them have pregnancy classifications.

psychcns :

Wellbutrin I don't believe does but it is not the best for anxious people...

Customer:

Are any category B? Is Buspar considered safe? I am going to breastfeed.

Customer:

I have a lot of anxiety

psychcns :

Not to my knowledge, they are category C.

psychcns :

But, if you are an anxious wreck and depressed to the point you can't function and attend to your or the baby's needs then the benefits of being medicated definitely outweigh the risks.

psychcns :

Are you on an antidepressant now?

psychcns :

The problem with being on an antidepressant alone without a mood stabilizer in BiPolar is it can induce mania or make you ride the emotional roller coaster up and down even faster.

psychcns :

Buspar is a category B.

Customer:

No I am not. I know but I am still concerned for baby. I have been solely on one before and I have cycled but not sure what to do at this point. This is my second child and I was on very small dose of zoloft during that pregnancy 25mg. I was a wreck though.

psychcns :

Lamictal has a pregnancy register you should be able to access online....the last I looked there was issues with cleft palate associated with taking it during pregnancy.

Customer:

Do you know if it is all doses or just high doses? Can you take while breastfeeding or not?

psychcns :

You mean Lamictal?

Customer:

Yes

psychcns :

Does Lamictal keep you stable?

psychcns :

Let me try to look up the info...might take a little bit to weed through it.

Customer:

For the most part. My doc would like to have me much higher but it affects my memory and hair

Customer:

I still have some hypomania associated with hypochondria, anxiety, and irritability but the depression is mostly absent

Customer:

If I decide to stay on Lamictal and can get by with 50 mg then should I take additional folic acid and would you know how much extra in addition to prenatal vitamin?

Customer:

I have a 3 year old as well and a full time job.

psychcns :

That is the pregnancy registry. It is quite lengthy and detailed but it looks like the later the trimester the less the significant problems.

Customer:

Ok thanks so much for your help!

psychcns :

And, many of them were on significantly higher dosages...as they were using it for seizure disorder...and some were on other anticonvulsants which are also known for birth defects.

psychcns :

I would feel more comfortable if you would ask your OB/GYN about the folic acid.

psychcns :

I wish you the best in your pregnancy ma'am.

Customer:

Ok, I will. Thanks again!

psychcns :

You are certainly welcome.

psychcns :

Take care.

Customer:

You too.

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