Re­view med­i­ca­tion use be­fore get­ting preg­nant

Cape Breton Post - - Advice/Games - Keith Roach

DEAR DR. ROACH: About 11 years ago, I was given a di­ag­no­sis of bipo­lar disor­der type I. I was fin­ish­ing up the first year of my med­i­cal grad­u­ate school. I have never heard voices or seen things that aren’t there. How­ever,

I ex­pe­ri­ence in­tense in­som­nia from time to time, es­pe­cially dur­ing my fe­male cy­cle. I also don’t han­dle stress very well, and be­come very an­gry and sen­si­tive. I have tried nu­mer­ous an­tipsy­chotic med­i­ca­tions. Most of them make me gain weight, and I just can’t bear the side ef­fects. Cur­rently, I am on Trilep­tal and Latuda, which seem to calm my ner­vous­ness, re­duce my anger and help me sleep through­out the night. I am very ex­u­ber­ant and have a pos­i­tive at­ti­tude in gen­eral.

Now, the big prob­lem is that I would like to have kids with my hus­band, but I don’t want to take med­i­ca­tion while preg­nant. My hus­band thinks we can stop the cur­rent med­i­ca­tion. I am afraid of end­ing up in a psy­chi­atric hos­pi­tal for a 10th time. Any sug­ges­tions? -H.K.

AN­SWER: This is not an easy ques­tion, and it re­quires ex­per­tise from your psy­chi­a­trist and an ob­ste­tri­cian, as well as your reg­u­lar doc­tor. I can’t tell you what to do, but let me ex­plain the is­sues.

Bipo­lar disor­der type I, for­merly called manic-de­pres­sive ill­ness, causes ups and downs in mood. Hal­lu­ci­na­tions can hap­pen, but they are less com­mon than in schizophre­nia. When peo­ple are manic (that’s the tech­ni­cal term for “el­e­vated mood”), their sense of re­al­ity of­ten be­comes dis­torted, and they some­times can be a dan­ger to them­selves or to oth­ers. There is a wide spec­trum of ill­ness. (Bipo­lar II has the de­pres­sive episodes, and some times of el­e­vated mood but never reach­ing full mania, when peo­ple have dif­fi­culty sleep­ing and take on mul­ti­ple tasks at once.) I’m not sure if “very ex­u­ber­ant” means that you have no de­pres­sion or your mood is ab­nor­mally el­e­vated.

Ox­car­bazepine (Trilep­tal), nor­mally used for epilepsy, helps to sta­bi­lize mood in peo­ple with bipo­lar ill­ness. Lim­ited data sug­gest an in­creased risk of birth de­fects, such as cleft palate, and heart de­fects. It should be used only if the risk of not tak­ing it is high.

Lurasi­done (Latuda) is an an­tipsy­chotic: It helps peo­ple to not de­velop a dan­ger­ously el­e­vated mood. There is very lit­tle in­for­ma­tion on Latuda in preg­nancy: There has been no in­di­ca­tion of any kind of birth de­fect. How­ever, chil­dren born to women tak­ing sim­i­lar drugs to Latuda in the third trimester (the last three months of preg­nancy) have had move­ment disor­ders and with­drawal symp­toms when first born. Un­for­tu­nately, I can’t find how of­ten th­ese oc­cur, but they do tend to sub­side af­ter a few hours to days.

Be­cause of the known and un­known risks of th­ese med­i­ca­tions, I would sug­gest that you con­sult with an ex­pert in treat­ing psy­chi­atric ill­ness dur­ing preg­nancy. There are other med­i­ca­tions that have been bet­ter stud­ied and prob­a­bly have less risk than what you are tak­ing. I don’t rec­om­mend com­ing off all your medicines with­out con­sult­ing your doc­tors. Be­ing ad­mit­ted to a hos­pi­tal would not be ideal; how­ever, you could pos­si­bly be a dan­ger to your­self and your un­born baby if you had se­vere symp­toms dur­ing preg­nancy.

READERS: The book­let on her­pes and gen­i­tal warts ex­plains th­ese two com­mon in­fec­tions in de­tail. Readers can ob­tain a copy by writ­ing: Dr. Roach, Book No. 1202, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low 4-6 weeks for de­liv­ery.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the column when­ever pos­si­ble. Readers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2017 North Amer­ica Syn­di­cate Inc. . All Rights Re­served

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