Valproate (brand names Depakote, Epival, Epilim and others worldwide) is linked to an alarming rate of serious congenital anatomical and cognitive defects, and deaths, in babies with in utero exposure. Valproate is used to treat epilepsy but is also a first-line mood stabilizer for bipolar disorders, and prescribed for migraine.

The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) ongoing study is assessing risks with three other drugs tagged as antiepileptics/anticonvulsants as well as mood stabilizers, including lamotrigine and carbemazepine (both also first-line bipolar meds), and a recent article involves data collected 1999-2004 at 25 epilepsy centres. Lamotrigine had a very low incidence of serious adverse effects (1%) while valproate emerged with 20%. For women who may become pregnant the benefits of treatment options must be reconsidered.

“What’s really overwhelming about this finding is not our single study per se, but the sheer volume of evidence [linking valproate to adverse outcomes in infants], all of which has emerged just in the past 2 years,” said Dr. Meador.

“The trouble is, all of this work has been published in specialty journals, so it is unlikely that primary care physicians [and psychiatrists?] are getting the message,” he said. “The word needs to get out that the drug has a 10% to 20% risk of birth defects. This is a clinically important piece of evidence that physicians need to know about.”

Read more in MedScape’s plainly-titled article Valproate Should Not Be Used as First-Line Therapy in Women of Childbearing Age, or if you have subscriber access, read the research article In utero antiepileptic drug exposure: Fetal death and malformations, Meador et al. 2006, Neurology.

It’s neurology news at MedScape, and mainstream news (like Reuters) don’t mention bipolar. I also haven’t seen it yet from bipolar news sources. That maybe speaks against the arbitrary separation of brain disorders and disciplines. Other treatments for epilepsy now used for depression include cutting-edge neurotechnology like the vagus nerve stimulator (VNS) and deep brain stimulation (DBS). No birth defects reported with those.

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From Psych Central's World of Psychology:
Female Hormones, Reward, and Mood - World of Psychology (2/12/2007)

    Last reviewed: By John M. Grohol, Psy.D. on 17 Aug 2006
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