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Higher dose Lamotrigine treatment during pregnancy


During pregnancy, higher dose of Lamotrigine should be considered to treat bipolar disorder, a recent study published in the American Journal of Psychiatry has suggested. Reduced plasma concentration of the drug was observed in pregnant women due to increased metabolic rate. The recommended dosage may not be sufficient to treat the symptoms, the researchers from Northwestern University have suggested. However, the study results were based on small number of participants.


The team assessed the treatment benefits of Lamotrigine in eight expectant mothers. The treatment and clinical history were recorded before and after delivery. Worsening of depression symptoms was observed even after administration of recommended dosage. The researchers believed that increased metabolic rate could be the probable cause. In such patients, reduced energy, happiness with signs of depression was observed.


Physicians should increase drug dosage based on the clinical response, said Dr. Crystal Clark, assistant professor of psychiatry and behavioural sciences, Northwestern University. The drug dosage should be optimized in accordance with the requirement. However, the risk of iatrogenic adverse events in the fetus should be monitored, he noted.


Depression during pregnancy may lead to poor nutritional status, lack of prenatal care and compliance, isolation from family and caregivers. These complications can increase the risk of low fetal birth weight and premature births, Dr. Crystal added.


The present study could help the clinicians to increase the drug dosage in the gestational bipolar disorder patients. The dosage can be gradually reduced after delivery to avoid drug toxicity, Dr. Crystal concluded.

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