Brief Report Lamotrigine in bipolar disorder: efficacy during pregnancy Bipolar disorders (BPD) have a high prevalence, morbidity burden, and mortality risk among women of childbearing age. Nevertheless, remark- ably little is known about: (i) possible influences of pregnancy on the course of BPD; (ii) comparative effectiveness of specific mood-stabilizing treatments in pregnancy; or (iii) their maternal and fetal safety (1–3). Recent evidence indicates that the rates of BPD recurrence, particularly early depressive epi- sodes, are very high during pregnancy (2, 4–7). Exposure early in pregnancy to some anticonvul- sants used to treat BPD (e.g., carbamazepine, divalproex) or to lithium increases risk of fetal teratogenic effects, but the reproductive safety of most other mood stabilizers remains uncertain (3, 8). Concern about potential risks often leads clinicians to recommend discontinuing mood- stabilizing treatment in anticipation of pregnancy, despite high risks of maternal morbidity and the potential adverse impact of maternal distress on fetal development (9). Newport DJ, Stowe ZN, Viguera AC, Calamaras MR, Juric S, Knight B, Pennell PB, Baldessarini RJ. Lamotrigine in bipolar disorder: efficacy during pregnancy. Bipolar Disord 2008: 10: 432–436. ª Blackwell Munksgaard, 2008 Objective: Clinical management of bipolar disorder (BPD) patients during pregnancy is a major challenge. The high risk of bipolar depression during pregnancy encourages consideration of lamotrigine (LTG). We therefore compared recurrence risks among pregnant women with BPD treated with LTG to those discontinuing mood stabilizer therapies. Methods: We compared risks and weeks to new DSM-IV illness- episodes among 26 initially clinically stable pregnant women diagnosed with DSM-IV BPD who continued LTG treatment to those discontinuing all mood stabilizer treatment during pregnancy. Results: The risk of new illness-episodes with LTG was 30% versus 100% after discontinuing mood stabilizers, and survival-computed time- to-25%-recurrence was 28.0 versus 2.0 weeks (v 2 = 17.3, p < 0.0001; hazard ratio = 12.1; 95% confidence interval = 1.6–91.7). Conclusions: Discontinuing mood stabilizer treatment presents high risks of illness-recurrence among pregnant women diagnosed with BPD. LTG may afford protective effects in pregnancy, and its reported fetal safety compares favorably to other agents used to manage BPD. D Jeffrey Newport a , Zachary N Stowe a,b , Adele C Viguera c , Martha R Calamaras a , Sandra Juric a , Bettina Knight a , Page B Pennell d and Ross J Baldessarini c a Department of Psychiatry, b Department of Gynecology / Obstetrics, Emory University School of Medicine, Atlanta, GA, c Department of Psychiatry, Harvard Medical School, Boston, MA, d Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Key words: bipolar disorder – lamotrigine – mood stabilizers – pregnancy – treatment discontinuation – women Received 15 February 2007, revised and accepted for publication 30 April 2007 Corresponding author: D Jeffrey Newport, MD, Department of Psychiatry, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6100, Atlanta, GA 30322, USA. Fax: +1 404 778 2535; e-mail: jeff.newport@emory.edu DJN has received research support from Eli Lilly & Co., GlaxoSmithKline, Janssen, Wyeth, NARSAD and NIH; and speakers honoraria from AstraZeneca, Eli Lilly & Co., GlaxoSmithKline, and Pfizer. ZNS has received research support from GlaxoSmithKline, NIH, and Wyeth; has served on the advisory boards for Wyeth, Bristol-Myers Squibb and GlaxoSmithKline; and has received speakers honoraria from Eli Lilly & Co., GlaxoSmithKline, Pfizer, and Wyeth. ACV has received research support from AstraZeneca, a Harvard Medical School Fellowship, NARSAD, NIH, and the Stanley Institute; and has served as a consultant or received speakers honoraria from GlaxoSmithKline and Novartis. MRC and SJ have received NIH research support. BK has received research support from Bristol-Myers Squibb, Cyberonics, Eli Lilly & Co., Forest, Janssen, NIH, Novartis, and Wyeth. PBP has received research support from GlaxoSmithKline, NIH, and Pfizer; has served on the advisory boards for GlaxoSmithKline, SleepMed Digitrace, and UCB Pharma; and received speakers honoraria from GlaxoSmithKline and UCB Pharma. RJB has had research or consulting relationships but no equity holdings with the following companies: Auritec, Biotrofix, Eli Lilly & Co., IFI SpA, Janssen, JDS, Merck, NeuroHealing, Novartis, and Solvay, as well as NIH grant support. Bipolar Disorders 2008: 10: 432–436 Copyright ª Blackwell Munksgaard 2008 BIPOLAR DISORDERS 432