Wesseloo Richard, Liu Xiaoqin, Clark Crystal T, Kushner Steven A, Munk-Olsen Trine, Bergink Veerle
Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands.
Aarhus University, National Centre for Register-based research, Aarhus, Denmark.
J Affect Disord. 2017 Aug 15;218:394-397. doi: 10.1016/j.jad.2017.04.070. Epub 2017 May 3.
Women with bipolar disorder are at high risk for relapse/recurrence postpartum. Among all mood stabilizers, lithium has the largest evidence base for efficacy in the peripartum period, but lamotrigine is increasingly prescribed for bipolar spectrum disorders during pregnancy. The aim of this study was to investigate whether lamotrigine use during pregnancy is as effective as lithium in the prevention of severe episodes postpartum.
Danish national registries were used to identify pregnancies of women with a diagnosis of bipolar spectrum disorders at the time of conception who used lamotrigine or lithium during pregnancy. We compared the risk of inpatient psychiatric admission within three months postpartum between women who used lamotrigine (N=55) versus lithium (N=59) during pregnancy. A logistic regression model was used to calculate crude and adjusted odds ratios.
We did not find a significant difference in the risk of postpartum psychiatric admission between women who used lamotrigine versus lithium during pregnancy (7.3% versus 15.3% respectively, adjusted OR 0.83; 95% CI 0.22-3.14). We adjusted for year of delivery, parity, previous admissions and antidepressant/benzodiazepine use during pregnancy. Other variables did not differ substantially between groups.
We used an observational design and therefore patients were not randomized to lamotrigine or lithium. The study has a small sample size.
Lamotrigine was not inferior to lithium in the prevention of severe postpartum episodes. Our findings suggest lamotrigine could be a reasonable alternative treatment option for bipolar disorder during pregnancy in patients with vulnerability for depression and may prevent severe episodes postpartum.
双相情感障碍女性产后复发/再发风险较高。在所有心境稳定剂中，锂盐在围产期疗效的证据最为充分，但在孕期双相谱系障碍患者中，拉莫三嗪的处方量日益增加。本研究旨在探讨孕期使用拉莫三嗪预防产后严重发作是否与锂盐同样有效。
利用丹麦国家登记系统，识别出在妊娠时诊断为双相谱系障碍且孕期使用拉莫三嗪或锂盐的女性的妊娠情况。我们比较了孕期使用拉莫三嗪（N = 55）与锂盐（N = 59）的女性产后三个月内住院精神科治疗的风险。采用逻辑回归模型计算粗比值比和调整比值比。
我们发现孕期使用拉莫三嗪与锂盐的女性产后精神科住院风险无显著差异（分别为7.3%和15.3%，调整后OR为0.83；95%CI为0.22 - 3.14）。我们对分娩年份、产次、既往住院情况以及孕期使用抗抑郁药/苯二氮䓬类药物进行了校正。两组间其他变量无显著差异。
我们采用的是观察性设计，因此患者未被随机分配至拉莫三嗪或锂盐组。本研究样本量较小。
在预防产后严重发作方面，拉莫三嗪并不劣于锂盐。我们的研究结果表明，对于有抑郁易感性的双相情感障碍患者，拉莫三嗪可能是孕期合理的替代治疗选择，且可能预防产后严重发作。
