Abstract
BackgroundAnticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues.MethodsA retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought.ResultsValproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate.ConclusionWe found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes.
Highlights
Anticonvulsants have been used to manage psychiatric conditions for over 50 years
Anticonvulsants have been used in the management of psychiatric conditions for over fifty years [1,2] in the management of bipolar affective disorder [3]
While carbamazepine is recommended by the Scottish Intercollegiate Guidelines Network (SIGN) as an alternative maintenance therapy to lithium, in patients with bipolar II or where lithium therapy is not tolerated or is ineffective
Summary
Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. While carbamazepine is recommended by the Scottish Intercollegiate Guidelines Network (SIGN) as an alternative maintenance therapy to lithium, in patients with bipolar II or where lithium therapy is not tolerated or is ineffective [3]. Both valproate and carbamazepine are recognised as human teratogens. Mostly in women with epilepsy indicate that both medications independently increase the risk of major congenital abnormalities when administered in the first trimester. This effect is not thought to be related to maternal seizure activity [5]. Carbamazepine is associated with higher rates of neural tube defects, cardiovascular and urinary tract abnormalities [9] and there is some evidence that it reduces birth weight [10], reduces fetal head circumference [11] and reduces gestational age at delivery
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