Lamictal and your baby? Maybe not the greatest combination

It can be a quandary if you have epilepsy and you want a child...manage your seizures or have a healthy baby? It's important to work with a physician who knows epilepsy medications inside and out before you get to a point where this is even an issue.

For example, lamotrigine (Lamictal), a medication I know is a favorite in the population I work with because it is less likely to provoke polycystic ovary syndrome than other medications, was reported in the study referenced below, to cause hippocampal and cortical malformations. (The hippocampus is the brain's factual memory center and the cortex is where many "human" executive functions are organized and carried out.) These malformations did not occur at large, research-provoked doses, but rather at blood concentrations in the mother that would be considered clinically effective.

In the same study, topiramate (Topamax), phenobarbitol, and levetiracetam (Keppra) did not have the same effect.

No option will be 100% safe or perfect, that's just how it is with science/medicine. The best defenses you can have if you're a woman with epilepsy in your child-bearing years, is to have or find an epilepsy physician with whom you can develop a collaborative relationship...and to be informed.

Manent JB, Jorquera I, Franco V, Ben-Ari Y, Perucca E, Represa A. Antiepileptic drugs and brain maturation: Fetal exposure to lamotrigine generates cortical malformations in rats. Epilepsy Res. 2008 Feb;78(2-3):131-9. Epub 2007 Dec 31.

What's in your water? And your soap, and your mascara, and your kitchen cleaner...

Since you're reading this post, you're online, and that likely means you've heard the "big" news about what's been found in our water. It's not really new news, but it's important news to pay attention to.

There's a lot of stuff in our water that shouldn't be. And it's been affecting the health of other species for a very long time. There are a whole lot of chemicals in our world that mimic hormones and cause a plethora of health problems. They get into the water too. These compounds are found in most cosmetics (which is why I am beginning to collaborate with Arbonne), many cleaning solvents, inks, fertilizers, paints, basically any chemical that was not known to man before 1900.

It's been a secondary mission of mine to create awareness of this issue, through the connection that these compounds affect hormone balance, which in turn affect mood, fertility, risk of heart disease and diabetes.....etc....etc....etc.

It didn't feel so great to see this on the news yesterday, but it did feel wonderful that a message I've been trying to get out there with my limited resources as a small business person was finally getting major attention. And in an election year, too! So maybe someone will finally grab onto it in a meaningful way. It's not a topic as glamorous as Iraq, or the economy, or what seems to be the political topic du jour...and grotesque birth defects and infertility are not the kind of things that give a candidate pretty, election-winning sound bites. But the issue affects each and every one of us, every day, in some pretty significant ways. I'm very distressed at the number of medications we have placed ourselves on, the rise in infertility, and the medical problems I now see in young people that used to be considered diseases of old age. It's no wonder the residual from that is showing up outside of our bodies.

I really hate the fact that this issue likely means job security for me. I'm trying to put myself out of business so I can improve my golf game!!!

This is not my area of expertise, it's merely a point of interest and something I am committed to providing awareness of. The website I've used for years, which is well researched and referenced, is http://e.hormone.tulane.edu. (Note there is no "www" in the URL.) They even have an annual conference on the topic, which I aspire to get to one of these days.

Maybe I'll see you there.

Folic acid, depression, and Prozac

Folic acid is clearly essential for brain and nervous system health.

When animals are depressed, they have a delayed response to stressful situations. Researchers in this study reported that rats given folic acid who were then forced to swim (a standard test for depression in lab rats, believe it or not!) started swimming sooner than rats who did not receive the supplement.

Folic acid also seemed to promote a synergistic effect with fluoxetine (Prozac), meaning in the presence of folic acid, Prozac was more effective. What this finding has the potential to translate into...is that if you DO need an antidepressant, eating well (or at least taking a multivitamin at the same time)may reduce the dose of the medication you actually need, which in turn reduces the potential for side effects. And side effects are a major reason why people do not maintain compliance with their psychotropic medications.

This seems like it's too simple to be true. But the reality is, when you're depressed, you may not feel like making the effort to eat well. Or, you grab something quick and easy (and likely low in essential vitamins/minerals and high in the wrong kind of fats), which only worsens the depression. If you have time to do only one thing a day that is just for YOU...make it eating well.

Whether it's a Flintstones or a One A Day, consider a multi as an essential part of your mental health bag of tricks!

Brocardo PS, Budni J, Kaster MP, Santos AR, Rodrigues AL. Folic acid administration produces an antidepressant-like effect in mice: Evidence for the involvement of the serotonergic and noradrenergic systems. Neuropharmacology. 2008 Feb;54(2):464-73. Epub 2007 Nov 5.

Your antidepressants and your baby's future drug habit

Whether it's food or drugs, the compounds in your body while your baby is developing can have a significant impact on your child. In this study, it is reported that (in rats) the offspring of mothers who were exposed to fluoxetine (Prozac) had fewer neurons in their nucleus accumbens, as well as less serotonin activity in their raphe nucleus. The nucleus accumbens is a brain region thought to be important in, among other things, reward, addiction, and pleasure. The raphe nucleus, a part of the brain stem, is responsible for releasing serotonin to other parts of the brain. With fewer neurons to tell the brain it's pleased, and less serotonin to help regulate mood, scientists wondered about the practical implications of these findings.

So....they put the offspring in a situation where they had free access to cocaine. Using a maze, they conditioned rats to associate a specific location of that maze with cocaine. Actually, the rats exposed to their mother's Prozac were a lot less active in the maze than rats who didn't have this exposure. However, those rats who did use the maze showed a preference for the location that had been associated with cocaine. When the cocaine was gradually removed from the protocol, Prozac-exposed rats took 350% longer to stop looking for the cocaine.

I don't need to add a comment, this study speaks for itself.

Forcelli PA, Heinrichs SC. Teratogenic effects of maternal antidepressant exposure on neural substrates of drug-seeking behavior in offspring. Addict Biol. 2008 Mar;13(1):52-62. Epub 2007 Sep 11.

Are you epileptic? Another reason to use folic acid during pregnancy

Most women these days are advised to use a folic acid supplement, even if they are not intending to become pregnant but there is a possibility that they might. In this study, researchers were interested to see if the incidence of birth defects in babies born to women using antiepileptics would be reduced if these women also took folic acid.

The medication history of the mothers of children born with birth defects was compared to the medication history of mothers whose children were not born with birth defects. The particular medication category of interest to these researchers was antiepileptics: carbemazepine (Tegretol), phenobarbital, phenytoin (Dilantin), and primidone (Mysoline).

The researchers found that if the mothers were using any of these medications, and they also used folic acid, that the risk of birth defects was decreased. It is important to note, however, that this risk did not completely go away.

It seems as though some of the best insurance for mothers and potential mothers is a simple folic acid supplement. Also, if you're thinking of becoming pregnant, or sexually active, it's important to let the caregiver managing your epilepsy know this, so that a treatment plan most beneficial to both mother and baby can be implemented.

I have to interject here, one of the most effective natural therapies for epilepsy, is fish oil. I get so frustrated that we encourage pregnant women not to eat fish, but then we seem to be ok giving them medications that might be worse! The recommendations for fish during pregnancy DO NOT say don't eat fish at all. They advise against four types of fish: shark, tilefish, King mackerel, and swordfish. If you're STILL hesitant about eating fish...you can either take a supplement that has been molecularly distilled, thereby removing the mercury, or you can use an algal-based supplement that is mercury free.

It's a very simple solution with the potential to put many researchers and drug company employees out of work, but this is not about who gets to work and who gets to make money. The last I heard, working in health care was about keeping people safe and healthy!

Kjaer D, Horvath-Puhó E, Christensen J, Vestergaard M, Czeizel AE, Sørensen HT, Olsen J. Antiepileptic drug use, folic acid supplementation, and congenital abnormalities: a population-based case-control study. BJOG. 2008 Jan;115(1):98-103. Epub 2007 Nov 12.

Mania and free fatty acids

Plasma free fatty acids (primarily omega-3's) have gained much attention for their therapeutic potential in many psychiatric diagnoses--including depression, anxiety, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, schizophrenia, post-traumatic stress disorder, and bipolar disorder. Now researchers are discovering that the level of these fatty acids in the blood may actually influence the symptom severity of these illnesses.

In this particular study, done in patients with bipolar disorder, medication-free patients who were seeking help for a manic episode had their blood tested for free fatty acid levels. These levels were compared to those in individuals who did not have bipolar disorder. In the manic individuals, the lower the levels of arachidonic acid (AA) or eicosapentaenoic acid (EPA), the worse the manic symptoms were. The greater the AA/EPA ratio, the worse the manic symptoms were.

In plain English? While the diets of these individuals were not analyzed, it is well-established that a diet high in fish and omega-3's promotes good EPA levels. A diet high in meat and pro-inflammatory oils (those "S" and "C" oils I like to refer to), the higher the AA levels.

So...eat a lot of meat and processed foods with the wrong kinds of fat, and your bipolar disorder stability might pay the price. Focus on fish, flax, and nuts...and you might not need as many emergency room visits.

It's kind of a catch-22. In working with bipolar disorder, it seems that the very foods that cause trouble are the very foods these individuals seem to crave. It can take a concerted effort to stay on track with nutrition. However...what I do notice is that if these individuals DO stick with the plan and pull their nervous systems back into balance, the cravings eventually lessen and appetites for healthier food begin to surface.

I've been in the presence of a client in the middle of her mania. At least from my shoes, on the outside looking in, knowing what danger her state put her in, I'd highly recommend making the effort and minimizing the manic episodes.


Sublette ME, Bosetti F, DeMar JC, Ma K, Bell JM, Fagin-Jones S, Russ MJ, Rapoport SI. Plasma free polyunsaturated fatty acid levels are associated with symptom severity in acute mania.Bipolar Disord. 2007 Nov;9(7):759-65.

Melatonin and REM sleep behavior disorder

REM sleep behavior disorder is a condition in which a person acts out dreams during his or her sleep...understandingly, it can be dangerous for that person's bed partner!

What is important to know, is that there is a link between this disorder and Parkinson's disease. So anything you can do to discourage the nervous system from progressing in this direction can be crucial.

Researchers recently reported that a variety of medications can be helpful in treating REM sleep disorder, especially clonazepam (Klonopin). Second in line was a natural hormone that is available as an over the counter supplement, melatonin.

While the researchers promoted clonazepam as their first choice, I would have to put my money on melatonin. Not only is it a sleep enhancer, it is a very powerful antioxidant, which means it can not only help with current symptoms, but do that preventive work I mentioned.

One of the biggest problems with the way medicine is practiced, in my opinion, is that we tend to focus on the current problem and what band-aid...er...drug...we can prescribe, to feel like we've fixed the problem. Rarely do we look deeper to the core issue. And that's why so many people are on so many medications today.

I can guarantee you, people with REM sleep disorder are not having problems because their bodies are deficient in clonazepam! But they could be having trouble with melatonin metabolism. Which is why this option makes so much sense to me.

Gugger JJ, Wagner ML. Rapid eye movement sleep behavior disorder. Ann Pharmacother. 2007 Nov;41(11):1833-41.

Bubenik GA, Blask DE, Brown GM, Maestroni GJ, Pang SF, Reiter RJ, ViswanathanM, Zisapel N. Prospects of the clinical utilization of melatonin. Biol Signals Recept 1998 jul-Aug;7(4):195-219.

Deigner HP, Haberkorn U, Kinscherf R. Apoptosis modulators in the therapy of neurodegenerative diseases. Expert Opin Investig Drugs 2000 Apr;9(4):747-64.

Srinivasan V, Pandi Perumal SR, Maestroni GJ, Esquifino AI, Hardeland R, Cardinali DP. Role of melatonin in neurodegenerative diseases. Neurotox Res 2005;7(4):293-318.

Antolin I, Mayo JC, Sainz RM, del Brio Mde L, Herrera F, Martin V, Rodriguez C. Protective effect of melatonin in a chronic experimental model of Parkinson's disease. Brain Res 2002 Jul 12;943(2):163-73.

Mayo JC, Sainz RM, Tan DX, Antolin I, Rodriguez C, Reiter RJ. Melatonin and Parkinson's disease. Endocrine 2005 Jul;27(2):169-78.