Q:  Pregnancy and Depakote

I am only in my 9th week of pregnancy and I have been off my Depacote for 4 weeks now.  I'm losing it.  I can't deal with our children and I'm scared.  I am usually very capable, loving, and organized as a mother and wife but I don't know if I'm going to make it.  They let me continue my Zoloft of 200mg. daily, I have been of antidepressants with my previous pregnancies.  It's not doing the job.  We had just found an o.k. dosage of the Depacote, 1000mg.  when I became pregnant witch was not planned.  I really want this baby to comlete our family but I'm feeling awful.  I feel like I wish I didn't have a family so I could end things.  Is there anything else that can be moderately used during pregnancy?  If not, when can I begin my Depacote?  Please help.

Thank you,

Dear Ms. S' -- 
You're in a very tough spot; sorry to hear of it.   The choices you have are going to be tough, too; and will involve balancing risks.  As you probably know, many pregnancies turn out ok even if Depakote was taken throughout.  Risk is lower if the mother takes folate, which lowers slightly the risk of a "neural tube defect" that Depakote can cause.  And the risk of Depakote goes down after the first trimester, so you only have a few weeks to go before some new options (e.g. resuming Depakote, which some even regard as safe during breastfeeding) open up.  

However, these are very tricky decisions and should be made with your family and your doctor.  You can look at the risk of other medications like lithium, versus medications with virtually unknown risk in this situation like Zyprexa (olanzapine), or the older antipsychotics that have much less risk by comparison with lithium or Depakote but might not help as directly with symptoms you have.  

Obviously when you begin to think about wanting to end things, that is not good for your baby-to-be either, if something actually were to happen.  So if you start thinking like that too much, especially if you start thinking about how and when to take an action, then you have an emergency that must be addressed, even if it means taking greater risk to your baby.  I hope you don't face that situation, but if you do, make sure you tell somebody.  The risk to your baby even if you started Depakote today is not so great that some doctors wouldn't have you just get going immediately, so I hope you can get a discussion going soon about your options.  

Dr. Phelps

Published May, 2001