Expert: Jennifer - 4/14/2010

Question
QUESTION: Hello, How are ya?

I was trying to find information about depakote and trying to conceive, but I can't find much other than depakote could cause fertility issues in women. Is this true?! Is there a different medication I can ask the doctor to place me on? I'm allergic to lamictal and currently I'm seeing a new doctor, he boosted up the level of my depakote and wants me to do a blood test before he goes further as to what medication would be best for me. BUT I haven't told him that I'm trying to conceive, I have this fear of telling him because of how I was treated by my previous doctor. Such as I'm afraid he would say that it wouldn't be a wise decision to have a baby since I'm bipolar.
I know in your profile it says your knowledge is based on reading and such, but I figured you could be the best help as you may be able to provide some helpful links or give some advice as to how to talk to the doctor about switching medication and my reason for wanting to.

Thank you in advance

ANSWER: I won't lie, there's little information on medications (including depakote)in regards to women trying to have a child.  What little there is seems to fall into the category warning of potential birth defects that can occur, with one of the most commonly seen problems are 'neural tube defects'. You can find information of a general nature at nih.gov, nimh.gov, both of which provide a link to medlineplus.gov for people looking for medical information and related topics such as medications.

It is very important that you discuss your plans to have a child.  Any psychiatrist will ask if you've considered all of the things involved with a pregnancy, it's their job to make sure that you have.  Still, any doctor worth sticking with won't stop there - they'll work with the patient to make sure that they get what they need before, during, and after a pregnancy as best as they can.  You should give this information to your doctor in a straight-to-the-point manner; tell them that you're trying to conceive, and need an appropriate treatment strategy that takes this into account without endangering you or the health of the developing child. Let me know if I can be of any further assistance, and I'd love to hear back from you regarding pregnancy and your experiences during that time - it's a way of providing information for others out there who find themselves in a similar situation in the future.  Good luck!

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QUESTION: this is mostly my mind going into hyper-drive and assuming what he'll say.  I shouldn't make an assumption based on past experiences with my previous doctor.

I'm also concerned with whether or not depakote has bad effects on the reproductive system. I'm completely normal in my cycles, and my gynecologist(SP) said I am perfectly healthy. Yet I cannot conceive, and my husband is healthy in that department as well. I'm just wondering if the depakote is somehow messing with my system, and making conceiving that much more difficult. Would taking folic acid be a bad idea? I mean without talking to him first. I'm on lithium, depakote and synthroid. These meds are what the old doctor put me on, and I haven't gone in for my blood test yet to see where my levels are. But is folic acid something I can take that isn't going to affect the current medication I'm on?

Have you ever come across anything that states whether there's been a connection between fertility and depakote? Like you said, it's difficult to find ample information.
I will definitely keep you posted, If I can at least help one person it'll make me happy.  I know there's so many hopeful potential moms out there, and where there's hope there's a chance :)
Thanks for answering quickly, and forgive me bc I sometimes tend to ramble before I even ask a question lol.

ANSWER: What medical condition did your doctor prescribe synthroid for? This may be the reason you are having difficulty conceiving, as it is a synthetic hormone commonly used in women who have reached menopause and wish to begin hormone replacement therapy.  In younger women, it normally "tricks" the body into thinking that it has entered menopause.  Since you are taking both lithium and depakote, it is recommended that you regularly go in and have blood tests to make sure that the serum level for each is in the therapeutic range, especially lithium which can 'accumulate' in your system and become toxic.  I don't know a lot about your meds in terms of whether it's a good idea for them to be combined with folic acid, thus advise discussing this with your doctor before taking it.

If your general practitioner is the doctor you see for treating your bipolar disorder, you may find that changing to someone who specializes in treating psychiatric disorders exclusively will be a positive thing.  Of course, you'll still need to see your ob/gyn on a regular basis - especially during a pregnancy - but most general practice physicians simply don't have the kind of training or experience to address the needs of patients seeking treatment for psychiatric illnesses and many require documentation of a diagnosis from a psychiatrist before they'll start prescribing any medication or take on the job of regular monitoring of such treatment.

One last thing - I wouldn't stress too much over how long it takes to conceive; you and your husband have seen a doctor and told that you're both healthy, medications can be adjusted or changed fairly easy, and worrying can make it seem a longer wait/bigger concern than it needs to be.  Many times couples are so worried and anxious, but if they can manage to put things into perspective and let things go back to being about more than just having a baby - they finally succeed in getting pregnant. Arrange for regular time where you and your husband can enjoy being alone together, without it getting to a point when both sides are on auto-pilot and too focused on conceiving, and let things happen naturally. Good luck and let me know if I can help with anything further, and of course I'm looking forward to the updates!

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QUESTION: wow, there's a lot of things my previous doctor didn't tell me. She's a psychiatrist, and you would think that she would've educated me instead of just saying that "synthroid will help with your thyroid and mood." Originally she put me on lithium as a starter stabilizer. 2 years go by, I  had lab tests, they were all fine. Then one lab test in particular, she said my thyroid levels were borderline low, and just sticks me on synthroid that day. It's been about 4? years since I started taking synthroid. Now when I first started taking any type of medication, I had no clue what these meds could and could not do. Noone took the time to explain,even when I asked questions I got short unclear answers. But from what I understand now...Am I basically stuck taking synthroid forever?

Answer
From the information you've given, I can't see any reason that would make it necessary for you to take synthroid "forever", but you should never stop a medication without consulting a doctor about doing so first.  You don't need to ask the same doctor who prescribed it to you, but you do need to get an appointment with a doctor regarding the matter.  

It is critical to ask the important questions whether it's a regular checkup appointment or you're beginning a complex treatment strategy that is intended to be ongoing throughout your life.  If you don't know what a medication is for and why it's being prescribed you're hurting yourself more than you may think; anyone with a chronic condition needing frequent visits to the doctor for maintenance/review of their health and assessment of whether the treatment is working adequately or needs to be adjusted or changed has an even greater responsibility to be their own advocate and a smart consumer. A doctor of any type should know about anything you're experiencing that isn't normal for you.  I don't want to alarm you, but the current legal climate surrounding some medications and treatments under scrutiny, some because the doctors involved were making bad decisions - none of us can take for granted that if its from a medical professional it must be appropriate not to mention safe.  If the answers you get aren't clear or don't feel adequate, keep asking for answers until they are.  You may need to ask other medical professionals or even go higher up, asking the governing agencies who are charged with overseeing what is allowed for use by the public consumer and what for. Sometimes the people we go to when we have a health issue are going to be reliable and adequately trained to help; it's not that we should worry about there being a large number of doctors who aren't acting in the best interests of their patients, it's that the few that are out there have the potential to hurt someone - usually many someones.  This is why being your own health advocate is vital. If you have any further questions I'm here to answer them the best I can. Good luck!