Q:  Pregnancy & Meds --Topomax & Psoriasis

I have a two part question:

First and foremost, I am pregnant.  My obgyn recently put me on Topomax 200mg a day and EffexorRX 75mg a day at my req as I am bipolar.  I am at the end of my second trimester at 5 months.  I discussed the risks of the drugs prior to taking them, but still feel uneasy about it.  Can you please tell me more about pregnancy and bipolar medication?

Secondly,  I also have psoriosis ( a skin condition in which the skin cells produce faster than the body can shed them) which seems to get worse when I take some medications such as litium and now one of the two I am on now (topomax & effexor).  Please tell me that it isn't my beloved topomax that casues my condition to worsen.  Is there any bipolar meds that don't irritate psoriosis?


Dear Heather -- 

I’ve gotten way behind on replies so am opting for now to be "short and sweet" (hopefully, and hopefully still useful):

First, re: pregnancy -- wow, too complicated for here.  However, you're beyond the trimester where everyone worries about medication effects.  Most psychiatrists I've read on this would go ahead and use lithium or Depakote or Tegretol now.  Don't know as much about Topomax in this context.   Getting more opinions about your options, including if possible from a psychiatrist with experience managing pregnancies, might be a good idea. 

Second, Topomax and psoriasis?  A search (Medline, and Google) of "topiramate psoriasis" yielded no connections, nor have I seen it.  However, haven't seen it with Effexor either.  However, there are couple of reports of psoriasis (maybe not your type, though?) and pregnancy, e.g this one.  

Lithium is widely known and consistently linked to psoriasis.  I actually had to look it up (Medline again) to see if others are -- and valproate and carbamazepine have been associated, but only very weakly by the source I just examined, e.g. this one (not a widely read journal).  I'm not sure I've ever seen them make it worse; of course, I'm going to look closer now.  Thanks for your question. 

Dr. Phelps