Comparative analysis of postpartum depression incidence in patients with epilepsy on levetiracetam or lamotrigine monotherapy during pregnancy.

The objective of this study was to investigate differences in the rates of postpartum depression (PPD) among patients with epilepsy treated with either lamotrigine (LTG) or levetiracetam (LEV) monotherapy, two commonly prescribed anti-seizure medications (ASMs) during pregnancy, with differential effects on mood. This is an observational study of 84 pregnancies monitored at Brigham and Women's Hospital Epilepsy-Obstetrics clinics between January 2018 and June 2022. Clinical information on patient demographics, medical history, seizure types and frequency, and postpartum mood was collected. PPD was observed in 10 of the 84 pregnancies analyzed (11.9 %), as indicated by an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 approximately six weeks post-delivery. We found that rates of PPD did not differ significantly by ASM (P = 1.0): 10.4 % of pregnancies managed with LTG monotherapy were associated with a PPD episode, as compared to 13.9 % of pregnancies managed with LEV monotherapy. Analysis suggested higher PPD risk with antidepressant use in pregnancy and non-white race, and a possible protective effect of breastfeeding and multiparity. In conclusion, we found no difference in PPD incidence between patients on LTG and LEV monotherapy, despite the ASMs' varied mood-related effects.