Medicines related to valproate: risk of abnormal pregnancy outcomes

The below text is a press release from MHRA (Medicines Healthcare Regulatory Agency) with regards to Epilim……. INFACTS figures are somewhat different to theirs

Children exposed in utero to valproate are at a high risk of serious developmental disorders (in up to 30-40% of cases) and/or congenital malformations (in approximately 10% of cases).

  1. Risk of abnormal pregnancy outcomes
  2. Treatment during pregnancy
  3. Further information
  4. Usage during pregnancy in the UK
  5. Future action
  6. Call for reporting
  7. Further materials

This is to inform you of important new information and strengthened warnings related to safety of medicines related to valproate (sodium valproate, valproic acid [brand leader: Epilim] and valproate semisodium [brand leader: Depakote]), following completion of a Europe-wide review:

  • children exposed in utero to valproate are at a high risk of serious developmental disorders (in up to 30-40% of cases) and/or congenital malformations (in approximately 10% of cases)
  • valproate should not be prescribed to female children, female adolescents, women of childbearing potential or pregnant women unless other treatments are ineffective or not tolerated
  • valproate treatment must be started and supervised by a doctor experienced in managing epilepsy or bipolar disorder
  • carefully balance the benefits of valproate treatment against the risks when prescribing valproate for the first time, at routine treatment reviews, when a female child reaches puberty and when a woman plans a pregnancy or becomes pregnant
  • you must ensure that all female patients are informed of and understand:
    • risks associated with valproate during pregnancy
    • need to use effective contraception
    • need for regular review of treatment
    • the need to rapidly consult if she is planning a pregnancy or becomes pregnant

Please refer to the General Medical Council’s consent andprescribing guidance.

Risk of abnormal pregnancy outcomes

Valproate is associated with a dose-dependent risk of abnormal pregnancy outcomes, whether taken alone or in combination with other medicines. Data suggest that when valproate is taken for epilepsy with other medicines, the risk of abnormal pregnancy outcomes is greater than when valproate is taken alone.

The risk of congenital malformations is approximately 10 % while studies in preschool children exposed in utero to valproate show that up to 30-40% experience delays in their early development such as talking, and/or walking, have low intellectual abilities, poor language skills and memory problems.12345

Intelligence quotient (IQ) measured in a study of 6 years old children with a history of valproate exposure in utero was on average 7-10 points lower than those children exposed to other antiepileptics.6

Available data show that children exposed to valproate in utero are at increased risk of autistic spectrum disorder (approximately three-fold) and childhood autism (approximately five-fold) compared with the general study population Limited data suggests that children exposed to valproate in utero may be more likely to develop symptoms of attention deficit/hyperactivity disorder (ADHD).789

Given these risks, valproate for the treatment of epilepsy or bipolar disorder should not be used during pregnancy and in women of child-bearing potential unless clearly necessary ie in situations where other treatments are ineffective or not tolerated.

Carefully balance the benefits of valproate treatment against the risks when prescribing valproate for the first time, at routine treatment reviews, when a female child reaches puberty and when a woman plans a pregnancy or becomes pregnant.

If you decide to prescribe valproate to a woman of child-bearing potential, she must use effective contraception during treatment and be fully informed of the risks for the unborn child if she becomes pregnant during treatment with valproate.

Treatment during pregnancy

If a woman with epilepsy or bipolar disorder who is treated with valproate plans a pregnancy or becomes pregnant, consideration should be given to alternative treatments.

If valproate treatment is continued during the pregnancy:

  • the lowest effective dose should be used and the daily dose should be divided into several small doses to be taken throughout the day – the use of a prolonged release formulation may be preferable to other treatment forms
  • initiate specialised prenatal monitoring in order to monitor the development of the unborn, including the possible occurrence of neural tube defects and other malformations
  • folate supplementation before the pregnancy may decrease the risk of neural tube defects common to all pregnancies; however the available evidence does not suggest it prevents the birth defects or malformations due to valproate exposure

Further information

The Cochrane review10 published in November 2014 assessed 22 prospective cohort studies and 6 registry studies. The review supported findings from the European review that children exposed to valproate in utero were at an increased risk of poorer neurodevelopmental scores compared to the general study population both in infancy and when school aged.

A dose-related risk of developmental disorders was reported for valproate in 6 of the 28 studies included in the Cochrane review. However, based on the available data, it is not possible to establish a threshold dose below which no risk of developmental disorders exists.

Usage during pregnancy in the UK

Data from the Clinical Practice Research Datalink suggest that approximately 35,000 women aged 14 to 45 per year had a prescription for sodium valproate between 2010 and 2012, the majority for epilepsy. Of these, at least 375 per year had a prescription for sodium valproate while pregnant.

Future action

Pharmaceutical companies holding licences for valproate containing medicines must monitor the usage of these medicines to assess the effectiveness of these new measures on reducing the number of pregnant women taking valproate. We will continue to monitor valproate usage using the Clinical Practice Research Datalink. We will also work with stakeholders such as clinical guideline bodies to develop tools to aid decision-making for healthcare professionals and patients. We have already developed information booklets for healthcare professionals and patients (see further information below).

The product information will now be updated to reflect our current understanding of the available evidence and to make information as clear as possible.

Educational materials are available to healthcare professionals and patients in order to inform about the risks associated with valproate in female children, female adolescents, women of childbearing potential and pregnant women (see further materials below).

Call for reporting

Valproate is now a black triangle medicine and is subject to additional monitoring. Therefore please report any suspected side effects to valproate via the Yellow Card scheme www.gov.uk/yellowcard.

Further materials

Guide for healthcare professionals Jan 2015

Valproate booklet for patients Jan 2015

Summaries of product characteristics and patient information leaflets

Letter sent to healthcare professionals 21 Jan 2015

Information from the European Medicines Agency Nov 2014

Article citation: Drug Safety Update volume 8 issue 6 January 2015: 1

  1. Meador K, Reynolds MW, Crean S et al. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81(1):1-13.
  2. Meador KJ, Penovich P, Baker GA, Pennell PB, Bromfield E, Pack A, Liporace JD, Sam M, Kalayjian LA, Thurman DJ, Moore E, Loring DW; NEAD Study Group. Antiepileptic drug use in women of childbearing age. Epilepsy Behav. 2009;15(3):339-43.
  3. Bromley RL, Mawer G, Clayton-Smith J, Baker GA; Liverpool and Manchester Neurodevelopment Group. Autism spectrum disorders following in utero exposure to antiepileptic drugs. Neurology. 2008;71(23):1923-4.
  4. Thomas SV, Sukumaran S, Lukose N, George A, Sarma PS. Intellectual and language functions in children of mothers with epilepsy. Epilepsia. 2007 Dec;48(12):2234-40.
  5. Cummings C, Stewart M, Stevenson M, Morrow J, Nelson J. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Arch Dis Child 2011 July;96(7):643-7.
  6. Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD Study Group. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013;12(3):244-52.
  7. Christensen J, Grønborg TK, Sørensen MJ et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013; 309(16):1696-703.
  8. Cohen MJ, Meador KJ, Browning N, May R, Baker GA, Clayton-Smith J, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW; NEAD study group. Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6years. Epilepsy Behav. 2013;29(2):308-15.
  9. Cohen M.J et al. Fetal Antiepileptic Drug Exposure: Motor, Adaptive and Emotional/Behavioural Functioning at age 3 years. Epilepsy Behav. 2011; 22(2):240-246
  10. Bromley R, Weston J, Adab N et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014, Issue 10

NICE Guidelines : Antenatal and postnatal mental health: clinical management and service guidance

images

NICE guidelines [CG192] Published date: December 2014

In pregnancy and the postnatal period, many mental health problems have a similar nature, course and potential for relapse as at other times. However, there can be differences; for example, bipolar disorder shows an increased rate of relapse and first presentation in the postnatal period. Some changes in mental health state and functioning (such as appetite) may represent normal pregnancy changes, but they may be a symptom of a mental health problem.

The management of mental health problems during pregnancy and the postnatal period differs from at other times because of the nature of this life stage and the potential impact of any difficulties and treatments on the woman and the baby. There are risks associated with taking psychotropic medication in pregnancy and during breastfeeding and risks of stopping medication taken for an existing mental health problem. There is also an increased risk of postpartum psychosis.

Depression and anxiety are the most common mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety at some point; many women will experience both. Depression and anxiety also affect 15‑20% of women in the first year after childbirth. During pregnancy and the postnatal period, anxiety disorders, including panic disorder, generalised anxiety disorder (GAD), obsessive‑compulsive disorder (OCD), post‑traumatic stress disorder (PTSD) and tokophobia (an extreme fear of childbirth), can occur on their own or can coexist with depression. Psychosis can re‑emerge or be exacerbated during pregnancy and the postnatal period. Postpartum psychosis affects between 1 and 2 in 1000 women who have given birth. Women with bipolar I disorder are at particular risk, but postpartum psychosis can occur in women with no previous psychiatric history.

Changes to body shape, including weight gain, in pregnancy and after childbirth may be a concern for women with an eating disorder. Although the prevalence of anorexia nervosa and bulimia nervosa is lower in pregnant women, the prevalence of binge eating disorder is higher. Smoking and the use of illicit drugs and alcohol in pregnancy are common, and prematurity, intrauterine growth restriction and fetal compromise are more common in women who use these substances, particularly women who smoke.

Between 2006 and 2008 there were 1.27 maternal deaths per 100,000 maternal deliveries in the UK as a result of mental health problems. Although response to treatment for mental health problems is good, these problems frequently go unrecognised and untreated in pregnancy and the postnatal period. If untreated, women can continue to have symptoms, sometimes for many years, and these can also affect their babies and other family members.

This guideline makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth) and in women who are planning a pregnancy. The guideline covers depression, anxiety disorders, eating disorders, drug and alcohol‑use disorders and severe mental illness (such as psychosis, bipolar disorder, schizophrenia and severe depression). It covers subthreshold symptoms as well as mild, moderate and severe mental health problems. However, the guideline focuses on aspects of expression, risks and management that are of special relevance in pregnancy and the postnatal period.

The recommendations are relevant to all healthcare professionals who recognise, assess and refer for or provide interventions for mental health problems in pregnancy and the postnatal period. It will also be relevant to non‑NHS services, such as social services and the voluntary and private sectors, but does not make specific recommendations for these. The guideline also makes recommendations about the primary and secondary care services needed to support the effective identification and treatment of most mental health problems in pregnancy and the postnatal period. This guideline should be read in conjunction with other NICE guidelines on the treatment and management of specific mental health problems. The guideline indicates where modifications to treatment and management are needed in pregnancy and the postnatal period.

The guideline draws on the best available evidence. However, there are significant limitations to the evidence base, including limited data on the risks of psychotropic medication in pregnancy and during breastfeeding.

Mood stabilising drugs during pregnancy, childbirth and breastfeeding

images

As a general rule all drugs are best avoided in pregnancy unless essential, so as to minimise possible risk to the developing and newborn infant.

Lithium, valproate, carbamazepine, and lamotrigine should not normally be taken during pregnancy because of known risks to the developing infant. As asenapine is a new drug, there is very little evidence on its safety in pregnancy. Newborns who have been exposed to asenapine in the last three months of pregnancy show side effects in the first weeks of life, including agitation, abnormal muscle tone, tremor, extreme sleepiness, breathing problems, and difficulty feeding.

What are the risks of taking anticonvulsants during pregnancy?

NICE guidelines say, ‘Women with bipolar disorder who are considering pregnancy should normally be advised to stop taking valproate, carbamazepine, lithium and lamotrigine, and alternative prophylactic drugs (such as an antipsychotic) should be considered.’ The use of anticonvulsants in pregnancy is associated with children having developmental delay and needing special educational support.

The following problems are also recorded:

  • Carbamazepine taken in the first three months of pregnancy increases the risk of spina bifida and related conditions; the risk may be reduced by taking folate supplements. In the last three months of pregnancy there is a risk of vitamin K deficiency in the infant, who should be monitored closely for signs of bleeding.
  • Valproate should be avoided in pregnancy as it may cause defects and delay in development in the foetus. The possible harms include heart defects, spinal defects such as spina bifida, hare lip and cleft palate, malformed penis, and extra fingers or toes, as well as bleeding and liver disease in the newborn. The NICE guidelines on treatment of bipolar disorder state that valproate should not generally be given to women of child-bearing potential; if no effective alternative to valproate can be found, ‘adequate’ contraception should be used and women should be informed about the risk of harm to the foetus.
  • Lamotrigine carries a risk of malformations, including cleft lip and palate.

NICE suggests that, during pregnancy, a low dose of antipsychotic is preferable to any of the anticonvulsants above or lithium, because they carry a smaller risk of harm to the foetus.

Epilim-anti-epilepsy-tabl-006

What are the risks of taking lithium during pregnancy?

Lithium may be taken during pregnancy providing it is done cautiously with awareness of the possible hazards, discussed below. For a few women, lithium maintenance treatment may be thought to be essential.

In the first three months of pregnancy there is some risk of malformation of the heart in the developing infant.

If lithium is given in late pregnancy there is risk of dangerous levels of lithium in mother and infant, as the way in which lithium is cleared from the body alters suddenly at childbirth. Lithium is also associated with a higher than expected frequency of stillbirths and deaths soon after birth.

If lithium is to be taken at any stage of pregnancy, careful monitoring of lithium levels is most important to avoid toxic effects.

lithium-carbonate

Planned pregnancy

If you are planning to get pregnant, it’s a good idea to discuss this with your doctor. If you decide to come off lithium, this should be done gradually over six to eight weeks, or longer, depending how long you have been taking it for. Afterwards it might be an idea to wait a few weeks before trying to conceive, in case your bipolar symptoms recur and you decide you need to go back on lithium.

Unplanned pregnancy

If you find you are pregnant while you are taking lithium and it is early in pregnancy, you and your doctor might decide you should stop taking lithium immediately.

If you have been pregnant for some time without realising it, you should discuss with your doctor whether you should have an ultrasound scan. This can usually identify any possible problems in your baby’s development, looking especially at the heart.

Continuing lithium during pregnancy

If you and your doctor decide it’s best to continue with the lithium treatment, then you may need to adjust your dose. For example, the kidneys clear lithium from the body differently during pregnancy, so your dose may need to be increased to cope with this.

During the first half of pregnancy, blood lithium levels should be checked monthly; towards the end this should be done weekly. It may also be better to split the total daily dose into three or more doses a day, so that the level of lithium in your blood does not reach such high peaks as it does if you take larger doses less often.

In late pregnancy it is very important that the doctor who is prescribing and monitoring your lithium treatment consults closely with the obstetrician responsible for your baby’s delivery.

Lithium and childbirth

In childbirth, the way that the body clears lithium alters suddenly. If you have continued taking lithium during pregnancy, some doctors may suggest you withdraw lithium treatment gradually in the weeks leading up to the estimated date of delivery, in order to minimise the risk of toxic effects in both you and the child.

Others may suggest continuing with lithium treatment until the date the baby is due or until labour begins. They may think you should continue with lithium as long as possible as a protective factor against the risk of serious mental illness (postnatal psychosis).

Lithium should be stopped as soon as labour begins. The obstetrician will need to carefully check your fluid and salt balance and the level of lithium in the blood.

After childbirth

For those who have already had a bipolar episode there is a significant risk of serious mental illness (puerperal psychosis) during the weeks after the birth. Because of this, lithium is often started again as a preventive measure a few days after childbirth. Frequent monitoring of the level of lithium in the blood will be needed at this time to achieve a therapeutic dose. Continuing use of the drug would need to be reviewed in the normal way at the end of the period of risk.

Are there alternatives to taking lithium during pregnancy?

If drug treatment is considered to be essential, then antidepressants or antipsychotic drugs may be prescribed instead. The type of drug given would depend on the pattern of your mood changes and your symptoms. The following information indicates particular risk periods associated with these alternative drugs.

Tricyclic antidepressants given in late pregnancy have been associated with withdrawal symptoms in newborn babies. Irritability, muscle spasms, restlessness, sleeplessness, fever and fits have been reported.

One antipsychotic drug, prochlorperazine (Stemetil), is associated with malformations in the developing baby when given during the first three months of pregnancy. The use of antipsychotic drugs in late pregnancy may cause temporary reactions in newborn infants: Parkinson’s reactions have occasionally been reported. These include muscular rigidity, involuntary movements and shaking. If long-acting drugs are taken they take time to clear from the body. The last dose should be taken six to eight weeks before the expected birth.

For further information about these drugs see antidepressants, antipsychotics and coming off psychiatric drugs.

You should be able to get further information from your doctor regarding any drug you are advised to take during pregnancy. It is very important to discuss all aspects of your drug treatment and any concerns you may have with your doctor, obstetrician, midwife and pharmacist.

What are the risks of taking mood stabilisers while breastfeeding?

You should not breastfeed while taking lithium, as lithium passes into the breast milk in sufficient amounts to be dangerous to the baby.

Carbamazepine, valproate and lamotrigine all appear in breast milk in small amounts so breastfeeding is not recommended. However the British National Formulary suggests that amounts are not considered sufficient to be harmful.

You should not breastfeed while taking asenapine.

Children and mood stabilisers

The ‘British National Formulary (BNF)’ and the ‘Summaries of Product Characteristics(produced by the drug manufacturers) say that lithium is not suitable for children. However, the ‘BNF for children’ states that lithium may be given to children, only on the advice of a specialist. Because of the long-term effects, the need for treatment should be reviewed regularly.

The ‘BNF for children’says that carbamazepine and valproate may be useful in children unresponsive to lithium. It gives no guidance on the use of lamotrigine as a mood stabiliser in children.

Asenapine is not recommended for anyone below the age of 18.

All drugs should be used with caution, and at doses appropriate to the child’s age and size.

Information from:

http://www.mind.org.uk/information-support/drugs-and-treatments/lithium-and-other-mood-stabilisers/during-pregnancy-and-for-children/?o=6816

Mums on Anti Depressents Have Babies With Malformed Brains

Almost one in five children born to mothers taking antidepressants during pregnancy have a brain defect – called a “Chiari type 1 malformation” – according to a groundbreaking study by researchers at the University of North Carolina at Chapel Hill.

The study, titled Rate of Chiari I Malformation in Children of Mothers with Depression with and without Prenatal SSRI Exposure, was published May 19 in the peer-reviewed journal Neuropsychopharmacology.

The researchers found that “children of depressed mothers treated with a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) during pregnancy were more likely to develop Chiari type 1 malformations than were children of mothers with no history of depression,” according to their press statement.

So-called SSRI antidepressants encompass almost all of today’s major brands, including Prozac, Paxil, Luvox, Zoloft, Celexa and Lexapro. According to the Centers for Disease Control and Prevention, in 2010 an astonishing 254 million prescriptions for antidepressants were written for Americans. And between 7 and 13 percent of all pregnant women in the U.S. are currently taking them, even though virtually every study performed to date demonstrates that mothers taking SSRIs – especially in the first trimester of pregnancy – significantly increase the risk of their giving birth to children with autism, as well as other disorders and birth defects.

In a Chiari type 1 malformation (pronounced key-are-ee), brain tissue in the cerebellum – which controls a person’s balance, coordination, muscle movement and some cognitive functions – squeezes out into the spinal canal. While some people never develop noticeable symptoms, others experience symptoms including dizziness, headaches, balance and coordination problems that in serious cases require surgery.

A child with a Chiari type 1 malformation “might fall down a lot, walk unusually, have trouble grasping items, or have poor hand-eye coordination,” according to one advocacy organization, which lists as other possible symptoms: “neck or chest pain; headaches that are brought on by coughing, sneezing, or laughing; difficulty swallowing, which may cause gagging, choking, or vomiting; difficulty speaking; rapid eye movements or vision problems like light sensitivity or blurred vision; hearing problems like a tinnitus (ear ringing) or hearing loss; weakness, numbness, tingling, or other abnormal feelings in the arms and legs; insomnia; and depression.”

In babies, indications of a Chiari malformation could include “irritability when being fed; excessive drooling; weak cry; trouble gaining weight; arm weakness; and developmental delays.”

Regarding the University of North Carolina study, “Our results can be interpreted two ways,” says Rebecca Knickmeyer, Ph.D., lead author of the study and assistant professor of psychiatry at UNC’s School of Medicine. “Either SSRIs increase risk for Chiari type 1 malformations, or other factors associated with SSRI treatment during pregnancy, such as severity of depression itself, increase risk.” Additional research, she adds, “is urgently needed.”

One prominent expert alarmed, but not surprised, by the study is Adam C. Urato, M.D., a maternal-fetal medicine specialist at Tufts Medical Center in Boston and MetroWest Medical Center in Framingham, Massachusetts.

Urato, who closely follows research on the effects SSRIs have on mothers and their offspring, spoke with WND.

“This group from UNC did MRI studies on one- and two-year-olds who were exposed to SSRIs (or depression without SSRIs) and they found that 18 percent of the SSRI-exposed children had a brain malformation (Chiari I Malformation). This is the first study of its kind and these results are of grave concern,” he said.

Urato added: “Animal studies suggest that exposure to these SSRI chemicals will lead to changes in the brain and behavior. Now, with this study, we have evidence of increased rates of brain malformation in babies with exposure to SSRIs during pregnancy.”

In the study, researchers analyzed MRI brain scans performed on four groups of children.

Thirty-three children whose mothers were diagnosed with depression and took SSRI antidepressants were compared to 66 children whose mothers had no history of depression. In addition, 30 children whose mothers were diagnosed with depression but did not take SSRIs were compared to 60 children whose mothers had no history of depression.

Bottom line: “Fully 18 percent of the children whose mothers took SSRIs during pregnancy had Chiari type 1 malformations, compared to 3 percent among children whose mothers had no history of depression,” explained the University of North Carolina press statement.

“What’s astounding is that this study is basically receiving no media attention,” Urato told WND. “They even put out a press release on it and no one appears to be covering this groundbreaking study.”

Why no other media coverage? As WND has previously documented in detail, the major media tend to downplay or altogether ignore peer-reviewed studies – and there are many – that document the hazards of antidepressants.

Indeed, the establishment media tend to mirror the viewpoint of the medical establishment and particularly the pharmaceutical companies, as explained by David Healy, M.D., a U.K.-based psychiatrist, psycho-pharmacologist and expert on antidepressants.

In his influential book “Pharmageddon,” Healy describes the effect of “turbo-charged pharmaceutical industry marketing” this way: “The horrors are best caught by the example of the increasing numbers of pregnant women who religiously steer clear of alcohol, tobacco, soft cheeses, or anything that might harm their unborn child, but who are nonetheless being urged by their doctors to take drugs like the antidepressants – now the most commonly prescribed drugs in pregnancy – even as the evidence accumulates that these drugs cause birth defects, double the rate of miscarriages, and cause mental handicap in children born to mothers who have been taking them.”
Read more at http://mobile.wnd.com/2014/06/moms-on-antidepressants-have-babies-with-malformed-brains/#wus04z1wfyzD0rKH.99

Groovy Mums – Im Getting My Groove On

Groovy Mums
Are you a mum who wants to make changes in your life?
You might know exactly what you want to do. You might have a few ideas that you would like to investigate further. You may be feeling a bit down and just sense that there must be more to life that what you have currently.
Groovy Mums can help! Groovy Mums is hosted by the lovely Kate (Twitter : @kateonthinice )

groovinggrabbadge.jpg Groovy Mums

So here I am, I’m joining Groovy Mums . The only person in this world realisticly who will help ourselves is us……me and you. No one else is going to take charge so with it being a new year…..lets go.

I have always been self conscious, going back to when I was a teenager. Ive tried every diet going, Atkins, Weight Watchers, Slimming World the lot, you name it Ive tried it. All these diets are successful for other people….but never me. I say it it every year “Im losing weight this year” but it never happens. However Im at the point now with a pending holiday to Portugal in a few months…… what more motivation do I need

Ive joined our local Curves and I must say out of all the gyms Ive been too, this is a workout that does work every part of your body. Its a circuit of different machines and you go around each station 3 times…… but the best bit is, it takes 30 minutes. You may be reading this thinking “shes not doing it right, 30 minutes is not a lot to excercise” but when I come out of their I am knackered…..but feel great having been. On days I dont manage to go Ive created a “spinning list” of all the best songs I love and Im going to spin for 47 minutes. I normally beat myself up and become obsessed with the latest diet craze, but Im not letting it control me this year…..Im going to be in control. If I have a day I dont feel like excercising Im not going to do it.. Since I turned 30 (3 years ago) even though I already knew it, its clicked and registered that the only way of losing weight is to excercise and eat the correct food……Not starving myself and having a good portion of cheesecake in the evening ::))

Excercise is also the best way to lift mood. Being diagnosed with depression this is mainly why I want to spend time on excercise. Learning what I have learned about medicines through my campaign, Medicines is not the answer…..its excercise.

I do have other ways I want to get my groove on…. but for the moment am concentrating on this one. I will keep blogging about this and look forward to hearing from everyone else……………………We can do it ::))

20131122-094325.jpg