Mood and Anxiety Disorders during the postpartum period
Panic Disorder
The postpartum period appears to be a time of increased vulnerability to recurrent panic symptoms.31,72,73
In a prospective study of 10 pregnant women with previous histories of panic disorder,32 7 (70%) of 10 subjects continued to meet DSM-III-R criteria for panic disorder at all trimester visits. A total of 9 women (90%) with panic disorder—some of whom had experienced a reduction in symptoms during pregnancy—were actively symptomatic in the 1 to 3 months postpartum; the remaining patient who stayed well was also on antipanic medications. Some investigators have hypothesized that the sharp fall in progesterone concentration after delivery may increase vulnerability to panic symptoms.
74 Elevated progesterone during pregnancy produces hyperventilation and a subsequent reduction in PCO2 levels. One theory posits that the rise in PCO2 levels after delivery corresponds with the decline in progesterone and may predispose postpartum women to panic attacks.30
The onset of panic disorder during the postpartum period has recently been reported. In the computerized search of 215 pregnancies in 8 relevant studies reported by Hertzberg and Wahlbeck,33 83 (38%) of the 215 reviewed pregnancies exhibited onset or exacerbation of panic disorder in the postpartum period. As a consequence of these latest findings, clinicians are urged to differentiate presentations of the more widely known postpartum depression and the newly reported postpartum panic disorder.
The postpartum period marks a time of increased vulnerability to OCD, even if attempts at medication discontinuation are successful during pregnancy.
Buttolph and Holland37 reported that OCD symptoms in 39 women increased in the postpartum period in 4 women (10%) after the birth of a first child and in 2 women (5%) after the birth of a subsequent child. Another study76 assessed the occurrence of potentially traumatizing life events among patients with OCD. When examining types of stressful life events, women with OCD were found to be more likely than normal women subjects to report exposure to postpartum events, and high rates of obstetric complications were observed in these patients.
Subjects with postpartum OCD also had significantly higher rates of aggressive obsessions to harm their newborn infants. These findings confirm that the postpartum period represents a risk factor for OCD in some individuals and suggest that obstetric complications may be relevant to the development of OCD.