Mood and Anxiety Disorders During Pregnancy |

Mood and Anxiety Disorders during the postpartum period

 May 13, 2010 Viewed: 2500

CONCLUSION
Mood and anxiety disorders frequently begin during the childbearing years, and management of women with these disorders poses a substantial challenge to clinicians, especially during pregnancy and the postpartum period.

Depressive relapse during pregnancy is of particular concern because of an increased risk of inadequate prenatal care,  poor maternal/fetal nutrition,  obstetric complications,  and postpartum depression.  The etiology of postpartum depression remains unclear,  but the disorder affects approximately 12% to 16% of new mothers. Recent data suggest that pregnancy is not protective against the risk for relapse after lithium discontinuation in women with bipolar illness.

The course of panic disorder during pregnancy and the postpartum period is variable.  Some women do poorly when attempts are made to discontinue their medications during pregnancy. Other women experience a diminution of symptoms that allows them to tolerate medication discontinuation. For reasons that are unclear,  pregnancy and the puerperium may precipitate or exacerbate symptoms of obsessive-compulsive disorder.

Future prospective studies of women during pregnancy and the postpartum period should begin prior to conception and end several weeks after delivery of the infant.

Although the use of psychotropic medications is appropriate in many clinical situations, pharmacologic treatment should include thoughtful weighing by the clinician of the risk of prenatal exposure to psychotropic drugs versus the risk of relapse following drug discontinuation. Decisions regarding medication discontinuation during pregnancy should be made carefully and should take into account the previous psychiatric history and its severity as well as chronicity of the illness as measured by the number of previous episodes of illness.

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Check also
Mood and Anxiety Disorders During Pregnancy and the Postpartum Period

Mood and Anxiety Disorders during pregnancy

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Received Aug.  25,  2000;  accepted Sept.  1,  2000.  From the UCLA Neuropsychiatric Institute and Hospital (Drs. Altshuler and Hendrick) and West L.A.  Veterans Administration Medical Center (Dr.  Altshuler),  Los Angeles; and Massachusetts General Hospital, Boston (Dr. Cohen).

Financial disclosure:  Dr.  Altshuler has received research support from Abbott, Eli Lilly, Forest, Glaxo Wellcome, SmithKline Beecham, and Solvay; is on the speakers’ bureau of Abbott, Glaxo Wellcome, and Solvay; is a consultant for Abbott, Eli Lilly, Forest, Janssen, Parke-Davis, Solvay, and Bristol-Myers Squibb; and is an advisory board member with Abbott, Eli Lilly, and Forest. Dr. Cohen has received grant/research support from Eli Lilly, Glaxo Wellcome, Organon, Pfizer, and SmithKline Beecham; is a consultant for Eli Lilly, Janssen, Pfizer, Solvay, and Wyeth-Ayerst; and is on the speakers’  bureau of Eli Lilly,  Janssen,  Pfizer,  SmithKline Beecham, Solvay, and Wyeth-Ayerst.

Reprint requests to: Lori L. Altshuler, M.D., VA Medical Center, West Los Angeles,  B116AA,  Bldg.  158,  Room 104,  11301 Wilshire Blvd.,  Los Angeles, CA 90073.

Lori L. Altshuler, M.D.; Victoria Hendrick, M.D.; and Lee S. Cohen, M.D.

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