ABSTRACT
Anxiety is common in women during the perinatal period, manifests with various symptoms and severity, and is associated with significant maternal morbidity and adverse obstetric and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is positioned optimally to create a therapeutic alliance and to treat perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit the clinician's ability to initiate informed risk-benefit discussions. Clear understanding of the role of the obstetric provider in the identification, stabilization, and initiation of medication and/or referral to psychotherapy for women with perinatal anxiety disorders is critical to maternal and neonatal wellbeing. Informed by our clinical practice as perinatal psychiatric providers, we have provided a concise summary of current research on the approach to the treatment of perinatal anxiety disorders in the obstetric setting that includes psychotherapy and supportive interventions, primary and adjuvant psychiatric medication, and general prescribing pearls. Medications that we examined include antidepressants, benzodiazepines, sedative-hypnotics, antihistamines, quetiapine, buspirone, propranolol, and melatonin. Further research into management of perinatal anxiety, particularly psychopharmacologic management, is warranted.
Subject(s)
Anxiety Disorders/psychology , Pregnancy Complications/psychology , Prenatal Care , Anxiety Disorders/therapy , Benzodiazepines/therapeutic use , Female , Humans , Pregnancy , Pregnancy Complications/therapy , Psychotherapy , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
Subject(s)
Bipolar Disorder/diagnosis , Depression, Postpartum/psychology , Menarche/psychology , Menopause/psychology , Pregnancy Complications/psychology , Bipolar Disorder/psychology , Bipolar Disorder/therapy , Comorbidity , Depression, Postpartum/diagnosis , Depression, Postpartum/physiopathology , Female , Gravidity/physiology , Humans , Menarche/physiology , Menopause/physiology , Parity/physiology , Postpartum Period , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Psychotherapy , Risk Factors , Sexual BehaviorABSTRACT
Major depression is a frequent complication of the postpartum period. Untreated postpartum depression increases the risk of maternal suicide and can impair parenting capability with resultant adverse effects on offspring development. A number of factors influence a woman's vulnerability to postpartum depressive episodes. This article summarizes processes for assessing these risk factors and implementing primary preventive interventions, and summarizes methods of early detection to promote secondary and tertiary prevention.
