Abstract
BackgroundIn the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4–39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. MethodsA systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. Results18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive–compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the open-label trial of fluvoxamine (up to 300mg/day) experienced a 30% or greater decrease in the total score of the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). During pregnancy, SSRIs and tricyclic antidepressants (TCAs) led to remission of panic symptoms and healthy outcomes for the babies. LimitationsStudy design, mostly case reports, and enrolment of subjects mainly from outpatient specialty units might have limited community-wide generalisability. ConclusionsKeeping in mind the scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that CBT should be the first treatment offered to pregnant and breastfeeding women with AnxD. However SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT.
Highlights
Even though pregnancy is a period of emotional well-being for most women, one fourth of pregnant women are affected by a mental disorder, with one-twelfth experiencing one of these disorders for the first time (Vesga-Lopez et al, 2008)
We systematically reviewed the available literature on the treatment of perinatal anxiety disorders (AnxD) and we provide recommendations for clinical management and future research
In all the considered studies diagnosis of anxiety disorders were based on the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria and were established using validated assessment scales (Table 1)
Summary
Even though pregnancy is a period of emotional well-being for most women, one fourth of pregnant women are affected by a mental disorder, with one-twelfth experiencing one of these disorders for the first time (Vesga-Lopez et al, 2008). Over the last few decades, more attention has been focused on anxiety disorders (AnxD), which were more extensively investigated in antenatal period (Goodman and Chenausky, 2014) than in postpartum. AnxD are diagnosed in 4–39% of pregnant women (Goodman and Chenausky, 2014) and prevalence rates are even higher if comorbid disorders are considered (Marchesi et al, 2014). Prenatal AnxD increase the risk of post-partum depression (Goodman and Chenausky, 2014), their effects on obstetric outcomes are debated. Regarding neonatal/infant outcomes, a low brain-derived neurotrophic factor (BDNF) level in the blood cord; no heart rate response to the mother anxiety; increase cortisol reactivity to stress (not replicated in other two studies) and early attention dysfunction, were found in infants of mothers with prenatal AnxD (Goodman and Chenausky, 2014). SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT
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