Cognitive behavioral therapy for postpartum panic disorder: a case series

Kazuki Matsumoto,Koichi Sato,Eiji Shimizu,Sayo Hamatani,Yukihiko Shirayama

doi:10.1186/s40359-019-0330-z

Abstract

BackgroundClinical anxiety is common during the perinatal period, and anxiety symptoms often persist after childbirth. Ten to 30 % of perinatal women are diagnosed with panic disorder (PD)—far more than the 1.5–3% rate among the general population. Although cognitive behavioral therapy (CBT) has been determined to be an effective treatment for PD, few studies have been conducted on CBT effectiveness in treating postpartum PD and, to the best of the knowledge of the present authors, no research has been conducted on postpartum PD among Japanese women. In this manuscript, we report on our administration of CBT to three postpartum patients with PD, detailing the improvement in their symptoms.Case presentationAll patients in this study were married, in their thirties, and diagnosed using the Mini-International Neuropsychiatric Interview as having PD with agoraphobia. The Panic Disorder Severity Scale (PDSS) was used to evaluate patients’ panic symptoms and their severity. All patients received a total of 16 weekly 50-min sessions of CBT, and all completed the treatment. All patients were exceedingly preoccupied with the perception that a “mother must protect her child,” which reinforced the fear that “the continuation of their perinatal symptoms would prevent them from rearing their children”. After treatment, all participants’ panic symptoms were found to have decreased according to the PDSS, and two no longer met clinical criteria: Chihiro’s score changed from 13 to 3, Beth’s PDSS score at baseline from 22 to 6, and Tammy’s score changed from 7 to 1.ConclusionsCBT provides a therapeutic effect and is a feasible method for treating postpartum PD. It is important that therapists prescribe tasks that patients can perform collaboratively with their children.

Highlights

Clinical anxiety is common during the perinatal period, and anxiety symptoms often persist after childbirth
It is important that therapists prescribe tasks that patients can perform collaboratively with their children
A recent literature review reported that generalized anxiety disorder, panic disorder (PD), obsessive compulsive disorder (OCD), and post-traumatic stress disorder are frequently diagnosed in postpartum women [2]

Summary

Introduction

Clinical anxiety is common during the perinatal period, and anxiety symptoms often persist after childbirth. Cognitive behavioral therapy (CBT) has been determined to be an effective treatment for PD, few studies have been conducted on CBT effectiveness in treating postpartum PD and, to the best of the knowledge of the present authors, no research has been conducted on postpartum PD among Japanese women In this manuscript, we report on our administration of CBT to three postpartum patients with PD, detailing the improvement in their symptoms. The prevalence of clinically significant anxiety and depression, which is the most common mental condition during the postpartum period, has been observed at a rate of 10–20% in developed countries and approximately 30% in developing (2019) 7:53 and Care Excellence (NICE) guidelines, selective serotonin reuptake inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT), which have established effectiveness, are recommended as primary options for the treatment of PD [8]. In Japan, we already reported feasibility of CBT for adult patients with PD by 2 single arm trials [13, 14]; We confirmed a significant reduction of PD symptoms reporting a 60–80% improvement rate

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Conclusion