Pregnancy-related Mood Disorders

Perinatal depression is under-diagnosed and under-treated worldwide and in New York City. Recent studies have shown that 12% of pregnant women and 13% of postpartum women screen positive for anxiety and depression, essentially no different from the non-pregnant population. Only 26% of positively screened pregnant patients were recognized as having a mood or anxiety disorder by a health care provider, and only 12% with suicidal ideation were detected. Detection is particularly low in obstetric settings. Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, and Eating Disorders may also develop or worsen during pregnancy and postpartum. Women with Bipolar Disorder, Schizophrenia, or Schizoaffective Disorder are particularly vulnerable during pregnancy and postpartum.

Not infrequently, depressed pregnant and postpartum women also have obsessional thoughts about harming the baby or themselves. While unlikely to lead to actual harm, such illogical and intrusive thoughts cause significant shame, guilt, and doubt, leading women to conceal their suffering, and to delay seeking treatment. Women who actually avoid taking care of their baby should be evaluated promptly.

Postpartum psychosis, which occurs in 1-2/1000 women who deliver, is a serious psychiatric disorder that is associated with both suicide and infanticide. It may present as an acute illness within a few weeks of delivery, characterized by agitation, confusion, and hallucinations, or several months later, as a delusional form of depression. In either case, postpartum psychosis is often a manifestation of Bipolar Disorder.

Sexual abuse and domestic violence are reported by up to 30% of women, independent of social class. The prevalence of Post-traumatic Stress Disorder in economically disadvantaged pregnant women has been estimated at 7.7%. Women who have been victims of trauma (in various forms) are at risk for developing emotional symptoms in pregnancy and postpartum. Substance abuse is also more prevalent than most people realize, with 19% of pregnant women abusing alcohol, 20 % smoking cigarettes, and 5.5% using illicit drugs.

Untreated psychiatric disorders in pregnant and postpartum women have serious implications for the mother, the child, and the family. Prompt treatment will reduce the risks of obstetrical complications, self-medication with drugs and alcohol, suicide, infanticide and of developing a chronic and relapsing mental illness.

Medications (pharmacotherapy) and psychotherapy (using interpersonal psychotherapy and cognitive-behavioral techniques) both play a role in the treatment of perinatal psychiatric disorders .

Shari I. Lusskin, MD