PMS & PMDD
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INFERTILITY & MENTAL HEALTH
In the United States, about 9% of men and 11% of women of reproductive age have experienced fertility problems. In a recent review (FULL TEXT available), Paraskevi and colleagues discuss how stress, anxiety and depression impact the outcomes of assisted reproductive technologies (ART) and explore whether supportive interventions may help couples to minimize fertility-related stress, anxiety and depression and whether these interventions improve treatment outcomes. Data regarding the effect of assisted reproduction techniques on couples’ levels of anxiety or depression have yielded conflicting results. While some studies suggest increased levels of anxiety and depression among couples pursuing ART, typically more prominent in women, many studies do not show a significant effect on mental health. The findings are also mixed when ...
PSYCHIATRIC DISORDERS DURING PREGNANCY
Perinatal anxiety is relatively common, affecting 15-20% of women during pregnancy and the postpartum period. Anxiety may reflect worries and fears about the pregnancy or caring for a new baby; however, anxiety symptoms may be more significant and may manifest as generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder. The impact of perinatal anxiety can be significant, potentially contributing to increased risk for pregnancy complications, including preterm birth, increased vulnerability to postpartum depression, and adverse neurodevelopmental outcomes in exposed children. Despite the prevalence of perinatal anxiety, there is a lack of consensus regarding the optimal timing for screening perinatal anxiety. Insights from the MAP Study The Methods of ...
Anxiety symptoms are common during pregnancy and the postpartum period. According to a recent meta-analysis from Fawcett and colleagues, about one out of every five women has at least one type of anxiety disorder during pregnancy or the postpartum period. In 2015, the American College of Obstetricians and Gynecologists issued a committee opinion recommending that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms. What Tools Should We Use to Screen for Perinatal Anxiety? Edinburgh Postnatal Depression Scale (EPDS): Most obstetric clinics use questionnaires, like the Edinburgh Postnatal Depression Scale, to screen for depression. While this screening tool was specifically designed to screen for depression, it does include questions ...
Major depressive disorder (MDD) affects approximately 10% to 15% of pregnant patients, causing maternal distress, increased risk of suicide, life-threatening obstetric complications, and lasting neurodevelopmental effects on offspring.1–4 The strongest evidence-based treatments for MDD during pregnancy are psychotherapy and pharmacotherapy, typically with selective serotonin reuptake inhibitors (SSRIs), but these may not always be viable or acceptable options for patients due to symptom severity, the need for rapid symptom resolution, and perceived concerns about the effects of medications on fetal development.1,5 Therefore, non-pharmacologic neuromodulation therapies such as transcranial magnetic stimulation (TMS) have gained interest and research attention. TMS is an FDA-approved, non-invasive, and safe neuromodulation therapy for MDD that uses magnetic pulses to stimulate specific areas ...
A peer support intervention is defined as “the provision of emotional assistance (e.g., attentive listening), appraisal assistance (communication of information that is pertinent to self-evaluation), and informational assistance (provision of knowledge relevant to problem-solving) by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population.” (Huang et al, 2020). In a recent review, Huang and colleagues review the effectiveness and feasibility of peer support interventions in pregnant and postpartum populations. Ten randomized controlled trials were included in the analysis, with a total of 3064 participants (1468 in the peer-delivered intervention groups and 1596 controls). The content of interventions provided by peers focused primarily ...
Perinatal psychiatry is a field in which we treat vulnerable patients, a mother and her child, where both the illness and the treatments prescribed to treat the illness have the potential to affect pregnancy outcomes. There is a deep and compelling literature documenting the negative impact of postpartum depression upon children, and we are constantly learning more about the short and long-term adverse effects of untreated depression and anxiety during pregnancy on pregnancy outcomes and child development. Treatment decisions during pregnancy must take into account the current status and previous course of illness for the individual patient, as well as the potential risks of treatment to the developing fetus. The calculus is complicated, and often ...
Neural tube defects (NTDs) are among the most common major malformations in the United States. Daily folic acid supplementation in the periconceptional period significantly reduces the risk of neural tube defects. However, most women do not receive the recommended daily intake of folate from diet alone; thus, it is recommended that all women of childbearing age should take supplemental folic acid. Since half of all pregnancies in the US are unplanned, the US Preventive Services TAsk Force recommends that all women who are capable of getting pregnant should take a daily supplement or multivitamin containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. In terms of preventing neural tube defects, the critical ...
About 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. Furthermore, women with a history of major depression appear to be at high risk for recurrent illness during pregnancy particularly in the setting of antidepressant discontinuation. We have long argued that it is important to identify and to offer treatment to women who suffer from depression during pregnancy, but we have yet to agree on what is the best instrument for this purpose. Using the EPDS to Identify Depression During Pregnancy? The Edinburgh Postnatal Depression Scale (EPDS), although initially engineered to detect postpartum depression, has been used in pregnant populations; however, there has been considerable variability in the estimates of the sensitivity ...
In this Special Report published in Psychiatric News, Dr. Laura Miller reviews the data regarding the impact of stress experienced by the mother during pregnancy on pregnancy outcomes and fetal development. “I just feel like I am broken. I am the worst pregnant woman ever.” These are the words of a woman interviewed by Aleksandra Staneva, Ph.D., and colleagues as they conducted a study on how women experience and interpret psychological distress while they are pregnant. The study was reported in the June 2017 Health Care for Women International. What they learned is that for many women, experiencing distress during pregnancy runs smack into unrealistic cultural expectations and fuels excessive guilt. Women report feeling totally responsible ...