Ruta Nonacs, MD PhD - MGH Center for Women's Mental Health

Screening for Peripartum Anxiety Disorders: What Are the Best Screening Tools?

A significant number of women experience anxiety symptoms during pregnancy, with about 8.5% of women meeting criteria for generalized anxiety disorder. Other anxiety disorders are less common. The estimated prevalence of panic disorder during pregnancy is 1-2%. The estimated prevalence of obsessive-compulsive disorder is 0.2-1.2%. While we use certain tools, including the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression during pregnancy, what are the best tools for indentifying women with clinically significant anxiety symptoms?

By Ruta Nonacs, MD PhD|2025-12-11T09:48:24-04:00February 12th, 2013|Anxiety Disorders, Diagnosis & Screening, Postpartum Psychiatric Disorders, Psychiatric Disorders During Pregnancy|Comments Off

What’s Worse for Pregnancy: Bipolar Disorder or the Medications Used to Treat It?

In studies of pregnant women with unipolar depression, it has been shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight. There is far less data on pregnancy outcomes in women with bipolar disorder. A recent Swedish study analyzes pregnancy outcomes in treated and untreated women with bipolar disorder and attempts to distinguish between the effects of medication versus the effects of untreated psychiatric illness in the mother.

By Ruta Nonacs, MD PhD|2024-03-24T11:55:47-04:00February 5th, 2013|Bipolar Disorder, Mood Stabilizers, Outcomes, Pregnancy & Medications, Psychiatric Disorders During Pregnancy|Comments Off

Postpartum PTSD As Common As Postpartum Depression

A recent study from McGill University has assessed the prevalence and course of Post-Traumatic Stress Disorder (PTSD) following childbirth. The sample included 308 women who were assessed at four time points: 25-40 weeks gestation, 4-6 weeks postpartum, 3 and 6 months postpartum. Current and prior PTSD were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) and the Modified PTSD Symptom Scale Self-Report (MPSS-SR).

By Ruta Nonacs, MD PhD|2026-01-11T11:58:15-04:00September 30th, 2012|Depressive Disorders, Postpartum Psychiatric Disorders, Prevalence & Risk Factors, PTSD and Stress Related Disorders|Comments Off

Use of Antipsychotic Medications in Pregnancy Increases Risk of Gestational Diabetes

Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data regarding the reproductive safety of these medications.

By Ruta Nonacs, MD PhD|2024-04-14T16:18:01-04:00July 17th, 2012|Antipsychotic Medications, Outcomes, Pregnancy & Medications, Pregnancy Outcomes|Comments Off

Outcomes of Children Exposed to Antiepileptic Drugs in Pregnancy: No Good News for Valproate

There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:15-04:00June 26th, 2012|Anti-Epileptic Drugs, Mood Stabilizers, Outcomes, Pregnancy & Medications, Risk of Malformations|Comments Off

From the North American AED Pregnancy Registry: The Newer Anticonvulsants Appear to Be Safer

While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). The North American AED Pregnancy Registry was established in 1997 for pregnant women in the United States and Canada at the Massachusetts General Hospital. The purpose of the registry is to obtain and publish information on the frequency of major malformations among infants whose mothers have taken one or more AEDs during pregnancy.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:16-04:00June 13th, 2012|Anti-Epileptic Drugs, Mood Stabilizers, Outcomes, Pregnancy & Medications, Risk of Malformations|Comments Off

Breastfeeding and Benzodiazepines: Good News

Clinically significant anxiety symptoms are common during the postpartum period and frequently complicate the treatment of postpartum depression. While SSRIs are indicted for the treatment anxiety symptoms, especially when they co-occur with depression, many women may need to use a benzodiazepine for managing more severe symptoms of anxiety or insomnia.

By Ruta Nonacs, MD PhD|2025-12-11T09:41:05-04:00April 30th, 2012|Anti-Anxiety Medications, Breastfeeding & Medications, Outcomes|Comments Off

Autoimmune Thyroid Disease More Prevalent in Women with Postpartum Psychosis

Postpartum psychosis is the most severe form of postpartum psychiatric illness, occurring in approximately 1 to 2 per 1000 women after childbirth. Although bipolar disorder is a risk factor for postpartum psychosis, a substantial number of women who develop postpartum psychosis have no history of psychiatric illness and experience psychiatric illness only in the context of childbearing. What may cause or trigger postpartum psychosis in this population is not well understood.

By Ruta Nonacs, MD PhD|2024-04-14T16:18:26-04:00November 8th, 2011|Postpartum Psychiatric Disorders, Postpartum Psychosis, Prevalence & Risk Factors|Comments Off

Antiepileptic Drugs in Breastfeeding: Neurodevelopmental Outcomes

Because breastfeeding has many psychological and medical benefits for both the mother and her child, many women would like to breastfeed. However, all medications taken by the mother are secreted into the breast milk. While various studies have addressed the safety of antiepileptic drugs (AEDs) in nursing infants, none have systematically assessed the long-term effects of exposure to these drugs on the cognitive development of children exposed to these agents through breastfeeding. This is an especially important issue as it has been demonstrated that certain AEDs, most notably valproic acid, may negatively affect the developing brain, a process which occurs in utero and into the first few decades of the child’s life.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:17-04:00January 24th, 2011|Anti-Epileptic Drugs, Breastfeeding & Medications, Child Outcomes, Neurodevelopmental Disorders, Outcomes|Comments Off

Insomnia Across the Female Life Cycle

In the July 2010 issue of Current Psychiatry, you will find a thorough review on the evaluation and treatment of insomnia in women across the life cycle. The bottom line is that many women experience insomnia during times of hormonal transition. The authors provide some useful guidelines for evaluating women who present with sleep problems (taken from Table 2):

By Ruta Nonacs, MD PhD|2025-12-11T09:41:06-04:00October 12th, 2010|Menopausal Symptoms, Postpartum Psychiatric Disorders, Prevalence & Risk Factors, Psychiatric Disorders During Pregnancy, Sleep Disorders|Comments Off

Ruta Nonacs

About Ruta Nonacs, MD PhD