The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population throughout the world, making OCD one of more common psychiatric diagnoses; however research on OCD in pregnancy and peurperium has been limited.
As more research is conducted within the field of women's mental health, there are times when recommendations may change depending on the available data.  We will discuss a case here to illustrate this point.
Infertility and its treatment have been shown to be a trigger for both depression and anxiety. Women with pre-existing histories of depression and anxiety who have been stable on medication may find themselves with worsening symptoms brought on by the stress involved in the process of infertility treatment. Many women find the process an emotional roller coaster of hopefulness and disappointment.
Selective serotonin reuptake inhibitors (SSRIs) account for approximately 62% of all antidepressants prescribed in the United States. There have been several recent studies suggesting that SSRIs may lower bone mineral density in individuals over the age of 65. However, depression itself has been shown to decrease bone mineral density and has also been associated with an increased risk of hip fractures in older women.
The link between maternal depression and anxiety during pregnancy and adverse neonatal outcome has been well-documented in the medical literature and reviewed on our website. A recent study published in the journal Early Human Development suggests that a mother's stress during pregnancy may also negatively affect her baby's sleep patterns.
While genetic factors are clearly important in determining a child’s risk for attention deficit hyperactivity disorder (ADHD), recent studies have investigated the link between exposure to certain maternal behaviors during pregnancy, such as smoking and alcohol use, and the risk of developing behavioral problems related to attention deficit hyperactivity disorder in childhood. While multiple studies have indicated a greater risk of ADHD symptoms among children whose mothers smoked during pregnancy, contradictory findings were reported in studies focusing on exposure to alcohol. Results from studies investigating the impact of psychological stress during pregnancy have been inconsistent but suggest a possible contribution to ADHD symptoms int he offspring.
Depression during pregnancy is common. While concerns have been raised regarding the potential teratogenic and long-term neurobehavioral effects of psychotropic drug use during pregnancy, what is often overlooked is the fact that untreated maternal depression may also put the unborn baby at risk.
At our clinic we have the opportunity to see patients at various stages of pregnancy. When we evaluate a patient while she is still in the planning stages, we may recommend changing medications to those that have a better studied safety profile during pregnancy and see how she does on those medications prior to conception. If that same patient came into our clinic for an evaluation, but was already pregnant, we may make different recommendations than if she was in the planning stages.
While there have been concerns regarding the reproductive safety of psychotropic medications, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may not always be the safest option. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that depression during pregnancy may negatively affect pregnancy outcomes (reviewed in Bonari 2004).
An article published in the October 2007 issue of Archives of General Psychiatry suggests that older women who experience panic attacks may be at increased risk of having a heart attack or stroke and at increased risk of death over the next five years. MGH researcher Jordan W. Smoller, M.D. and colleagues followed 3,369 healthy postmenopausal women as part of the Women’s Health Initiative. Upon entry into the study, participants filled out a questionnaire about the occurrence of panic attacks in the previous six months and were then followed prospectively for an average of 5.3 years to assess risk for cardiovascular disease. About 10 percent of the women reported having a full-blown panic attack in the six months prior to the study.
