Anxiety symptoms are relatively common during pregnancy but typically undiagnosed and undertreated. A recent study of 2793 women observed that 9.5% of women meet criteria for generalized anxiety disorder (GAD) at some point during their pregnancy. The highest rates of GAD were observed in the first trimester (7%). Only 2% of women met criteria for GAD in the second trimester, and 3% in the third trimester.
Cognitive Behavioral Therapy or CBT is a type of psychotherapy that has been shown to be effective for the treatment of depression, anxiety, and sleep problems. Recently, several randomized controlled trials have demonstrated that CBT is effective for managing vasomotor symptoms in menopausal women.
Although postpartum depression (PPD) affects about 15% of all women after the birth of a child, most women with PPD receive no treatment. One of the problems has been inadequate screening for perinatal mood and anxiety disorders. Over the last decade, there has been an emphasis on educating health care professionals to reliably screen for PPD; however, other obstacles to obtaining treatment remain. Many women cannot find appropriate treaters in their area. Others are not able to get childcare in order to attend weekly appointments. Given these limitations, it is important that we explore other types of interventions that might be used to reach and effectively treat women with PPD.
Pregnancy is a time of risk for women with histories of major depression. In a study where 201 women with histories of recurrent depression were followed prospectively through pregnancy, 43% experienced a relapse of major depression during pregnancy. Relapse rates were highest in the group of women who elected to discontinue antidepressant treatment proximate to conception (68% as compared to 26% in the group of women who maintained antidepressant treatment).
While postpartum depression (PPD) affects about 10%-15% of women, most women with PPD do not receive any treatment. Over the last decade, we have made progress in increasing awareness of postpartum mental health issues; however, there are still significant obstacles to obtaining treatment. Women are not able to find appropriate treaters or cannot access care in a timely fashion, especially in more remote areas. They may not have reliable childcare and thus cannot attend their own appointments. Or they may simply be too depressed or anxious to leave their homes.
During pregnancy, a woman develops increasing sensitivity and responsiveness to infants’ distress. If depression during pregnancy occurs, this process may be disrupted. Various studies are shown that women with depression are less responsive to an infant’s distress. The major concern is that this diminished responsiveness may persist as long as one year after the child is born, and when it persists, it may negatively affect the child. Decreased responsiveness of the mother to the infant’s cues may lead to emotional, cognitive and developmental problems in the child later on.
Given the prevalence of postpartum OCD and obsessive symptoms in women with postpartum depression, we should devote more time to this topic. This is an informative and well-written article by Alice Wolton on postpartum OCD in Forbes. In this piece, she mentions a recent study from Timpano and colleagues at the University of Miami where cognitive behavioral therapy (CBT) was used to prevent postpartum OCD.
Research indicates that women undergoing infertility treatment experience high rates of psychological distress (1). Additionally, it is believed that stress and depression have an impact on fertility, as it has been shown that certain psychological interventions may improve pregnancy rates in infertile women (2-4). In a recent study, Faramarzi and colleagues compared the effects of group cognitive behavioral therapy (CBT), fluoxetine, and no treatment on the mental health of infertile women who had been trying to conceive for at least 2 years (5).
Significant numbers of reproductive-aged women experience premenstrual syndromes characterized by depressed mood, irritability, mood swings, anxiety or tension, sleep disruption, and other physical symptoms, including bloating and breast tenderness. Typically these symptoms emerge during the week preceding menstruation, improve with the onset of menses, and are not present during the week after menstruation.
Mood disorders and symptoms during pregnancy and the postpartum period are not uncommon and affect women across the world. In spite of relatively high rates of depression among childbearing women, there are often inadequate resources for treatment, particularly in poorer countries. In countries lacking resources, health care is often managed by community health workers or individuals with basic health care training who provide care to difficult-to-reach populations. There are often few mental health professionals, leaving many women without adequate treatment. In an attempt to provide treatment to a greater number of women, some investigators are attempting to train community health workers to provide some psychotherapy as part of their standard duties.
