Treating women with psychiatric disorders during pregnancy is a challenge for numerous reasons. Balancing the risks and benefits of symptoms and treatments is particularly important during pregnancy because both medication and maternal illness may have adverse effects on the fetus. Pregnancy is generally thought to be a time of happiness and emotional well-being for a woman. However, for many women, pregnancy and motherhood increase their vulnerability to psychiatric conditions such as depression, anxiety disorders, eating disorders, and psychoses.
Depression in pregnancy: During pregnancy, symptoms of depression such as changes in sleep, appetite, and energy are often difficult to distinguish from the normal experiences of pregnancy. Depression is the most common psychiatric disorder associated with pregnancy. Pregnant women may also suffer from anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and eating disorders. While it is rare for women to experience first-onset psychoses during pregnancy, relapse rates are high for women previously diagnosed with some form of psychosis.
Panic disorder: Women may experience first-onset panic disorder during pregnancy. Women presenting with panic attacks for the first time should be screened for thyroid disorder. The possible effects of anxiety and panic on the course of the pregnancy and the health of the fetus are not well understood.
Obsessive-compulsive disorder: Obsessive-compulsive disorder (OCD) is characterized by thoughts that cannot be controlled (obsessions) and repetitive behaviors or rituals that cannot be controlled (compulsions) in response to these thoughts. Women may be at an increased risk for the onset of OCD during pregnancy and the postpartum period. Treatments for OCD in pregnancy are the same as those in non-pregnant adults and include cognitive behavioral therapy and pharmacotherapy. Women with severe OCD can become quite incapacitated and will require treatment.
Generalized anxiety disorder: Most women, naturally enough, worry about the health of the fetus and how they will cope with labor and bodily changes. Excessive worrying, however, may be a symptom of GAD or depression.
Psychoses in pregnancy: The occurrence of new episodes of psychosis during pregnancy is extremely rare. However, for women with a history of psychosis, particular psychosis in previous pregnancies, the relapse rates are high, with the most common manifestations being bipolar illness, followed by psychotic depression and schizophrenia.
Bipolar mood disorder: It appears that some women with bipolar disorder may experience a relief from symptoms during pregnancy, but that the risk of relapse in the postpartum period is high.