Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care

Grigoriadis, Sophie; Meschino, Diane de Camps; Barrons, Elaine; Bradley, Lana; Eady, Allison; Fishell, Alicja; Mamisachvili, Lana; Cook, Greer Slyfield; O’Keefe, Maura; Romans, Sarah; Ross, Lori E.

doi:10.1007/s00737-011-0223-5

Cited by 71 publications

(50 citation statements)

References 32 publications

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“…Grigoriadis and colleagues 25 found a high comorbid depression rate of 49.5% in perinatal women with GAD. Comorbidity with other anxiety disorders included: OCD (4.4%), agoraphobia (8.8%), panic disorder (9.9%), and phobia (19.8%).…”

Section: Consequences Of Gad In Mother and Infantmentioning

confidence: 96%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

113

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Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

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Section: Consequences Of Gad In Mother and Infantmentioning

confidence: 96%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

113

View full text Add to dashboard Cite

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“…70 Few studies included any information on diagnosis; that is, whether the medication was actually prescribed for depression. Antidepressants are also indicated for anxiety disorders, which are increasingly recognized as common in pregnancy 13,71 ; these disorders themselves are also associated with adverse birth outcomes, including lower birth weight, 72 placental abruption, 73 and decreased fetal activity. 74 Finally, we were not able to control for the effects of depression itself, and it is possible that the disease itself may be associated with malformations, perhaps via its association with inadequate prenatal care.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Grigoriadis¹,

VonderPorten²,

Mamisashvili³

et al. 2013

J. Clin. Psychiatry

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155

117

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Objective: Depression is often not optimally treated during pregnancy, partially because of conflicting data regarding antidepressant medication risk. This meta-analysis was conducted to determine whether antenatal antidepressant exposure is associated with congenital malformations and to assess the effect of known methodological limitations. Data Sources: EMBASE, CINAHL, PsycINFO, and MEDLINE were searched from their start dates to June 2010. Keywords of various combinations were used, including, but not limited to depressive/mood disorder, pregnancy, antidepressant drug/agent, congenital malformation, and cardiac malformation. Study Selection: English language studies reporting congenital malformations associated with antidepressants were included. Of 3,074 abstracts reviewed, 735 studies were retrieved and 27 studies were included. Data Extraction: Two reviewers working independently assessed article quality. Data on use of any antidepressant, including fluoxetine and paroxetine specifically, were extracted. Outcomes included congenital malformations, major congenital malformations, cardiovascular defects, septal heart defects (ventral septal defects and atrial septal defects), and ventral septal defects only. Results: Nineteen studies were above quality threshold and make up the primary meta-analyses. Pooled relative risks (RRs) were derived by using random-effects methods. Antidepressant exposure was not associated with congenital malformations (RR = 0.93; 95% CI, 0.85-1.02; P = .113) or major malformations (RR = 1.07; 95% CI, 0.99-1.17; P = .095). However, increased risk for cardiovascular malformations (RR = 1.36; 95% CI, 1.08-1.71; P = .008) and septal heart defects (RR = 1.40; 95% CI, 1.10-1.77; P = .005) were found; the RR for ventral septal defects was similar to septal defects, although not significant (RR = 1.54; 95% CI, 0.71-3.33; P = .274). Pooled effects were significant for paroxetine and cardiovascular malformations (RR = 1.43; 95% CI, 1.08-1.88; P = .012). These results are contrasted with those addressing methodological limitations but are typically consistent. Conclusions: Overall, antidepressants do not appear to be associated with an increased risk of congenital malformations, but statistical significance was found for cardiovascular malformations. Results were robust in several sensitivity analyses. Given that the RRs are marginal, they may be the result of uncontrolled confounders. Although the RRs were statistically significant, none reached clinically significant levels.

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“…However, there are limitations. First, an elevated score on the EPDS does not necessarily indicate a depressive disorder but can indicate an anxiety disorder, a substance use disorder or any emotional condition of high stress 2. The use of various licit and illicit substances in pregnancy is associated with adverse birth outcomes and may be a more potent risk factor for adverse birth outcomes than depression or stress 3.…”

Section: Commentarymentioning

confidence: 99%

The possible effects of depressive symptoms on risk of preterm birth are clouded by lack of control over confounding factors

Yonkers

2013

Evid Based Med

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The possible effects of depressive symptoms on risk of preterm birth are clouded by lack of control over confounding factors Kimberly A Yonkers Commentary on: Straub H, Adams M, Kim JJ, et al. Antenatal depressive symptoms increase the likelihood of preterm birth. Am J Obstet Gynecol 2012;207:e1-4. ContextDepressive symptoms have been associated with risk of preterm birth (PTB). 1 Straub and colleagues sought to explore whether an elevated score on the Edinburgh Postnatal Depression Scale (EPDS) is associated with adverse birth outcomes, including PTB. MethodsThe authors present results from a 'universal' screening project that enrolled 14 175 women who received prenatal care through the NorthShore University Health System. Approximately 50% of women receiving prenatal care were screened. Barriers to inclusion were participant refusal and administrative issues, but PTB rates were similar in screened and non-screened subgroups. Screening occurred between 24 and 28 weeks gestation; the method (eg, self-report or clinician-administered) was not described. A screen was considered positive if the score was >12, or if the woman endorsed suicidal thoughts. Screening results were linked with electronic medical records, and birth outcome data were extracted. The authors used multivariable logistic regression to model risk of birth <37 weeks (PTB), <34 weeks, <32 weeks, <28 weeks or delivery of a small for gestational age (SGA) infant. The analytical approach included possible confounders of race, age, history of prior PTB and insurance status. The use of antidepressant medications, tobacco or other licit and illicit substances, was not included in models. FindingsThe rate of PTB was 13.9% in women with as compared to 10.3% in women without elevated depressive symptoms. The adjusted OR for PTB was 1.3 (95% CI 1.09 to 1.35). The risk was slightly higher when only singleton pregnancies were included (1.7, 95% CI 1.38 to 1.99). Exposure to depressive symptoms also increased the risk of earlier PTB and SGA (6.6% vs 5.1%; p<0.001). CommentaryThis study included a large and generalisable cohort of pregnant women. However, there are limitations. First, an elevated score on the EPDS does not necessarily indicate a depressive disorder but can indicate an anxiety disorder, a substance use disorder or any emotional condition of high stress. 2 The use of various licit and illicit

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Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care

Cited by 71 publications

References 32 publications

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

The possible effects of depressive symptoms on risk of preterm birth are clouded by lack of control over confounding factors

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