Abstract
During pregnancy and the postpartum, a woman’s body must make extraordinary physical, biochemical, and hormonal adjustments. These physiological changes occur in concert with profound psychological experiences as women make the transition to motherhood. Most women do not suffer from significant mental health issues after giving birth. Although 80 % of women experience the baby blues, these symptoms quickly resolve by 2 weeks postpartum and are not considered a serious problem that requires medical intervention. For other women, however, this transition is more emotionally and psychologically challenging and can be a period of more serious mood and anxiety symptoms. This chapter reviews postpartum depression and anxiety, including the phenomenology, risk factors, and treatment options. In particular obsessive-compulsive disorder and generalized anxiety disorder, often overlooked, but not uncommon conditions are reviewed in detail.
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References
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behavior Research & Therapy, 44(9), 1361–1374. doi:10.1016/j.brat.2005.09.011.
Altshuler, L. L., Hendrick, V., & Cohen, L. S. (1998). Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry, 59(Suppl 2), 29–33.
American Psychiatric Association., & American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association., & American Psychiatric Association. Task Force on DSM-IV. (1994). Diagnostic and statistical manual of mental disorders : DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.
Austin, M. P., Hadzi-Pavlovic, D., Priest, S. R., Reilly, N., Wilhelm, K., Saint, K., et al. (2010). Depressive and anxiety disorders in the postpartum period: How prevalent are they and can we improve their detection? Archives of Women’s Mental Health, 13(5), 395–401. doi:10.1007/s00737-010-0153-7.
Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275–285.
Beck, C. T. (2006). Postpartum depression: It isn’t just the blues. American Journal of Nursing, 106(5), 40–50. quiz 50-41.
Birnbaum, C. S., Cohen, L. S., Bailey, J. W., Grush, L. R., Robertson, L. M., & Stowe, Z. N. (1999). Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics, 104(1), e11.
Bloch, M., Schmidt, P. J., Danaceau, M., Murphy, J., Nieman, L., & Rubinow, D. R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry, 157(6), 924–930.
Brandes, M., Soares, C. N., & Cohen, L. S. (2004). Postpartum onset obsessive-compulsive disorder: Diagnosis and management. Archives of Women’s Mental Health, 7(2), 99–110. doi:10.1007/s00737-003-0035-3.
Chaudron, L. H., & Nirodi, N. (2010). The obsessive-compulsive spectrum in the perinatal period: A prospective pilot study. Archives of Women’s Mental Health, 13(5), 403–410. doi:10.1007/s00737-010-0154-6.
Cohen, L. S., Sichel, D. A., Dimmock, J. A., & Rosenbaum, J. F. (1994). Postpartum course in women with preexisting panic disorder. Journal of Clinical Psychiatry, 55(7), 289–292.
Connor, K. M., & Davidson, J. R. (1998). Generalized anxiety disorder: Neurobiological and pharmacotherapeutic perspectives. Biological Psychiatry, 44(12), 1286–1294.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. British Journal of Psychiatry, 150, 782–786.
Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Systematic Reviews, 2, CD001134. doi:10.1002/14651858.CD001134.pub3.
Dennis, C. L., Ravitz, P., Grigoriadis, S., Jovellanos, M., Hodnett, E., Ross, L., et al. (2012). The effect of telephone-based interpersonal psychotherapy for the treatment of postpartum depression: Study protocol for a randomized controlled trial. Trials, 13, 38. doi:10.1186/1745-6215-13-38.
Engineer, N., Darwin, L., Nishigandh, D., Ngianga-Bakwin, K., Smith, S. C., & Grammatopoulos, D. K. (2013). Association of glucocorticoid and type 1 corticotropin-releasing hormone receptors gene variants and risk for depression during pregnancy and post-partum. Journal of Psychiatry Research, 47(9), 1166–1173. doi:10.1016/j.jpsychires.2013.05.003.
Forray, A., Focseneanu, M., Pittman, B., McDougle, C. J., & Epperson, C. N. (2010). Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. Journal of Clinical Psychiatry, 71(8), 1061–1068. doi:10.4088/JCP.09m05381blu.
Freeman, M. P. (2009). Complementary and alternative medicine for perinatal depression. Journal of Affective Disorders, 112(1–3), 1–10. doi:10.1016/j.jad.2008.06.017.
Gentile, S. (2005). The safety of newer antidepressants in pregnancy and breastfeeding. Drug Safety, 28(2), 137–152.
Healey, C., Morriss, R., Henshaw, C., Wadoo, O., Sajjad, A., Scholefield, H., et al. (2013). Self-harm in postpartum depression and referrals to a perinatal mental health team: An audit study. Archives of Women’s Mental Health, 16(3), 237–245. doi:10.1007/s00737-013-0335-1.
Jiang, W., Gagliardi, J. P., Krishnan, K., & Rama, R. (2009). Clinician’s guide to psychiatric care. Oxford: Oxford University Press.
Jonas, W., Mileva-Seitz, V., Girard, A. W., Bisceglia, R., Kennedy, J. L., Sokolowski, M., … on behalf of the, Mavan Research Team. (2013). Genetic variation in oxytocin rs2740210 and early adversity associated with postpartum depression and breastfeeding duration. Genes Brain Behavior, 12(7), 681–694. doi: 10.1111/gbb.12069
Jones, I., Cantwell, R., & Nosology Working Group, Royal College of Psychiatrists Perinatal Section. (2010). The classification of perinatal mood disorders–suggestions for DSMV and ICD11. Archives of Women’s Mental Health, 13(1), 33–36. doi:10.1007/s00737-009-0122-1.
Kapczinski F. F. K., Silva de Lima, M., dos Santos Souza, J. J. S. S., Batista Miralha da Cunha, A. A. B. C., & Schmitt, R. R. S. (2003). Antidepressants for generalized anxiety disorder. Cochrane Database of Systematic Reviews,2 (2). http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003592/abstract doi: 10.1002/14651858.CD003592
Kelly, L. E., Poon, S., Madadi, P., & Koren, G. (2012). Neonatal benzodiazepines exposure during breastfeeding. Journal of Pediatrics, 161(3), 448–451. doi:10.1016/j.jpeds.2012.03.003.
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. doi:10.1002/mpr.1359.
Khazaie, H., Ghadami, M. R., Knight, D. C., Emamian, F., & Tahmasian, M. (2013). Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial. Psychiatry Research, 201(3), 901–905. doi:10.1016/j.psychres.2013.08.017.
Lindsay, M., Crino, R., & Andrews, G. (1997). Controlled trial of exposure and response prevention in obsessive-compulsive disorder. British Journal of Psychiatry, 171, 135–139.
Markhus, M. W., Skotheim, S., Graff, I. E., Froyland, L., Braarud, H. C., Stormark, K. M., et al. (2013). Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. PLoS One, 8(7), e67617. doi:10.1371/journal.pone.0067617.
McGuinness, M., Blissett, J., & Jones, C. (2011). OCD in the perinatal period: Is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioral and Cognitive Psychotherapy, 39(3), 285–310. doi:10.1017/s1352465810000718.
Misri, S., Albert, G., Abizadeh, J., Kendrick, K., Carter, D., Ryan, D., et al. (2012). Biopsychosocial determinants of treatment outcome for mood and anxiety disorders up to 8 months postpartum. Archives of Women’s Mental Health, 15(4), 313–316. doi:10.1007/s00737-012-0288-9.
Moses-Kolko, E. L., Wisner, K. L., Price, J. C., Berga, S. L., Drevets, W. C., Hanusa, B. H., et al. (2008). Serotonin 1A receptor reductions in postpartum depression: A positron emission tomography study. Fertility and Sterility, 89(3), 685–692. doi:10.1016/j.fertnstert.2007.03.059.
Nanzer, N., Sancho Rossignol, A., Righetti-Veltema, M., Knauer, D., Manzano, J., & Palacio Espasa, F. (2012). Effects of a brief psychoanalytic intervention for perinatal depression. Archives of Women’s Mental Health, 15(4), 259–268. doi:10.1007/s00737-012-0285-z.
Nonacs, R., & Cohen, L. S. (1998). Postpartum mood disorders: Diagnosis and treatment guidelines. Journal of Clinical Psychiatry, 59(Suppl 2), 34–40.
Nonacs, R., & Cohen, L. S. (2002). Depression during pregnancy: Diagnosis and treatment options. Journal of Clinical Psychiatry, 63(Suppl 7), 24–30.
O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379–407. doi:10.1146/annurev-clinpsy-050212-185612.
O’Hara, M. W., Stuart, S., Watson, D., Dietz, P. M., Farr, S. L., & D’Angelo, D. (2012). Brief scales to detect postpartum depression and anxiety symptoms. Journal of Women’s Health (Larchmt), 21(12), 1237–1243. doi:10.1089/jwh.2012.3612.
O’Mahen, H., Himle, J. A., Fedock, G., Henshaw, E., & Flynn, H. (2013). A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes. Depression and Anxiety, 30(7), 679–687. doi:10.1002/da.22050.
Paul, I. M., Downs, D. S., Schaefer, E. W., Beiler, J. S., & Weisman, C. S. (2013). Postpartum anxiety and maternal-infant health outcomes. Pediatrics, 131(4), e1218–e1224. doi:10.1542/peds.2012-2147.
Pinheiro, R. T., Coelho, F. M., Silva, R. A., Pinheiro, K. A., Oses, J. P., Quevedo Lde, A., et al. (2013). Association of a serotonin transporter gene polymorphism (5-HTTLPR) and stressful life events with postpartum depressive symptoms: A population-based study. Journal of Psychosomatic Obstetrics & Gynaecology, 34(1), 29–33. doi:10.3109/0167482X.2012.759555.
Reay, R. E., Mulcahy, R., Wilkinson, R. B., Owen, C., Shadbolt, B., & Raphael, B. (2012). The development and content of an interpersonal psychotherapy group for postnatal depression. International Journal of Group Psychotherapy, 62(2), 221–251. doi:10.1521/ijgp.2012.62.2.221.
Ross, L. E., & McLean, L. M. (2006). Anxiety disorders during pregnancy and the postpartum period: A systematic review. Journal of Clinical Psychiatry, 67(8), 1285–1298.
Ross, L. E., Murray, B. J., & Steiner, M. (2005). Sleep and perinatal mood disorders: A critical review. Journal of Psychiatry Neuroscience, 30(4), 247–256.
Shaw, E., Levitt, C., Wong, S., Kaczorowski, J., & McMaster University Postpartum Research, Group. (2006). Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth, 33(3), 210–220. doi:10.1111/j.1523-536X.2006.00106.x.
Sichel, D. A., Cohen, L. S., Dimmock, J. A., & Rosenbaum, J. F. (1993). Postpartum obsessive compulsive disorder: A case series. Journal of Clinical Psychiatry, 54(4), 156–159.
Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). A review of postpartum psychosis. Journal of Women’s Health (Larchmt), 15(4), 352–368. doi:10.1089/jwh.2006.15.352.
Skalkidou, A., Hellgren, C., Comasco, E., Sylven, S., & Sundstrom Poromaa, I. (2012). Biological aspects of postpartum depression. Women’s Health (London, England), 8(6), 659–672. doi:10.2217/whe.12.55.
Slattery, D. A., & Neumann, I. D. (2008). No stress please! Mechanisms of stress hyporesponsiveness of the maternal brain. Journal of Physiology, 586(2), 377–385. doi:10.1113/jphysiol.2007.145896.
Spinelli, M. G. (2004). Maternal infanticide associated with mental illness: Prevention and the promise of saved lives. American Journal of Psychiatry, 161(9), 1548–1557. doi:10.1176/appi.ajp.161.9.1548.
Steiner, M., Peer, M., Macdougall, M., & Haskett, R. (2011). The premenstrual tension syndrome rating scales: An updated version. Journal of Affective Disorders, 135(1–3), 82–88. doi:10.1016/j.jad.2011.06.058.
Stowe, Z. N., & Nemeroff, C. B. (1995). Women at risk for postpartum-onset major depression. American Journal of Obstetrics & Gynecology, 173(2), 639–645.
Stuart, S. (2012). Interpersonal psychotherapy for postpartum depression. Clinical Psychology Psychotherapy, 19(2), 134–140. doi:10.1002/cpp.1778.
Studd, J., & Nappi, R. E. (2012). Reproductive depression. Gynecology & Endocrinology, 28(Suppl 1), 42–45. doi:10.3109/09513590.2012.651932.
Suda, S., Segi-Nishida, E., Newton, S. S., & Duman, R. S. (2008). A postpartum model in rat: Behavioral and gene expression changes induced by ovarian steroid deprivation. Biological Psychiatry, 64(4), 311–319. doi:10.1016/j.biopsych.2008.03.029.
Sutter-Dallay, A. L., Giaconne-Marcesche, V., Glatigny-Dallay, E., & Verdoux, H. (2004). Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. European Psychiatry, 19(8), 459–463. doi:10.1016/j.eurpsy.2004.09.025.
Swanson, L. M., Pickett, S. M., Flynn, H., & Armitage, R. (2011). Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. Journal of Women’s Health (Larchmt), 20(4), 553–558. doi:10.1089/jwh.2010.2371.
Uguz, F., Akman, C., Kaya, N., & Cilli, A. S. (2007). Postpartum-onset obsessive-compulsive disorder: Incidence, clinical features, and related factors. Journal of Clinical Psychiatry, 68(1), 132–138.
Weissman, M. M., Prusoff, B. A., Dimascio, A., Neu, C., Goklaney, M., & Klerman, G. L. (1979). The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American Journal of Psychiatry, 136(4B), 555–558.
Westberg, L., & Eriksson, E. (2008). Sex steroid-related candidate genes in psychiatric disorders. Journal of Psychiatry Neuroscience, 33(4), 319–330.
Wisner, K. L., Peindl, K. S., Gigliotti, T., & Hanusa, B. H. (1999). Obsessions and compulsions in women with postpartum depression. Journal of Clinical Psychiatry, 60(3), 176–180.
Wisner, K. L., Peindl, K. S., & Hanusa, B. H. (1996). Effects of childbearing on the natural history of panic disorder with comorbid mood disorder. Journal of Affective Disorders, 41(3), 173–180.
Worsley, R., Gilbert, H., Gavrilidis, E., Naughton, B., & Kulkarni, J. (2013). Breastfeeding and psychotropic medications. Lancet, 381(9870), 905. doi:10.1016/S0140-6736(13)60671-6.
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Puryear, L.J. (2014). Postpartum Adjustment: What Is Normal and What Is Not. In: Barnes, D. (eds) Women's Reproductive Mental Health Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-05116-1_6
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