PANIC DISORDER IN PREGNANCY

Background: Some reports have suggested that panic disorder may go int o remission during pregnancy. The universality of this finding, howeve r, is questionable. In this retrospective survey, we examined the infl uence of pregnancy on the course of panic disorder in 46 women who dev elop panic disorder either before, during, or between pregnancies. Met hod: A questionnaire inquired about the clinical course of panic disor der before, during, and after each pregnancy. Additional questions wer e asked about symptom change following breastfeeding and about caffein e use during pregnancy. The questionnaire was mailed to 138 women with a DSM-III-R diagnosis of panic disorder who had been assessed in our Anxiety Disorders Clinic. Results: Response rate to the questionnaire was 70%. Forty-six women reported a total of 67 pregnancies occurring after the development of panic disorder. Of these pregnancies, 43% wer e associated with improvement in panic symptoms, 33% with worsening, a nd 23% with no change. Furthermore, women were unlikely to experience the same outcome (i.e., worsening, improvement, or no change) in subse quent pregnancies were associated with exacerbation of symptoms in the postpartum period. No association with weaning or caffeine use was de tected. Conclusion: Our findings suggest that pregnancy may have a hig hly variable influence on the course of panic disorder. In contrast, p ostpartum worsening of panic may be a more consistent phenomenon. Impl ications for pregnancy counseling and management are discussed.