ANXIETY AND DEPRESSION - DIAGNOSIS AND TREATMENT DURING PREGNANCY

Anxiety and depression are two of the most common disorders women may expect to experience in a lifetime. Up to 2% may suffer from anxiety-r elated disorders,(35) while 25% may suffer from depression (48) Even t hough anxiety and depression are seen more often in women, obstetricia ns-gynecologists traditionally have not been trained in the diagnosis or treatment of these conditions. For example, two major textbooks in obstetrics fail to address these disorders.(13, 19) Pregnancy is a hig hly stressful time in a woman's life and is often associated with anxi ety and depression. Fear of a deformed infant, pain in childbirth, and motherhood are common sources of anxiety that may ultimately lead to depression. Fortunately, most women do well with simple reassurance fr om their provider and family support. A small subset of symptomatic pa tients require psychotropic medications prior to conception, during th e embryonic period, or initiation during the pregnancy. The purpose of this article is to review diagnostic criteria used in diagnosing anxi ety and depressive disorders and to discuss available treatment option s. Additionally, how pregnancy may affect these disorders is explored. A concern to all obstetricians is the potential and real risks to the developing fetus from pharmacologic treatments. What is known about t he common medications used in treating these disorders is emphasized. From this information, the authors suggest guidelines to answer the fo llowing questions: Should psychotropic medications be discontinued pri or to conception or as soon as pregnancy is diagnosed? If a potential teratogen was taken during pregnancy, what are the recommendations for screening the fetus for anomalies? What is the necessity of using a d rug that is known or suspected to cause fetal anomalies?