Perinatal mood and anxiety disorders. Clinical assessment and management. A review of current literature

This article reviews recent literature on mood and anxiety disorders during the perinatal period. We conducted a search of the PubMed databases. Key words included pregnancy, perinatal depression, risk factors, clinical presentation, drug treatment. Childbearing is one of the most complex periods of human experience; pregnant women and mothers who recently delivered are vulnerable to the entire spectrum of psychiatric disorders. The cumulative point-prevalence rates of major and minor depression range from 8.5% to 11% during pregnancy, and from 6.5% to 12.9% during the first year postpartum. Anxiety symptoms are frequently reported by pregnant women; in recent literature antenatal anxiety has received increased attention with regard to both its impact on infant outcomes and as a risk factor for postnatal depression. Gender-specific differences in the prevalence and clinical course of depression undoubtedly stem from a variety of factors, including biological differences between women and men. Several studies reveal the psychoactive effects of female hormones; low estrogen levels are associated with premenstrual syndrome, postpartum, and menopausal depression. Untreated perinatal mental disorders may have severe obstetrical and psychiatric short-and long-term consequences, not only for the woman but also for her family and mostly for the newborn baby, such as premature birth, cesarean section, instrumental vaginal deliveries, intrauterine growth retardation, low birth weight, and postnatal complications. Every woman is potentially at risk for developing postpartum depression, women who present specific risk factors have a significantly increased risk for becoming depressed after delivery. These risk factors are widely studied in literature; the strongest predictors of postpartum depression are the experience of depression or anxiety during pregnancy or a previous depressive illness; in addition to these predictors, life stress and lack of social support have a moderate-severe effect size. Psychological factors and marital problems have a moderate effect size, while obstetric factors and socioeconomic status have a small effect size. Pharmacological treatment of mood and anxiety disorders are based on clinical experience and management of disorders during pregnancy, postpartum and lactation requires a careful balancing of maternal and fetal risks and benefits. Antidepressants are relatively safe in pregnancy and during lactation; a greater attention should be given to the use of stabilizers and neuroleptics, but clinical dates are still contradictory.