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Mood and Anxiety Disorders During Pregnancy and Postpartum PDF

165 Pages·2005·1.21 MB·English
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Mood and Anxiety Disorders During Pregnancy and Postpartum Review of Psychiatry Series John M. Oldham, M.D., M.S. Michelle B. Riba, M.D., M.S. Series Editors Mood and Anxiety Disorders During Pregnancy and Postpartum EDITEDBY Lee S. Cohen, M.D. Ruta M. Nonacs, M.D., Ph.D. REVIEW VOLUME 24 OF PSYCHIATRY No. 4 Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2005 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 09 08 07 06 05 5 4 3 2 1 First Edition Typeset in Adobe’s Palatino. American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org The correct citation for this book is Cohen, Lee S., Nonacs, Ruta M. (editors): Mood and Anxiety Disorders During Pregnancy and Postpartum (Review of Psychiatry Series, Volume 24, Number 4; Oldham JM and Riba MB, series editors). Washington, DC, American Psychiatric Publishing, 2005 Library of Congress Cataloging-in-Publication Data Mood and anxiety disorders during pregnancy and postpartum / edited by Lee S. Cohen, Ruta M. Nonacs.—1st ed. p. ; cm.—(Review of psychiatry series ; v. 24, 4) Includes bibliographical references and index. ISBN 1-58562-225-7 (pbk. : alk. paper) 1. Mental illness in pregnancy. 2. Postpartum depression. 3. Affective disorders. 4. Anxiety in women. I. Cohen, Lee S. II. Nonacs, Ruta. III. Series. [DNLM: 1. Anxiety Disorders—Pregnancy. 2. Mood Disorders—Pregnancy. 3. Depression, Postpartum. 4. Postpartum Period—psychology. WQ 240 M817 2005] RG588.M66 2005 618.7′6—dc22 2005004568 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors ix Introduction to the Review of Psychiatry Series xi John M. Oldham, M.D., M.S., and Michelle B. Riba, M.D., M.S. Preface xv Lee S. Cohen, M.D., and Ruta M. Nonacs, M.D., Ph.D. Chapter 1 Course of PsychiatricIllness During Pregnancy and the Postpartum 1 Laura Fagioli Petrillo, M.D., Ruta M. Nonacs, M.D., Ph.D., Adele C. Viguera, M.D., and Lee S. Cohen, M.D. Unipolar Depression 2 Bipolar Disorder 4 Anxiety Disorders 5 Psychotic Disorders 8 Risks of Untreated Illness in the Mother 9 Conclusion 10 References 11 Chapter 2 Diagnosis and TreatmentofMood and Anxiety Disorders in Pregnancy 17 Ruta M. Nonacs, M.D., Ph.D., Lee S. Cohen, M.D., Adele C. Viguera, M.D., and Juliana Mogielnicki, B.A. Prevalence of Mood and Anxiety Disorders DuringPregnancy 19 Risks of Untreated Maternal Illness During Pregnancy 20 Treatment of Mood Disorders During Pregnancy 22 Treatment of Anxiety Disorders During Pregnancy 36 General Guidelines for Treatment of Mood and Anxiety Disorders During Pregnancy 39 Conclusion 41 References 42 Chapter 3 Management of BipolarDisorder During Pregnancy and the Postpartum Period: Weighing the Risks and Benefits 53 Adele C. Viguera, M.D., Lee S. Cohen, M.D., Ruta M. Nonacs, M.D., Ph.D., and Ross J. Baldessarini, M.D. Risk and Course of Bipolar Disorder DuringPregnancy 54 Risk and Course of Bipolar Disorder Duringthe Postpartum Period 56 Potential Risks of Pharmacotherapy DuringPregnancy 58 Fetal Risks Associated With Mood-Stabilizing Agents 60 Treatment Planning for the Pregnant Patient With Bipolar Disorder 65 Treatment Planning for the Patient With Bipolar Disorder in the Postpartum Period 69 Conclusion 70 References 70 Chapter 4 Postpartum Mood Disorders 77 Ruta M. Nonacs, M.D., Ph.D. Clinical Features 79 Screening for Postpartum Mood Disorders 81 Course and Prognosis 83 Risk Factors 83 Treatment 86 Conclusion 95 References 96 Chapter 5 Use of Antidepressants and Mood Stabilizers in Breast-Feeding Women 105 Kimberly Ragan, M.S.W., Zachary N. Stowe, M.D., and D. Jeffrey Newport, M.D., M.S., M.Div. Pharmacologic Treatment Options for Unipolar Depression and Bipolar Disorder in Breast-Feeding 106 Mental Illness in Postpartum Women: Spectrum of Psychiatric Conditions 131 Clinical Decision Making 132 Conclusion 134 References 135 Index 145 This page intentionally left blank Contributors Ross J. Baldessarini, M.D. Professor of Psychiatry (Neuroscience), Harvard Medical School, Bos- ton, Massachusetts; Director, McLean Psychopharmacology Program, Neuropsychopharmacology Laboratory and International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, Massachu- setts Lee S. Cohen, M.D. Associate Professor of Psychiatry, Harvard Medical School; Director, Perinatal and Reproductive Psychiatry Clinical Research Program, Clinical Psychopharmacology Unit, Department of Psychiatry, Massa- chusetts General Hospital, Boston, Massachusetts Juliana Mogielnicki, B.A. Perinatal and Reproductive Psychiatry Clinical Research Program, Clinical Psychopharmacology Unit, Department of Psychiatry, Massa- chusetts General Hospital, Boston, Massachusetts D. Jeffrey Newport, M.D., M.S., M.Div. Assistant Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia Ruta M. Nonacs, M.D., Ph.D. Instructor in Psychiatry, Harvard Medical School; Associate Director, Perinatal and Reproductive Psychiatry Clinical Research Program, Clinical Psychopharmacology Unit, Department of Psychiatry, Massa- chusetts General Hospital, Boston, Massachusetts John M. Oldham, M.D., M.S. Professor and Chair, Department of Psychiatry and Behavioral Sci- ences, Medical University of South Carolina, Charleston, South Carolina Laura Fagioli Petrillo, M.D. Instructor in Psychiatry, Harvard Medical School and Perinatal and Reproductive Psychiatry Clinical Research Program, Clinical Psycho- pharmacology Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts Contributors ix

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Mood and Anxiety Disorders During Pregnancy and Postpartum earns its important place in the literature by detailing our current understanding of the course, diagnosis, and treatment of psychiatric illness during pregnancy and postpartum, including breast-feeding—a top priority today because we now
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