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

This article offers a recent review of the literature on mood disorders and anxiety during the perinatal period. We conducted a literature search of the PubMed databases. Key words included the following: pregnancy, perinatal depression, risk factor, clinical presentation, pharmacological treatment. Childbearing is one of the most complex period in human experience: pregnant women and recently delivered mothers are vulnerable to the whole spectrum of general psychiatric disorders. The point prevalence rates of major and minor depression ranges 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 regards 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 psychiatric and obstetrical 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, postnatal complications. Every woman is potentially at risk of developing postpartum depression, women who present specific risk factors have a significantly increased risk of becoming depressed after delivery. These risk factors are widely studied in literature; the strongest predictors of PPD 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, lactation and requires a careful balancing of maternal and fetal risks and benefits. Antidepressant 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.