UC DAVIS HEALTH
EVIDENCE-BASED PRACTICE

Implications of Treatment for Perinatal Generalized Anxiety Disorder on Postpartum Depression

Bayan Odeh, Kevin Barnwell, Christopher Burleson, Alexis Garcia, Sanam Karamouz, Jocelyn Nguyen, Danielle Stewart

 
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POSTER - #PI1053

Implications of Treatment for Perinatal Generalized Anxiety Disorder on Postpartum Depression

Bayan Odeh, Kevin Barnwell, Christopher Burleson, Alexis Garcia, Sanam Karamouz, Jocelyn Nguyen, Danielle Stewart
UC DAVIS HEALTH -  EVIDENCE-BASED PRACTICE

Background
● Generalized anxiety disorder (GAD) consists of two classic, generalized symptom clusters: excessive worry and uncontrollable anxiety.
● Perinatal depressive and anxiety disorders are common with at least 8% experiencing GAD during pregnancy.
● Untreated GAD has damaging effects on both mother and infant including cognitive and behavioral impairment.
● As the use of pharmacological interventions in pregnancy are controversial, there appears to be uncertainty regarding the most appropriate interventions for management of perinatal anxiety. Since a potential link between perinatal anxiety and onset of postpartum depression has been identified, investigation is imperative.

PICO Question
In women, what is the effect of treatment (therapy and/or medication) on GAD compared with non-treatment during the perinatal window on the development of postpartum depression?

Search Strategy
Search Databases: Google Scholar, PubMed [NCBI], CINAHL [via EBSCO] Key Words: anxiety, perinatal, pharmacologic, non-pharmacologic, postpartum depression

Results
● Women who were given prophylactic treatment 3 days postnatal with SSRI’s experienced reduction of depressive and anxious symptoms. (LOE: II)
● 17-week trial of Sertraline immediately following birth reduced the rate of recurrence of postpartum depression and increased the time of recurrence. (LOE: I)
● Women who were given probiotic, Lactobacillus rhamnosus (HN001), which is not contraindicated perinatally, during pregnancy until 6 months postpartum reported significantly lower depression and anxiety scores. (LOE: I)
● 8 weeks of partner-delivered chair massage helped improve perinatal moods and anxiety. (LOE: II)
● Mindfulness-integrated cognitive behavioral therapy showed to help alleviate anxiety and depression in pregnant women. (LOE: I)
● Women who suffered from anxiety disorders during pregnancy are more likely to have “intense postnatal depressive symptoms”. (LOE: II)
● Discontinuation of antidepressant treatment during pregnancy increased the risk of depression
(LOE: III)
● There are no consistent differences in risk level for birth weight outcomes, spontaneous abortion and preterm birth associated with the use of antidepressants during pregnancy in mothers with depression. (LOE: I)
● There is evidence to suggest a correlation between perinatal anxiety and depression with preterm birth and low birth weight. (LOE: I)

Summary
● Both pharmacological and non-pharmacological interventions such as cognitive behavioral therapy and other alternative treatments are effective at reducing perinatal anxiety and depression.
● There is no significant risk for preterm birth or low birth weight in women who use antidepressant drugs during gestation
● There appears to be greater fetal risks associated with not treating depression and anxiety in pregnant women compared to treating depression.

Conclusions/Further Study
● The need for a definition of perinatal GAD in DSM criteria
● An increased need for screening for perinatal anxiety and depression in at-risk patients
● Further research for perinatal anxiety specifically, the birth outcomes associated with use of perinatal antidepressant treatment, and the correlation between perinatal anxiety and onset of PPD

References
Misri, S., Abizadeh, J., Sanders, S., & Swift, E. (2015). Perinatal Generalized Anxiety Disorder: Assessment and Treatment. Journal of Women's Health, 24(9), 762-772, DOI: 10.1089/jwh.2014.5150.
Slykerman, R. F., Hood, F., Wickens, K., Thompson, J., Murphy, R., Kang, J., . . . Mitchell, E. A. (2017). Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine, 24, 159-165, DOI: https://doi.org/10.1016/j.ebiom.2017.09.013 2.
Thomas R. B. (2019). A Pilot Study of Partner Chair Massage Effects on Perinatal Mood, Anxiety, and Pain. International journal
of therapeutic massage & bodywork, 12(2), 3–11.
Uguz, F., Subasi, E., Dalboy, F., & Ak, M. (2019). Pharmacological prophylaxis of postpartum exacerbation in depressive and anxiety symptoms: a retrospective study. Journal of Maternal-Fetal and Neonatal Medicine, 32(16), 2774-2775, DOI: 10.1080/14767058.2018.1447559.
Ugz, F., Yakut, E., Aydogan, S., Byman, M. G., & Gezginc, K. (2019). Prevalence of mood and anxiety disorders during pregnancy: A case-control study with a large sample size. Psychiatry Research, 272, 316-318, DOI:
https://doi.org/10.1016/j.psychres.2018.12.129.
Wisner, K. L., Perel, J. M., Peindl, K. S., Hanusa, B. H., Piontek, C. M., & Findling, R. L. (2004). Prevention of Postpartum Depression: A Pilot Randomized Clinical Trial. American Journal of Psychiatry, 161, 1290-1292, DOI:
https://doi.org/10.1176/appi.ajp.161.7.1290. 

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