title: Recurrence of panic disorder during pregnancy: a 7-year naturalistic follow-up study.
abstract: OBJECTIVE
  The aim of this naturalistic follow-up study was to examine the effect of pregnancy as a predicting factor of relapse in patients with panic disorder (PD).
  
  
  METHODS
  Eighty-five female patients with PD (between the ages of 20 and 35 years) were included in this study. They were divided into 2 groups based on whether the onset of PD had been during pregnancy (PD-pregnancy [PD-P]) or whether the onset of PD had been while not pregnant (PD-nonpregnant [PD-NP]). Patients were treated with paroxetine up to 40 mg/day for 12 months, and the full responders were tapered off their medication and were monitored for an additional 6 years. Treatment response was assessed using the Panic Self-Questionnaire (PSQ) with full response being defined as "0" panic attacks. Assessments using the PSQ were made at baseline and every 4 weeks for the first twelve months. During the 6-year drug-free follow-up period, patients were assessed using the PSQ every 3 months. Relapse was defined as the occurrence of a panic attack in any phase of the study. The effect of group membership (PD-P vs. PD-NP) and new pregnancies as risk factors for relapse were explored.
  
  
  RESULTS
  Sixty-eight patients completed the 6-year follow-up, and each of the study groups (PD-P and PD-NP) was composed of 34 patients. Twenty-six of 34 (76.6%) patients in the PD-P group had another pregnancy, and 15/26 (57%) in this group experienced a relapse during the subsequent pregnancy. Three of 8 (37%) PD-P patients experienced a relapse without pregnancy. Among the second group (PD-NP), 18/34 (52.9%) became pregnant and 8/18 (44.4%) experienced a relapse at the time of pregnancy, whereas 4/16 (25%) experienced a relapse while not pregnant. Patients who relapsed during pregnancy had a more severe relapse (as defined by the severity of the PSQ score) compared with nonpregnant relapsers.
  
  
  CONCLUSIONS
  Our naturalistic follow-up study demonstrated that pregnancy might confer an increased risk of relapse in PD. Moreover, when compared with patients who develop PD while not pregnant (PD-NP), patients who develop PD during pregnancy (PD-P) appear to have a higher risk of relapse at the time of a subsequent pregnancy (P < 0.001).
authors.affiliation: The Rehovot Community Mental Health and Rehabilitation Clinic, Ness Ziona-Beer Yaakov Medical Campus, Rehovot, Israel. pinhasd@post.tau.ac.il
authors.forename: Pinhas N
authors.initials: PN
authors.lastname: Dannon
authors.forename: Iulian
authors.initials: I
authors.lastname: Iancu
authors.forename: Katherine
authors.initials: K
authors.lastname: Lowengrub
authors.forename: Leon
authors.initials: L
authors.lastname: Grunhaus
authors.forename: Moshe
authors.initials: M
authors.lastname: Kotler
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016584:Panic Disorder / Q000453:epidemiology* / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology*; D012008:Recurrence