title: Perinatal Generalized Anxiety Disorder: Assessment and Treatment.
abstract: Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.
authors.affiliation: 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .|2 Department of Obstetrics and Gynecology, University of British Columbia , Vancouver, British Columbia, Canada .|3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .|4 British Columbia Mental Health and Addiction Services, Provincial Health Services Authority , Vancouver, British Columbia, Canada .
authors.forename: Shaila
authors.initials: S
authors.lastname: Misri
authors.affiliation: 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .|3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Jasmin
authors.initials: J
authors.lastname: Abizadeh
authors.affiliation: 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .|3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Shawn
authors.initials: S
authors.lastname: Sanders
authors.affiliation: 1 Reproductive Mental Health Program, British Columbia Children's & Women's Hospital , Vancouver, British Columbia, Canada .|3 Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Elena
authors.initials: E
authors.lastname: Swift
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D002170:Canada; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology* / Q000628:therapy*; D011619:Psychotropic Drugs / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors