title: Clinical management of perinatal anxiety disorders: A systematic review.
abstract: BACKGROUND
  In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited.
  
  
  METHODS
  A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.
  
  
  RESULTS
  18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the open-label trial of fluvoxamine (up to 300mg/day) experienced a 30% or greater decrease in the total score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). During pregnancy, SSRIs and tricyclic antidepressants (TCAs) led to remission of panic symptoms and healthy outcomes for the babies.
  
  
  CONCLUSIONS
  Study design, mostly case reports, and enrolment of subjects mainly from outpatient specialty units might have limited community-wide generalisability.
  
  
  CONCLUSIONS
  Keeping in mind the scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that CBT should be the first treatment offered to pregnant and breastfeeding women with AnxD. However SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT.
authors.affiliation: Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy. Electronic address: carlo.marchesi@unipr.it.
authors.forename: C
authors.initials: C
authors.lastname: Marchesi
authors.affiliation: Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy. Electronic address: paolo.ossola@unipr.it.
authors.forename: P
authors.initials: P
authors.lastname: Ossola
authors.affiliation: Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA. Electronic address: andrea.amerio@studenti.unipr.it.
authors.forename: A
authors.initials: A
authors.lastname: Amerio
authors.affiliation: Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy. Electronic address: daniel.benjamindaniel@gmail.com.
authors.forename: B D
authors.initials: BD
authors.lastname: Daniel
authors.affiliation: Department of Mental Health, Local Healthy Service of Parma, Parma, Italy. Electronic address: mtonna@ausl.pr.it.
authors.forename: M
authors.initials: M
authors.lastname: Tonna
authors.affiliation: Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy. Electronic address: chiara.depanfilis@unipr.it.
authors.forename: C
authors.initials: C
authors.lastname: De Panfilis
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Antidepressant; Anxiety disorders; Cognitive-behavioural therapy; Perinatal period; Treatment