title: Generalized Anxiety Disorder and Major Depressive Disorder in Pregnant and Postpartum Women: Maternal Quality of Life and Treatment Outcomes.
abstract: OBJECTIVE
  Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in perinatal women is often under-diagnosed, resulting in suboptimal treatment and leading to significant maternal dysfunction. We describe a prospective, longitudinal study of the course, treatment outcomes, and quality of life (QoL) in pregnant and postpartum women with MDD and anxiety disorders.
  
  
  METHODS
  Two separate cohorts of women were recruited through the Reproductive Mental Health Program, Women's and Children's Hospital, Vancouver, British Columbia, for pharmacotherapy of depressed mood. One cohort was recruited during pregnancy and followed to one month postpartum; the other cohort was recruited postpartum and followed for 12 weeks. All women met the DSM-5 criteria for MDD and anxiety disorders. This non-lactating perinatal population completed measures of depression, anxiety, worry symptoms, and QoL at multiple study visits. Depressed women with GAD or excessive worry were compared to those without GAD in each cohort.
  
  
  RESULTS
  Analysis revealed that despite the majority of women with MDD having remission of symptoms with treatment, those with postpartum GAD displayed a poorer quality of life, with persistent worry symptoms, and their illness was slower to remit. Pregnant depressed women with uncontrollable worry (a GAD indicator) showed a lower probability of achieving remission of symptoms with treatment than those without uncontrollable worry.
  
  
  CONCLUSIONS
  All pregnant and postpartum women with GAD and MDD responded to pharmacotherapy, and the majority attained complete remission of MDD. However, their GAD symptoms persisted, and their QoL was compromised. Given the chronic debilitating course of concomitant MDD and GAD in the perinatal population, it is essential to focus on adjunctive therapies to aim for full recovery.
authors.affiliation: Reproductive Mental Health Program, BC Children's and Women's Hospital, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Psychiatry, University of British Columbia, Vancouver BC; BC Mental Health and Addiction Services, Provincial Health Services Authority, Vancouver BC.
authors.forename: Shaila
authors.initials: S
authors.lastname: Misri
authors.affiliation: Reproductive Mental Health Program, BC Children's and Women's Hospital, Vancouver BC; Department of Psychiatry, University of British Columbia, Vancouver BC.
authors.forename: Elena
authors.initials: E
authors.lastname: Swift
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
keywords: anxiety disorders; comorbidity; major depressive disorder; postpartum period; pregnancy; quality of life