MOOD AND AXIETY PERGNANCY ADN POSPARTUM

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Mood and
Anxiety Disorders
During Pregnancy
and Postpartum

Review of Psychiatry Series
John M. Oldham, M.D., M.S.
Michelle B. Riba, M.D., M.S.
Series Editors

Mood and
Anxiety Disorders
During Pregnancy
and Postpartum
EDITED BY
Lee S. Cohen, M.D.
Ruta M. Nonacs, M.D., Ph.D.
REVIEW
OF
PSYCHIATRY
No. 4
24
VOLUME
Washington, DC
London, England

Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consistent
with standards set by the U.S. Food and Drug Administration and the general
medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these
reasons and because human and mechanical errors sometimes occur, we
recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views
and opinions of the individual authors and do not necessarily represent the
policies and opinions of APPI or the American Psychiatric Association.
Copyright © 2005 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
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The correct citation for this book is
Cohen, Lee S., Nonacs, Ruta M. (editors): Mood and Anxiety Disorders During
Pregnancy and Postpartum (Review of Psychiatry Series, Volume 24, Number 4;
Oldham JM and Riba MB, series editors). Washington, DC, American Psychiatric
Publishing, 2005
Library of Congress Cataloging-in-Publication Data
Mood and anxiety disorders during pregnancy and postpartum / edited by
Lee S. Cohen, Ruta M. Nonacs.—1st ed.
p. ; cm.—(Review of psychiatry series ; v. 24, 4)
Includes bibliographical references and index.
ISBN 1-58562-225-7 (pbk. : alk. paper)
1. Mental illness in pregnancy. 2. Postpartum depression. 3. Affective
disorders. 4. Anxiety in women. I. Cohen, Lee S. II. Nonacs, Ruta. III. Series.
[DNLM: 1. Anxiety Disorders—Pregnancy. 2. Mood Disorders—Pregnancy.
3. Depression, Postpartum. 4. Postpartum Period—psychology. WQ 240 M817
2005]
RG588.M66 2005
618.7′6—dc22
2005004568
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.


Contents
Contributors ix
Introduction to the Review of Psychiatry Series xi
John M. Oldham, M.D., M.S., and
Michelle B. Riba, M.D., M.S.
Preface xv
Lee S. Cohen, M.D., and Ruta M. Nonacs, M.D., Ph.D.
Chapter 1
Course of Psychiatric Illness During
Pregnancy and the Postpartum 1
Laura Fagioli Petrillo, M.D., Ruta M. Nonacs, M.D., Ph.D.,
Adele C. Viguera, M.D., and Lee S. Cohen, M.D.
Unipolar Depression 2
Bipolar Disorder 4
Anxiety Disorders 5
Psychotic Disorders 8
Risks of Untreated Illness in the Mother 9
Conclusion 10
References 11
Chapter 2
Diagnosis and Treatment of Mood and
Anxiety Disorders in Pregnancy 17
Ruta M. Nonacs, M.D., Ph.D., Lee S. Cohen, M.D.,
Adele C. Viguera, M.D., and Juliana Mogielnicki, B.A.
Prevalence of Mood and Anxiety Disorders
During Pregnancy 19
Risks of Untreated Maternal Illness During Pregnancy 20
Treatment of Mood Disorders During Pregnancy 22
Treatment of Anxiety Disorders During Pregnancy 36
General Guidelines for Treatment of Mood and
Anxiety Disorders During Pregnancy 39
Conclusion 41
References 42
Chapter 3
Management of Bipolar Disorder During
Pregnancy and the Postpartum Period:
Weighing the Risks and Benefits 53
Adele C. Viguera, M.D., Lee S. Cohen, M.D.,
Ruta M. Nonacs, M.D., Ph.D., and Ross J. Baldessarini, M.D.
Risk and Course of Bipolar Disorder During Pregnancy 54
Risk and Course of Bipolar Disorder During the
Postpartum Period 56
Potential Risks of Pharmacotherapy During Pregnancy 58
Fetal Risks Associated With
Mood-Stabilizing Agents 60
Treatment Planning for the Pregnant Patient
With Bipolar Disorder 65
Treatment Planning for the Patient With
Bipolar Disorder in the Postpartum Period 69
Conclusion 70
References 70
Chapter 4
Postpartum Mood Disorders 77
Ruta M. Nonacs, M.D., Ph.D.
Clinical Features 79
Screening for Postpartum Mood Disorders 81
Course and Prognosis 83
Risk Factors 83
Treatment 86
Conclusion 95
References 96
Chapter 5
Use of Antidepressants and Mood Stabilizers in
Breast-Feeding Women 105
Kimberly Ragan, M.S.W., Zachary N. Stowe, M.D., and
D. Jeffrey Newport, M.D., M.S., M.Div.
Pharmacologic Treatment Options for Unipolar
Depression and Bipolar Disorder in Breast-Feeding 106

Mental Illness in Postpartum Women: Spectrum of
Psychiatric Conditions 131
Clinical Decision Making 132
Conclusion 134
References 135
Index 145