Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T08:14:10.909Z Has data issue: false hasContentIssue false
  • English
  • Français

Panic disorder during pregnancy and postpartum period

Published online by Cambridge University Press:  16 April 2020

Borwin Bandelow ,
Felicita Sojka ,
Andreas Broocks ,
Göran Hajak ,
Stefan Bleich  and
Eckart Rüther
Borwin Bandelow*
Affiliation:
von-Siebold-Str. 5, Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
Felicita Sojka
Affiliation:
von-Siebold-Str. 5, Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
Andreas Broocks
Affiliation:
Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
Göran Hajak
Affiliation:
Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
Stefan Bleich
Affiliation:
Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Germany
Eckart Rüther
Affiliation:
von-Siebold-Str. 5, Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
*
*Corresponding author. Tel.: +49 551 39 6607; fax: +49 551 39 2004. E-mail address: [email protected] (B. Bandelow).
Get access

Abstract

Background

– Earlier studies on the influence of pregnancy and postpartum period on the course of panic disorder have been inconsistent. The present study aims to quantify panic manifestations in these periods in large sample of women.

Method

– Panic manifestations, including exacerbations and new manifestations of panic disorder, were assessed retrospectively in a sample of 128 women with panic disorder with or without agoraphobia, 93 of whom had had 195 pregnancies.

Results

– Panic manifestations were fewer during pregnancy and more frequent in the postpartum period when compared with the control period. Women who had never been pregnant had significantly more panic manifestations than women with prior pregnancies. Breastfeeding and miscarriages did not have a significant effect. Women with postpartum panic reported more psychosocial stress events during this period.

Conclusions

– Possible reasons for postpartum panic and the protective effects of pregnancy are discussed, including psychosocial or hormonal factors and other neurobiological changes. Postpartum panic coincides with a sudden drop of hormones after delivery.

Keywords

Panic disorderPregnancyPostpartumEstrogenProgesterone
Type
Original article
Information
European Psychiatry , Volume 21 , Issue 7 , October 2006 , pp. 495 - 500
Copyright
Copyright © Elsevier SAS 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrade, L., Eaton, W.W., Chilcoat, H.D.Lifetime co-morbidity of panic attacks and major depression in a population-based study: age of onset Psychol. Med. 26(5)1996 991–996.CrossRefGoogle Scholar
APA. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC: American Psychiatric Press; 1994.Google Scholar
Bandelow, B., Sengos, G., Wedekind, D., Muether, G., Pilz, J., Broocks, A.et al.Urinary excretion of cortisol, norepinephrine, testosterone, and melatonin in panic disorder Pharmacopsychiatry 30(4)1997 113–117. [published erratum appears in Pharmacopsychiatry 1997 Nov;30(6):278]CrossRefGoogle ScholarPubMed
Bandelow, B., Wedekind, D., Pauls, J., Broocks, A., Hajak, G., Rüther, E.Salivary cortisol in panic attacks Am. J. Psychiatry 157(3)2000 454–456.CrossRefGoogle ScholarPubMed
Bandelow, B., Wedekind, D., Sandvoss, V., Broocks, A., Majak, G., Pouls, J.et al.Diurnal variation of cortisol in panic disorder Psychiatry Res. 95(3)2000 245–250.CrossRefGoogle ScholarPubMed
Bloch, M., Schmidt, P.J., Danaceau, M., Murphy, J., Nieman, L., Rubinow, D.R.Effects of gonadal steroids in women with a history of postpartum depression Am. J. Psychiatry 157(6)2000 924–930.CrossRefGoogle ScholarPubMed
Brunner, E., Domhof, S., Langer, F.Nonparametric Analysis of Longitudinal Data in Factorial Experiments. New York: Wiley; 2002.Google Scholar
Brunner, E., Langer, F.Nichtparametrische Analyse Longitudinaler Daten. Oldenbourg: München/Wien; 1999.Google Scholar
Buckwalter, J.G., Stanczyk, F.Z., McCleary, C.A., Bluestein, B.W, Buckwalter, D.K., Rankin, K.P.et al.Pregnancy, the postpartum, and steroid hormones: effects on cognition and mood Psychoneuroendocrinology 24(1)1999 69–84.CrossRefGoogle Scholar
Chakravorty, S.G., Halbreich, U.The influence of estrogen on monoamine oxidase activity Psychopharmacol. Bull. 33(2)1997 229–233.Google ScholarPubMed
Cohen, L.S., Sichel, D.A., Dimmock, J.A., Rosenbaum, J.F.Impact of pregnancy on panic disorder: a case series J. Clin. Psychiatry 55(7)1994 284–288.Google ScholarPubMed
Cohen, L.S., Sichel, D.A., Dimmock, J.A., Rosenbaum, J.F.Postpartum course in women with preexisting panic disorder J. Clin. Psychiatry 55(7)1994 289–292.Google ScholarPubMed
Cohen, L.S., Sichel, D.A., Faraone, S.V., Robertson, L.M., Dimmock, J.A., Rosenbaum, J.F.Course of panic disorder during pregnancy and the puerperium: a preliminary study Biol. Psychiatry 39(11)1996 950–954.CrossRefGoogle ScholarPubMed
Cowley, D.S., Roy-Byrne, P.P.Panic disorder during pregnancy J. Psychosom. Obstet. Gynaecol. 1989; 10:193–210.CrossRefGoogle Scholar
Cox, J.L., Murray, D., Chapman, G.A controlled study of the onset, duration and prevalence of postnatal depression Br. J. Psychiatry 1993; 163:27–31.CrossRefGoogle ScholarPubMed
Etgen, A.M., Karkanias, G.B.Estrogen regulation of noradrenergic signaling in the hypothalamus Psychoneuroendocrinology 19(5–7)1994 603–610.CrossRefGoogle ScholarPubMed
Fisch, R.Z.Postpartum anxiety disorder J. Clin. Psychiatry 50(7)1989 286.Google Scholar
George, D.T., Ladenheim, J.A., Nutt, D.J.Effect of pregnancy on panic attacks Am. J. Psychiatry 144(8)1987 1078–1079.Google ScholarPubMed
Gorman, J.M., Coplan, J.D.Comorbidity of depression and panic disorder J. Clin. Psychiatry 57(Suppl 10)1996 34–41. [discussion 42-3]Google ScholarPubMed
Gregoire, A.J., Kumar, R., Everitt, B., Henderson, A.F., Studd, J.W.Transdermal oestrogen for treatment of severe postnatal depression Lancet 347(9006)1996 930–933.CrossRefGoogle ScholarPubMed
Griez, E.J., Hauzer, R., Meijer, J.Pregnancy and estrogen-induced panic Am. J. Psychiatry 152(11)1995 1688.Google ScholarPubMed
Halbreich, U.Hormonal interventions with psychopharmacological potential: an overview Psychopharmacol. Bull. 33(2)1997 281–286.Google ScholarPubMed
Harris, B., Lovett, L., Newcombe, R.G., Read, G.F., Walker, R., Riad-Fahmy, D.Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II BMJ 308(6934)1994 949–953.CrossRefGoogle ScholarPubMed
Harris, B., Lovett, L., Smith, J., Read, G., Walker, R., Newcombe, R.Cardiff puerperal mood and hormone study. III. Postnatal depression at 5 to 6 weeks postpartum, and its hormonal correlates across the peripartum period Br. J. Psychiatry 168(6)1996 739–744.CrossRefGoogle ScholarPubMed
Hendrick, V., Stowe, Z.N., Altshuler, L.L., Hostetter, A., Fukuchi, A.Paroxetine use during breast-feeding J. Clin. Psychopharmacol. 20(5)2000 587–589.CrossRefGoogle ScholarPubMed
Hendrick, V.C., Altshuler, L.L.Management of breakthrough panic disorder symptoms during pregnancy J. Clin. Psychopharmacol. 17(3)1997 228–229.CrossRefGoogle ScholarPubMed
Hertzberg, T., Wahlbeck, K.The impact of pregnancy and puerperium on panic disorder: a review J. Psychosom. Obstet. Gynaecol. 20(2)1999 59–64.CrossRefGoogle ScholarPubMed
Iqbal, M.M., Sobhan, T., Ryals, T.Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant Psychiatr. Serv. 53(1)2002 39–49.CrossRefGoogle ScholarPubMed
Klein, D.F.False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis Arch. Gen. Psychiatry 50(4)1993 306–317.CrossRefGoogle ScholarPubMed
Klein, D.F.Pregnancy and panic disorder J. Clin. Psychiatry 55(7)1994 293–294.Google ScholarPubMed
Klein, D.F., Skrobala, A.M., Garfinkel, R.S.Preliminary look at the effects of pregnancy on the course of panic disorder Anxiety 1(5)1994 227–232.Google Scholar
Kraus, R.P.Postpartum anxiety disorder J. Clin. Psychiatry 50(7)1989 268–269. [letter; comment]Google Scholar
Martin, M.C., Hoffman, P.G.The endocrinology of pregnancy. Greenspan, F.S., Forsham, P.H.Basic and Clinicl Endocrinology, 2nd ed. Los Altos, CA: Lange; 1986. 476–500.Google Scholar
Metz, A., Sichel, D.A., Goff, D.C.Postpartum panic disorder J. Clin. Psychiatry 49(7)1988 278–279.Google ScholarPubMed
Misri, S., Kostaras, D., Kostaras, X.The use of selective serotonin reuptake inhibitors during pregnancy and lactation: Current knowledge Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie 45(3)2000 285–287.CrossRefGoogle ScholarPubMed
Northcott, C.J., Stein, M.B.Panic disorder in pregnancy J. Clin. Psychiatry 55(12)1994 539–542.Google ScholarPubMed
O′Hara, M.W., Zekoski, E.M., Philipps, L.H., Wright, E.J.Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women J. Abnorm. Psychol. 99(1)1990 3–15.CrossRefGoogle ScholarPubMed
Paul, S.M., Purdy, R.H.Neuroactive steroids FASEB J. 6(6)1992 2311–2322.CrossRefGoogle ScholarPubMed
Pigott, T.A.Gender differences in the epidemiology and treatment of anxiety disorders J. Clin. Psychiatry 60(Suppl 18)1999 4–15.Google ScholarPubMed
Schmidt, M.E., Matochik, J.A., Goldstein, D.S., Schouten, J.L., Zametkin, A.J., Potter, W.Z.Gender differences in brain metabolic and plasma catecholamine responses to alpha 2-adrenoceptor blockade Neuropsychopharmacology 16(4)1997 298–310.CrossRefGoogle ScholarPubMed
Seeman, M.V.Psychopathology in women and men: focus on female hormones Am. J. Psychiatry 154(12)1997 1641–1647.CrossRefGoogle ScholarPubMed
Sholomskas, D.E., Wickamaratne, P.J., Dogolo, L., O′Brien, D.W., Leaf, P.J., Woods, S.W.Postpartum onset of panic disorder: a coincidental event? J. Clin. Psychiatry 54(12)1993 476–480.Google ScholarPubMed
Sichel, D.A., Cohen, L.S., Robertson, L.M., Ruttenberg, A., Rosenbaum, J.F.Prophylactic estrogen in recurrent postpartum affective disorder Biol. Psychiatry 38(12)1995 814–818.CrossRefGoogle ScholarPubMed
Simpson, K., Noble, S.Fluoxetine—a review of its use in women's health CNS Drugs 14(4)2000 301–328.CrossRefGoogle Scholar
Spigset, O., Hagg, S.Excretion of psychotropic drugs into breast milk—pharmacokinetic overview and therapeutic implications CNS Drugs 9(2)1998 111–134.CrossRefGoogle Scholar
Stowe, Z.N., Cohen, L.S., Hostetter, A., Ritchie, J.C., Owens, M.J., Nemeroff, C.B.Paroxetine in human breast milk and nursing infants Am. J. Psychiatry 157(2)2000 185–189.CrossRefGoogle ScholarPubMed
Verburg, C., Griez, E., Meijer, J.Increase of panic during the second half of pregnancy Eur. Psychiatry 1994; 9:260–261.Google Scholar
Villeponteaux, V.A., Lydiard, R.B., Laraia, M.T., Stuart, G.W., Ballenger, J.C.The effects of pregnancy on preexisting panic disorder J. Clin. Psychiatry 53(6)1992 201–203.Google ScholarPubMed
WHO. World Health Organisation. Tenth Revision of the International Classification of Diseases, Chapter V (F): Mental and Behavioural Disorders (including disorders of psychological development). Clinical Descriptions and Diagnostic Guidelines Geneva: World Health Organisation; 1991.Google Scholar
Wieck, A.Endocrine aspects of postnatal mental disorders Baillieres Clin. Obstet. Gynaecol. 3(4)1989 857–877.CrossRefGoogle ScholarPubMed
Wisner, K.L., Peindl, K.S., Hanusa, B.H.Effects of childbearing on the natural history of panic disorder with comorbid mood disorder J. Affect. Disord. 41(3)1996 173–180.CrossRefGoogle ScholarPubMed
Wittchen, H.-U., Wunderlich, U., Gruschwitz, S., Zaudig, M.Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe; 1997.Google Scholar
Yonkers, K.A., Zlotnick, C., Allsworth, J., Warshaw, M., Shea, T., Keller, M.B.Is the course of panic disorder the same in women and men? Am. J. Psychiatry 155(5)1998 596–602.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.