Benefits of treating perinatal anxiety disorders ‘greatly outweigh’ risks

Untreated perinatal anxiety disorders and related stress or depression among mothers pose risks to offspring, according to a presenter at Psych Congress.

Kimberly Brandt, DO, PMH-C, a perinatal psychiatrist at the University of Missouri School of Medicine, said the benefits of treating these disorders outweigh potential risks.

“Untreated anxiety and depression, or both, can cause increased risk for early labor, decreased birth weight, increased reactivity to stress and some fetal brain structural changes,” Brandt said during a virtual presentation.

According to Brandt, medications are generally considered compatible with breastfeeding if they are less than 10% of the relative infant dose, with most medications used for anxiety and depression safe for mothers to take while breastfeeding. However, mothers should watch for changes in their infant’s alertness and their sleeping and eating habits, and they should alert their pediatrician about any medications they are taking, Brandt noted.

Current research shows that selective serotonin reuptake inhibitors likely do not increase the risk for birth defects, spontaneous abortion, stillbirth, neonatal deaths, cognitive impairment or behavioral problems, and they do not increase the risk for autism.

“There are some studies [showing that SSRIs] might increase the risk for late preterm birth and postpartum hemorrhage,” Brandt said. “We have evidence to indicate that they potentially have increased risk of neonatal side effects, specifically respiratory distress and persistent pulmonary hypertension of the newborn. That is a rare condition, but I still typically do educate patients about that possibility.”

However, the benefits of treating the mother's condition generally “greatly outweigh” the possible risks, according to Brandt.

Using adjunctive anxiolytics in the time period before the SSRI becomes fully effective, typically postpartum, would be beneficial among women without risk factors for substance abuse, Brandt said.

“Using short-term benzodiazepines, such as lorazepam or clonazepam, can really help with anxiety and insomnia and provide relief of symptoms while the SSRI is becoming more effective,” Brandt said.