Perinatal Stress, Mood and Anxiety Disorders

Perinatal Stress, Mood and Anxiety Disorders

Bibliotheca Psychiatrica No. 173 Series Editors A. Riecher-Rössler Basel M. Steiner Hamilton

Perinatal Stress, Mood and Anxiety Disorders From Bench to Bedside Volume Editors A. Riecher-Rössler Basel M. Steiner Hamilton 11 figures, 1 in color, and 5 tables, 2005 Basel Freiburg Paris London New York Bangalore Bangkok Singapore Tokyo Sydney

Bibliotheca Psychiatrica Formerly published as Abhandlung aus der Neurologie, Psychiatrie, Psychologie und ihren Grenzgebieten (Founded 1917) Edited by K. Bonhoeffer, Berlin (1917 1939), J. Klaesi, Bern (1948 1952), J. Klaesi and E. Grünthal, Bern (1955 1967), E. Grünthal, Bern (1968), E. Grünthal and Th. Spoerri, Bern (1969 1971), Th. Spoerri, Bern (1973), P. Berner and E. Gabriel, Wien (1975 1986), B. Saletu, Wien (1986 2003) Prof. Dr. med. A. Riecher-Rössler Psychiatrische Poliklinik Universitätsspital Basel Petersgraben 4 CH 4031 Basel (Switzerland) M. Steiner, MD, PhD Department of Psychiatry McMaster University Women s Health Concerns Clinic St. Joseph s Healthcare Hamilton, Ont. (Canada) Library of Congress Cataloging-in-Publication Data Perinatal stress, mood, and anxiety disorders : from bench to bedside / volume editors, A. Riecher-Rössler, M. Steiner. p. ; cm. (Bibliotheca psychiatrica ; no. 173) Includes bibliographical references and indexes. ISBN 3-8055-7865-2 (hard cover : alk. paper) 1. Postpartum psychiatric disorders. 2. Childbirth Psychological aspects. 3. Motherhood Psychological aspects. 4. Postnatal care Psychological aspects. 5. Mothers Mental health. 6. Stress (Psychology) 7. Anxiety in women. 8. Postpartum depression. 9. Mental illness in pregnancy. 10. Pregnant women Mental health. [DNLM: 1. Postpartum Period psychology. 2. Anxiety Disorders. 3. Mood Disorders. 4. Pregnancy Complications psychology. WQ 500 P4456 2005] I. Riecher-Rössler, Anita. II. Steiner, Meir. III. Series. RG850.P475 2005 618.7 6 dc22 2005006482 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2005 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN 0067 8147 ISBN 3 8055 7865 2

Contents VII Foreword Riecher-Rössler, A. (Basel); Steiner, M. (Hamilton) 1 A Historical Perspective on the Psychiatry of Motherhood Brockington, I. (Bredenbury) 6 Diagnostic Classification of Perinatal Mood Disorders Riecher-Rössler, A.; Rohde, A. (Basel) 28 Maternal Adversity,Vulnerability and Disease Matthews, S.G. (Toronto); Meaney, M.J. (Montréal) 50 Behavioral Perinatology Wadhwa, P.D. (Irvine, Calif.) 70 Maternal Depression: An Adverse Early Environment Beach, A.J.; Henry, A.L.; Stowe, Z.N.; Newport, D.J. (Atlanta, Ga.) 85 Perinatal Infanticide and Suicide Spinelli, M.G. (New York, N.Y.) 100 Relevance of Gonadal Hormones to Perinatal Mood and Anxiety Disorders Ahokas, A.; Kaukoranta, J.; Wahlbeck, K.; Aito, M. (Helsinki) 112 Pharmacotherapy for Psychiatric Disorders in Pregnancy Ross, L.E.; Gunasekera, S.; Rowland, M.; Steiner, M. (Hamilton) V

137 Maternal Depression in the Postpartum Period: Impact of Breast-Feeding on Treatment Planning Stowe, Z.N.; Ragan, K.; Newport, D.J. (Atlanta, Ga.) 150 The Use of Interpersonal Psychotherapy for Perinatal Mood and Anxiety Disorders Stuart, S.; O Hara, M.W. (Iowa City, Iowa) 167 Group Psychotherapy for Depression in Early Stages of Motherhood Hofecker-Fallahpour, M.; Riecher-Rössler, A. (Basel) 182 Alternative Treatment Strategies for Perinatal Depression and Anxiety O Higgins, M.; Glover, V. (London); Corral, M. (Vancouver) 194 Author Index 195 Subject Index Contents VI

Foreword Mood and anxiety disorders are very common during the perinatal period and confront us with specific needs. Thus, help seeking is often delayed due to shame and stigma, and diagnosis is often missed due to misinterpretation of symptoms. Services often do not adequately meet the needs of the women concerned as they do not take into account their specific situation, problems and fears. Untreated, peripartum disorders can have especially severe long-term consequences, not only for the mother but also for the whole family and especially for the child. Recent research has shown how maternal stress, anxiety and depression can adversely influence a child s early and later development. Despite this, perinatal mental health has until recently been very much neglected, overlooked, underdiagnosed and undertreated. A recent surge of clinical and research interest, prompted by some very active pioneers in this field and also by media exposures of several very tragic outcomes of mothers who committed infanticide and/or suicide during an episode of postpartum depression, is a most welcome change in this field. It is now widely accepted that mental disorders in the perinatal period need special attention and special treatments with modifications of the classical pharmacological, non-pharmacological and psychotherapeutic approaches. Universities around the world have started research programmes and implemented subspecialty clinics for perinatal mental health. Residency programmes in psychiatry and in obstetrics and gynaecology are including the topic in their curriculum and granting agencies have declared it a priority for research. We have assembled a group of internationally renown experts in the field to contribute to this volume. The twelve articles included here offer a comprehensive VII

up-to-date overview of the most relevant research and treatment considerations in this neglected field. A brief, though very interesting introduction to the history of psychiatry of motherhood is followed by the discussion of the old question if perinatal disorders are specific entities and if they should have a specific place in our classification systems. Further articles focus on the effects of chronic maternal stress on fetal developmental outcomes and on the relationship between adversity in early pre- and postnatal life and the risk for later cognitive and behavioural impairments and chronic illness. Maternal depression during pregnancy and early childhood is shown to be one of the child s earliest adverse life events which can contribute to a child s vulnerability to later psychiatric illness. Both clinical as well as preclinical evidence is discussed. In an article of outstanding importance for each clinician, the danger of perinatal infanticide and suicide is reviewed. Further articles deal with specific forms and modifications of therapies for perinatal mental disorders. The relevance of gonadal hormones in the pathogenesis of perinatal mental disorders is discussed, an innovative field of research which could offer new therapeutic possibilities. The most important questions of pharmacotherapy during pregnancy and breast-feeding are discussed in depth. New psychotherapeutic approaches are presented such as interpersonal psychotherapy as well as a new form of group therapy for mothers with depression and anxiety disorders. Last but not least, alternative treatment strategies for pregnant and breast-feeding women are reviewed. This book is aimed primarily at clinicians, teachers and researchers from the fields of psychiatry (adult as well as child and adolescent psychiatry), obstetrics and gynaecology, paediatrics, psychology, psychotherapy, neurobiology and psychoneuroendocrinology as well as their students and learners. The editors wish to thank all contributors as well as our administrative assistants, Ms. Cindy Tasch, Hamilton, Mrs. Elisabeth von Castelmur and Ms. Brigitte Howald, Basel, and the staff of S. Karger AG, Basel, for their professional help with the publication of this volume. Anita Riecher-Rössler Meir Steiner Foreword VIII