BACKGROUND: The postpartum period has typically been considered a time of risk for development of psychiatric disorder. Impact of the postpartum period on the course of anxiety disorders has not been characterized. This report describes the postpartum clinical course of 40 nondepressed women with preexisting panic disorder who were followed during pregnancy and the puerperium. METHOD: Through chart review and interview, we retrospectively evaluated the clinical course during the postpartum period of 40 women with pregravid panic disorder. Severity of illness, along with treatment received, was assessed from the third trimester of pregnancy to the twelfth postpartum week. RESULTS: While 26 patients (65%) either maintained (N = 23) or improved (N = 3) clinical status, 14 patients (35%) demonstrated puerperal worsening. Those patients who received pharmacotherapy by Trimester 3 were significantly less likely to experience puerperal worsening of anxiety than those who did not receive treatment prior to the puerperium (p < .0001). CONCLUSION: The puerperium is a period of risk for some women with pregravid panic disorder. Antipanic medication may be prophylactic for those women at greatest risk.
BACKGROUND: The postpartum period has typically been considered a time of risk for development of psychiatric disorder. Impact of the postpartum period on the course of anxiety disorders has not been characterized. This report describes the postpartum clinical course of 40 nondepressed women with preexisting panic disorder who were followed during pregnancy and the puerperium. METHOD: Through chart review and interview, we retrospectively evaluated the clinical course during the postpartum period of 40 women with pregravid panic disorder. Severity of illness, along with treatment received, was assessed from the third trimester of pregnancy to the twelfth postpartum week. RESULTS: While 26 patients (65%) either maintained (N = 23) or improved (N = 3) clinical status, 14 patients (35%) demonstrated puerperal worsening. Those patients who received pharmacotherapy by Trimester 3 were significantly less likely to experience puerperal worsening of anxiety than those who did not receive treatment prior to the puerperium (p < .0001). CONCLUSION: The puerperium is a period of risk for some women with pregravid panic disorder. Antipanic medication may be prophylactic for those women at greatest risk.