Anxiety Disorders in Women Across the Lifecycle
Marlene P. Freeman, MD, Massachusetts General Hospital
Almost one-third of women will meet criteria for an anxiety disorder during their lifetime, and symptoms can become worse during pregnancy and the postpartum period. Postpartum obsessions and psychosis can be difficult to distinguish, but the key is insight. Psychotherapy is first-line treatment for mild to moderate anxiety during pregnancy, but medication plus psychotherapy is indicated for severe cases. Antidepressants are considered compatible with breast-feeding, although the long half-life of fluoxetine means higher concentrations in breast milk. During menopause, women with preexisting anxiety may be more susceptible to the development of anxiety disorders. Serotonergic antidepressants, as well as gabapentin, have evidence of efficacy for hot flashes. A diagnosis of premenstrual dysphoric disorder (PMDD) indicates significant psychiatric morbidity that interferes with function, not an underlying psychiatric disorder that gets worse premenstrually. Ask patients to track their moods, especially while they are trying different treatments. Treating PMDD with serotonergic antidepressants has been well researched.
