Panic Attack During Pregnancy
Authored by:
Anna Glezer, M.D.
If you have experienced a panic attack during pregnancy, you remember the sensation – shortness of breath, tightness in the chest, racing thoughts, and feeling like you might be having a heart attack or something is terribly wrong. It involves the activation of the sympathetic nervous system, the one responsible for our “fight or flight” response.
Many – clinicians, friends, family members – might suggest that anxiety during pregnancy is normal. After all, you are expected to worry about your baby. However, panic attacks and panic disorder are functionally impairing, have consequences for both mom and baby, and are not a normal part of pregnancy. Fortunately, treatment is available.
What is panic disorder and who is at risk?
Panic disorder – a condition characterized by recurrent panic attacks – is much more common in women than men and tends to hit those under the age of 45, corresponding with peak reproductive years. Studies note that almost a tenth of women who develop panic disorder find it begins during pregnancy or the immediate postpartum period, affecting about 2% of pregnant women. One physiologic explanation for why pregnant women are predisposed may be the effect of progesterone (a pregnancy hormone) that stimulates respiration and can therefore lead to hyperventilation.
Research has shown conflicting results about whether or not pregnancy is a time of vulnerability toward relapse for those who have a history of panic disorder. More recent research confirms this is likely the case, and, even more so, the postpartum period is a heightened time of vulnerability.
Finally, panic disorder is a disabling condition by itself, but notably occurs with depression in half of cases.
Why is it important to recognize panic disorder in pregnancy?
Anxiety during pregnancy is a predictor for postpartum depression. Therefore, recognizing and treating panic during pregnancy is important to ensure a healthy postpartum period as well.
Additionally, panic disorder during pregnancy has been associated with worse birth outcomes, including:
higher risk of preterm birth
lower birth weight
smaller gestational age infants
complications during delivery.
One hypothesis explaining this is that the actual symptoms of panic – increased heart rate, chest pain, and overall higher nervous system arousal – can lead to negative fetal development consequences, in part because of oxygen being diverted away from the baby and uterus during this stressed state.
Finally, a stressed emotional state in pregnancy has long-term consequences for the infant later on in terms of cognition, behavior, and emotional problems.
What are the treatment options for panic disorder?
Anxiety disorders in general and panic in particular has been shown to be very responsive to psychotherapy, with the most research for cognitive-behavioral therapy. For women with mild to moderate symptoms, this is a good solution on its own.
For those with more severe symptoms, therapy can be combined with medication treatment options, of which there are two general categories: medications that work long-term to prevent panic attacks and medications that abort an active attack.
Consider reading about these options further (See my article on SSRIs) and speaking with your obstetrician about a prescription.
References:
Marchesi, C. et. al. Risk factors for panic disorder in pregnancy: A cohort study. Journal of Affective Disorders 156 (2014): 134-138.
Chen, Y., Lin, H-C., Lee, H-C. Pregnancy outcomes among women with panic disorder – Does panic during pregnancy matter? Journal of Affective Disorders 12 (2010): 258-262.
Dannon, P.N. et. al. Recurrence of panic disorder in pregnancy: A 7-year naturalistic follow up study. Clinical Neuropharamcology 29 (2006): 132-137.
Cohen, L.S. et. al. Course of panic disorder during pregnancy and the puerperium: A preliminary study. Biological Psychiatry 39 (1996): 950-954.
