Dr Richa Sharma, Dr Amit Basnotra
Infertility is a stressful condition not only for the couple but the whole family.Concern is not only the outcome but it has lots of many others impacts- Physical,financial, emotional and psychological and all are interrelated.At this time role of life partner and family plays a major part
Stress is added further especially in waiting period of beta HCG.
So all revolves around Six letters – STRESS which needs to be checked.Problem gets precipitated more when patient is already have some comorbidity especially Generalized anxiety or panic disorders which need to be tackled PATIENTLY by Doctor and family both both before and after pregnancy and during treatment cycle
What impact psychological factors have ?
Psychological factors have an important role to play in the development of anxiety disorders at this time. Often the expectant mother has concerns over the health of the child, the change in lifestyle likely to occur in her own life after the birth of the child, her own ability to be a good mother, and finances.
Emotional Dynamics Of Pregnancy-
Pregnancy is a time of great emotional change for women, often producing increased stress and anxiety. Gonadal steroid levels have been reported with as much as a 100-fold variation in serum estrogen levels and a 1000-fold change in serum progesterone levels during pregnancy.1These changes can exacerbate such emotional difficulties so adding stress further which is beyond control sometimes such that patient may have continuous panic attacks
Generalized anxiety disorder (GAD) and Panic Attacks-
Although it is obvious that pregnancy alone may produce states of anxiety, the question has been raised as to what happens to preexisting anxiety disorders during this period. Although childbirth may lead to the onset of panic disorder in some cases, research of the effect of pregnancy on preexisting panic disorder has revealed mixed results Current evidence suggests that pregnancy is not protective for panic symptoms and anxiety, and the postpartum period may be a time of particular vulnerability to exacerbations. In addition, evidence exists that anxiety disorders can affect pregnancy outcomes
Pregnant women with a history of anxiety or depression can face difficult and confusing choices about treating their symptoms with antidepressants and other medications.
Both anxiety disorders and depression are more likely to affect women than men, and women who are pregnant are not excluded. In fact, symptoms can develop or worsen during or after pregnancy, though in some cases women notice fewer symptoms while pregnant. Women can have an anxiety disorder and depression at the same time, too.
What should You Do ?
If you are pregnant or planning to start a family, it’s best to discuss these options and any concerns with your therapist, physician, and Gynaecologist who can work with you to develop or change your treatment plan. You may also consider a consultation with a psychiatrist who specializes in treating pregnant and postpartum women
What Does Guidelines Say (Recommendations ) ?
The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend the following:
* Women who plan to start a family and have mild depressive symptoms for six months or longer may be able to taper off medication. This may not be appropriate for women with a history of severe anxiety or depression, or who have bipolar disorder or a history of suicide attempts.
* Women who are pregnant, psychiatrically stable, and prefer to continue taking their medication may be able to do so after consulting with their therapist and OB-GYN.
*Women who are pregnant and have severe depression or anxiety should remain on medication, as they are at high risk for relapse.
In addition, women who are pregnant may benefit from therapy to replace or supplement medication. Therapy and other behavioral treatments can be effective in treating anxiety disorders and depression – before, during, and after pregnancy.
Remember to talk to your doctor before beginning or changing your treatment plan. An individualized approach to treating anxiety disorders and depression during pregnancy is usually best.
*Disclaimer for Patients- Purpose of Our Write ups after detailed research is to guide and help you and spreading awareness for social welfare.Kindly don’t follow it as treatment.Seek proper consultation for your ailments via proper channel.We will keep striving in our awareness revolution.
(The author are Senior IVF Consultant, and Senior Gastroentrologist)
Dr Richa Sharma, Dr Amit Basnotra