Panic Attacks During Pregnancy

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Pregnancy Panic Attacks

Pregnancy can be both an exciting and scary time in a woman’s life. Add panic attacks throughout the nine months of pregnancy and it can be even more stressful. Perinatal panic attacks are estimated to occur in 1.3% to 2% of pregnant women.1 Anxiety disorders are more common in women, particularly during childbearing years of the mid and late 20’s.1

How serious are panic attacks during pregnancy?

Panic attacks are characterized by physical symptoms such as rapid heartbeat, sweating, weakness, dizziness, stomach pain, nausea, or chills.2 They are more common in women than men.2 Panic attacks may be part of a larger diagnosis of panic disorder, which is defined as repeated panic attacks with physical symptoms as well as fear and anxiety of the attacks occurring again.2 In pregnant women who suddenly start experiencing panic attacks, these may not be caused by a panic disorder at all. In some cases, panic attacks can be symptoms of thyroid dysfunction, anemia, or preeclampsia.1 It is important to speak with your doctor to identify the cause of your panic attacks so you can effectively treat them.

Women with preexisting panic disorders may have improved or worsened panic attacks during their pregnancy.1,3 The presence of panic disorder also means a greater likelihood for having depression and postpartum depression.1 There is little evidence to determine how panic disorders affect pregnancy outcomes.3 Some studies suggest there may be an increased risk of preterm delivery and low fetal birth weight in pregnant women who are stressed, anxious, or suffering from panic disorder because of an elevation in stress hormones such as cortisol.1,4,5

Non-medication related interventions are typically recommended as a first line treatment approach in pregnant women suffering from panic attacks.6 Possible interventions include:

  • Psychotherapy such as cognitive behavioral therapy (CBT) and relaxation techniques like deep breathing can be used with medication or alone to treat panic disorders. CBT helps identify negative thinking patterns and provides techniques to focus on more positive thoughts.
  • Self care activities such as rest, a healthy diet, and exercise can ease symptoms of panic attacks.
  • Trustworthy friends and family can help provide support during emergency situations, or they can be helpful to discuss fears and insecurities.
  • A pre-developed plan should help address panic attacks or depression that develop during and after pregnancy.

It is important to talk to your doctor to determine if medications such as antidepressants will be safe or effective during pregnancy or during breastfeeding.3 Some studies show there may be risks associated with antidepressant use during pregnancy (i.e., low birth weight and respiratory difficulties).3,7 If medication is recommended during pregnancy, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, or beta-blockers may be used.2 Doses should be kept low throughout pregnancy to minimize any side effects.6 Both non-medication and/or medication therapies will take time to work.2

Medications used to treat panic disorder:
  • SSRIs and SNRIs: these medications are typically used to treat depression; they may take several weeks to start working; doses are started low and increased slowly; side effects may include headache, nausea, difficulty sleeping
  • Beta-blockers: this medication is used to treat symptoms of panic attacks such as fast heart rate; not commonly prescribed
  • Benzodiazepines: this medication quickly treats symptoms of a panic attack; it has high dependence so it is only prescribed for short-term use

Source: National Institute of Mental Health2

Women who have panic disorder but choose to avoid medication during pregnancy may need to be restarted postpartum since these women are at an increased risk of having postpartum depression.6

Additional resources:

References:

Lauren McMahan
Dr. Lauren McMahan has a Doctor of Pharmacy from Lipscomb University College of Pharmacy in Nashville, TN. She currently works for a large national healthcare company, where she provides her research and writing expertise to support evidence-based initiatives to improve patient care. She enjoys exercising, reading, and thrifting in her spare time.

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