Treatment of antenatal anxiety
If you are experiencing mild to moderate anxiety, support counselling and psychological therapies can be very effective for the treatment of antenatal anxiety.
This can be undertaken individually or in groups, providing you with an opportunity to talk through how you are feeling and thinking with someone who can support and listen in a non-judgemental way. It may help you develop strategies to help you develop effective ways to deal with challenges.
This can provide you with understanding and give you the tools and strategies to assist you to manage your physical symptoms, worrying thinking and any behaviours that may result (e.g avoiding situations). Two kinds of psychological or ‘talking therapies’ are recommended for the management of anxiety in the postnatal period, and can also be effective for managing anxiety in pregnancy. These include:
Cognitive behaviour therapy (CBT): Helps people to gain insight and understanding into the thoughts, feelings and behaviours that underly your anxiety. The cognitive component of the therapy involves identifying any worrying thoughts you may have (concerns about the health of your baby or risk of miscarriage) and teaching you how to challenge and change unhelpful thinking and how you respond to these thoughts (e.g look at test results, statistics regarding miscarriage at this stage of pregnancy). In addition, behaviour therapy will give you strategies to help you manage the physical symptoms of anxiety (e.g relaxation training, controlled breathing), as well as techniques to assist you to face situations that you may be avoiding (e.g breaking down situations which may seem too difficult into much smaller, more manageable steps).
Interpersonal Psychotherapy (IPT): As anxiety in pregnancy may be associated with past losses and/or changes, this type of therapy can assist you to resolve these losses, changes or manage conflicts which may be contributing to your experience of anxiety.
If your symptoms of anxiety are severe, however, and have reached the point where you are finding it difficult to function from day to day, medical treatments are likely to be important for your treatment and recovery.
Medications are effective and, importantly, can be safely used in pregnancy. Severe anxiety can have a negative impact on the growth and development of a baby so medications can be important to mediate these effects. It is up to the health professional to weigh up the advantages and disadvantages of prescribing medication for each woman.
There are two types of medication that can be safely used in pregnancy – selective serotonin reuptake inhibitors (SSRI’s) and tricyclic antidepressants. These are the most preferred medications for anxiety (also effective for depression), as they are not associated with birth defects. If you are prescribed one of these medications, be aware that it can take up to three weeks to have an effect and you may experience some side-effects. This is a good discussion to have with your health professional in relation to the medication being prescribed.
In cases where a woman’s anxiety symptoms are very severe, and faster relief is required, another class of medication called benzodiazapines may also be prescribed whilst the antidepressant takes effect. If required, these medications should only be used for a short period (up to three to four weeks), as they are addictive. Benzodiazapines also vary in the amount of time it takes for the body to eliminate them. Those that are eliminated more quickly (‘short-acting’ benzodiazapines) are the type that can be used in pregnancy, whilst ‘long acting’ benzodiazapines should be avoided. Again, if you are discussing medical treatment with your health professional, you can clarify the nature, type and action of the medication you are being prescribed, as well as discuss common side effects.
Whilst the thought of taking medication may be concerning, it’s important to weigh up the pros and cons of medication for you. Taking medication can help give you the resources to get on top of anxiety. Sometimes medication is important to take to manage the symptoms so that you can benefit from other psychological and/or supportive therapies.