Management of perinatal anxiety
Support and early intervention for women experiencing distress or anxiety symptoms may help to prevent more serious mental health problems from developing. Depending on the severity of a woman’s symptoms, management of perinatal anxiety may involve a combination of psychosocial support, psychological therapy and pharmacological treatment. Appropriate responses to assessments and clinical judgement are fundamental to decision-making about management.
Psychosocial interventions used as preventive approaches or as part of management of anxiety includes non-directive counselling, psychoeducation and peer support.
Women may also benefit from being given information about options for support in their communities (e.g. parent education groups, support groups, playgroups) and suggestions for where to seek practical support with tasks like cooking, cleaning and taking care of the baby, or any older children (e.g. family, friends, neighbours or community services).
The range of psychological therapies that are effective in treating anxiety disorders at times other than in the perinatal period would also be expected to be effective in the perinatal period as the disorders differ little from disorders among non-pregnant women in both their presentation and course.
During pregnancy use of selective serotonin reuptake inhibitors (SSRIs) can be considered as there is no evidence for a consistent pattern of birth defects. Tricyclic antidepressants (TCAs) can also be considered, especially if they have been effective previously, but should be used with caution due to the risk of overdose.
Both SSRIs and TCAs can also be safely used during breastfeeding.
Short-term use of short-acting benzodiazepines may be considered while awaiting onset of action of SSRIs.
More detail on the safety and effectiveness of pharmacological treatments is included in the National Perinatal Mental Health Guideline developed by COPE.
Guidelines for the use of antidepressants and benzodiazepines in the general population should be consulted.
Things to remember about perinatal anxiety