What is Generalized Anxiety Disorder?
Generalized Anxiety Disorder is a chronic illness characterized by excessive and difficult-to-control worry. People who have this disorder commonly have physical symptoms (muscle tension, upset stomach, headaches, fatigue), difficulty sleeping, irritability and poor concentration.
Everyone worries sometimes, particularly when they are facing major stress or life transitions. “Worry” becomes a disorder when it last for months on end, gets in the way of doing other things such as carrying out usual daily activities or causes the person distress.
In pregnancy and postpartum common worry ‘themes’ include:
| health of the pregnancy or the child | labour and delivery fears |
| financial worries | perfectionism/not being a good enough mom |
| changes in work life | changes in relationships |
How common is Generalized Anxiety Disorder?
About 6% of the population will experience Generalized Anxiety Disorder over their lifetime and it is twice as common in women than in men. In any given year, 1-3% of the population is affected by Generalized Anxiety Disorder.
It is important to recognize Generalized Anxiety Disorder because most women with this disorder have other mental health challenges or disorders as well (other anxiety disorders or mood disorders).
Why do women develop Generalized Anxiety Disorder in pregnancy and postpartum?
This is a complicated question with no clear answer. It is not uncommon that a woman who has always been a bit of a worrier gets extremely anxious in pregnancy or after delivery and this is the first time that anxiety becomes a problem.
Some reasons for this include the hormonal changes that occur, the psychological changes that occur as women transition to motherhood, and social changes that often occur around this time as well (career changes, changes in lifestyle).
Why should women seek treatment for Generalized Anxiety Disorder?
Untreated anxiety during pregnancy has been associated with pregnancy complications including low birth weight, preterm delivery, high blood pressure and failure to progress in labour leading to ceasarean section delivery. After birth, anxiety can impact a woman’s ability to manage the demands of her newborn, impair her ability to bond with the baby and can lead to depression.
How is Generalized Anxiety Disorder treated?
Like most mental health disorders, patients with Generalized Anxiety Disorder benefit from an approach that includes psychosocial aspects of treatment and should include psychoeducation about the illness and a plan to develop support from family, friends and/or community.
Cognitive Behaviour Therapy (CBT):
Cognitive Behaviour Therapy is based on the understanding that the way we think influences our behaviours and our feelings. By helping women identify unrealistic worries and replacing them with more realistic appraisals of the situation allows women to feel less anxious. Components of CBT for Generalized Anxiety Disorder include education, cognitive restructuring, exposure to anxiety provoking situations, relaxation techniques and problem solving skills.
CBT can be provided individually or in a group format.
Medications:
The use of medication in pregnancy or after birth needs to be evaluated on a case by case basis depending on the woman’s severity of illness, level of distress and impairment and her individual history. The goal is always to expose the pregnancy and breast feeding moms to the fewest number of medications at the lowest effective doses. Women should discuss their medications and treatment plant with their health care provider to get a full picture of the options available for her.
Antidepressant medications like Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line medication treatment for Generalized Anxiety Disorder. Sometimes women need both SSRIs and shorter term anti-anxiety medications like benzodiazepines for control of symptoms such as difficulty in sleeping.
Pregnancy
Although the SSRIs do cross the placenta, they are generally considered reasonably safe in pregnancy. and with a few exceptions have not been shown to cause major birth defects. At the time of delivery, the primary concern is a condition called Neonatal Adaptation Syndrome (jitteriness, difficulty feeding, irritability in the baby) which affects 10-25% of newborns exposed to these medications in late pregnancy. The baby's symptoms usually resolve without treatment within 3-7 days of birth.
Benzodiazepines do cross the placenta and can affect the fetus particularly if high doses are used or the medication is used for long periods of time. Any fetus exposed to benzodiazepines during pregnancy or delivery should be monitored for side effects of the drug. Benzodiazepine concentrations will be higher and persist for a longer period in premature infants.
Breastfeeding
For women who are breastfeeding, there is often concern about medication transmission to their baby through the breast milk.
The SSRIs do cross into the breast milk but in low concentrations (less than 10% of the maternal dose) and are generally considered compatible with breastfeeding.
Benzodiazepines also cross into the breast milk in small quantities, and can be found in the newborn’s blood serum but much less than is found in mom’s serum. The highest level of benzodiazepine in breast milk is found four hours after the woman takes her medication. If the woman is taking benzodiazepines, the baby should be observed for side effects including sedation, lethargy and slowed breathing. If any of this occurs, the mother’s dose should be reviewed and possibly reduced.
More information about Anxiety, Cognitive Behaviour Therapy and ways to increase a woman’s self-care when she is coping with anxiety is available in the guide Coping with Anxiety During Pregnancy and following the Birth in the Resources Section.