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If you are like most people, you feel stressed out from time to time. That’s even more true during pregnancy. When we talk about suffering from stress during pregnancy, however, it means that you feel as though you are struggling every day, the entire day, 24/7. In such cases, you are likely to have an anxiety disorder or features of an anxiety disorder that may not be enough for an actual diagnosis. A condition called generalized anxiety disorder (GAD) strikes 8.5 – 10.5 percent of pregnancies. After delivery, the rate is 4.4 – 10.8 percent. Anxiety disorders are diagnosed based on specific diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V). The diagnosis requires at least three of the following symptoms:
- Restlessness, or you feel “on the edge”
- Difficulty concentrating
- You are easily fatigued
- Muscle tension
- Sleep difficulty, such as trouble falling asleep, or staying asleep, or unsatisfying sleep
For you to be diagnosed, three or more symptoms must occur for more than six months, and they must interfere with your performance of normal activities.
If stress is very severe, it can make the physical discomforts of pregnancy worse than they usually are.
There also is a GAD-7 scale that allows doctors to use numerical grading of anxiety based on these criteria:
- Feeling nervous or anxious, or “on edge”
- Worrying too much
- Not being able to stop or control worrying
- Trouble relaxing
- Restless, such that it is hard to sit still
- Irritability, or getting easily annoyed
- Feeling afraid, as if something terrible could happen
Another way that doctors can assess your stress level is with the Beck Anxiety Inventory, which uses 21 criteria:
- Numbness or tingling
- Wobbliness in legs
- Feeling of heat
- Difficulty relaxing
- Fear that the worst is happening
- Dizziness or lightheadedness
- Palpitations (your heart is racing or pounding)
- You are terrified
- You are unsteady or clumsy
- Feelings of choking
- Your hands are trembling
- You are shaky
- You fear that you are losing control
- Breathing trouble
- You have a fear of dying
- You are very scared
- Indigestion or abdominal discomfort
- Face flushing
If stress is very severe, it can make the physical discomforts of pregnancy worse than they usually are. In some cases, severe stress can even trigger premature labor. Additionally, it can interfere with your sleep, both the overall amount and the patterns. This can cause a vicious cycle, because the lack of sleep can then cause more stress.
So what if you are diagnosed with an anxiety disorder during pregnancy, or, for that matter, after giving birth, when you are breastfeeding. How would you be treated? A family of anti-anxiety drugs called benzodiazepines may cause birth defects, if they given during the first trimester. It is best to avoid these drugs, however, since they are very addictive, and are reserved for short-term treatment. A different type of drug called buspirone is given for long-term treatment of GAD and also appears to be safe during pregnancy. Buspirone enters breast milk, but this does not necessarily mean that it’s harmful to a nursing infant, but more studies are needed. A class of drugs called selective serotonin reuptake inhibitors (SSRIs) can be given as treatment for certain anxiety orders. In particular, such as panic disorder and post-traumatic stress disorder (PTSD). SSRIs are not thought to be harmful during pregnancy or breastfeeding. Keep in mind that breastfeeding is not necessary so if you are doing well on an anti-anxiety drug, such as buspirone, it may be wise to continue your treatment and use infant formula. Whatever you do, it is best to discuss the plan with your child’s pediatrician.
Apart from medications, psychotherapy can be helpful to those with anxiety disorders, particularly a type of psychotherapy called cognitive behavioral therapy (CBT). If you are not yet taking any medications, it is worthwhile to try CBT without drug treatment. Keep in mind that medication may be helpful later in pregnancy or following birth. If you feel “stressed out”, and you do not have a diagnosable anxiety condition, exercise could also be helpful. Good exercises during pregnancy include long, fast walks, or even just stretching.
Depression, Anxiety, PTSD and Pregnancy: What You Need to Know