Pharmacotherapy of panic disorder during pregnancy and lactation

Panic disorder is one of important psychiatric problems during pregnancy and lactation. The prevalence rate of this disorder has been reported to be 0.4%-4.0% in the perinatal period. In addition, the perinatal period may affect the onset or course of panic disorder. Although pharmacotherapy of panic disorder is well known, data on treatment of this disorder during pregnancy and lactation are very limited. It is difficult to decide about pharmacotherapy of panic disorder during the perinatal period, particularly during pregnancy, because both effective pharmacological agents and untreated maternal anxiety seem to be associated with several negative outcomes on the course of pregnancy and the fetus. Despite the absence of practical guidelines for pharmacological management of panic disorder during pregnancy and lactation, some general points about pharmacological treatment include the following: (1) Pharmacotherapy should be preferred when the potential impact of untreated maternal panic disorder is higher than the impact of the pharmacological agent on the fetus or new mother. (2) The patient and relatives should be informed about the benefits and risks of pharmacological treatment or nontreatment of the current maternal psychiatric picture and written informed consent forms should be obtained. (3) Selective serotonin reuptake inhibitors except paroxetine and low dose imipramine may be preferred during pregnancy. (4) Sertraline, paroxetine, orlow doses of imipramine or clomipramine appear to be appropriate pharmacological agents during the lactation period.