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Introduction Mental illness in pregnancy and postpartum has significant and potentially serious long-term consequences for a mother, her entire family, and in particular, for her infant (Grigoriadis, VonderPorten et al. 2013c). Perinatal mood and anxiety disorders are not culturally bound: they affect women in every society and from every socioeconomic background. The aim of this chapter is to increase awareness among healthcare providers about mood- and anxiety-related disorders in pregnancy and postpartum (the “perinatal” period). To achieve this goal, the chapter provides key information about the presentation of these disorders in the perinatal period, along with research about biological and psychosocial risk factors for illness. Clinical presentations Most psychiatric disorders can occur in the perinatal period, but mood and anxiety disorders are particularly common among women of reproductive age. Pregnancy is not protective against the development or recurrence of these disorders, and evidence suggests that the postpartum period is a time of increased risk for new-onset mood and anxiety problems. In particular, there is a risk of mood-related psychosis in the postpartum period, with women suffering from bipolar disorder at high risk. Further, there is a high risk of comorbidity with mood and anxiety disorders co-occurring (Grigoriadis, et al. 2011). In the 5th edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) mood and anxiety disorders are classified into five separate categories: Depressive disorders, Bipolar and related disorders, Anxiety disorders (including generalized anxiety disorder, panic disorder and social anxiety disorder), Obsessive-compulsive and related disorders, and Trauma and Stressor-related disorders (including adjustment disorder, acute stress disorder and post-traumatic stress disorder [PTSD]) (American Psychiatric Association, 2013). Mood and anxiety disorders occurring in pregnancy or postpartum are not classified as distinct disorders in the DSM-5. However, due to the distinct risks related to perinatal mood disorders, episodes of depressive and bipolar disorders occurring during this time are classified with the use of the specifier: “with peripartum onset.” Specifically, the DSM-5 specifier indicates that “peripartum-onset” pertains only to episodes occurring in pregnancy or with onset in the first four weeks after delivery, although research suggests that risk is likely elevated throughout the first postpartum year.

The anxiety disorders are conventionally subdivided into: generalised anxiety disorder (GAD), panic disorder (PD), social phobia (social anxiety disorder (SAD)), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). The current edition of the Diagnostic and Statistical Manual of Mental Disorders, the (DSM)-IV-TR lists 12 anxiety disorders, with broadly similar categories listed in the International Classification of Impairments, Disabilities and Handicaps, 10th revision (ICD-10). Neurochemistry and brain imaging studies have influenced the development of theoretical models of GAD. Current neuroanatomical models of panic disorder draw on the understanding of the functional neuroanatomy of fear conditioning in animals. SAD is second only to specific phobia as the most common anxiety disorder in population-based community studies; onset is in the mid-teenage years and extends into the middle of the third decade. There are a wide range of medical conditions that can cause and perpetuate symptoms of anxiety.

This chapter outlines the ways of identifying women at risk and/or women who already show signs and symptoms of depression/anxiety associated with childbearing; and suggest treatment options and preventive measures. Depression during pregnancy is common, with reports suggesting that approximately 10-20" of pregnant women meet criteria for a major or minor depressive disorder. Postpartum psychosis may have any of the features of acute schizophreniform disorder, but most frequently resembles an episode of bipolar disorder, with an early manic phase and later depressive swing. Prevention is considered to be the first line of treatment for postpartum depression. A majority of women have significant psychological issues associated with their transition to motherhood. Interpersonal psychotherapy (IPT) has also shown promise in the treatment of depression, both during pregnancy and in the postnatal period. A number of studies have looked at hormonal treatment and prevention of perinatal psychiatric disorders.