Abstract
Anxiety disorders are highly prevalent and persist across the life course. As documented in earlier chapters of this volume, women are particularly prone to anxiety disorders, with around a third meeting diagnostic criteria over the course of a lifetime (Alexander et al. 2007). In this chapter, we will summarize some key points pertaining to the epidemiology, clinical presentation, and treatment of anxiety disorders in women. We will also address the comorbidity between physical illness and anxiety disorders in women. Finally, we will examine the specific challenges faced in treating women with anxiety disorders during pregnancy and lactation.
Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength (Charles Spurgeon)
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Abramowitz JS (1997) Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. J Consult Clin Psychol 65(1):44–52
Abramowitz JS, Schwartz SA, Moore KM et al (2003) Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 17:461–478
Alexander JL, Dennerstein L, Kotz K, Richardson G (2007) Women, anxiety and mood: a review of nomenclature, comorbidity and epidemiology. Expert Rev Neurother 7(11 Suppl):S45–S58
Andersson L, Sundstrom-Poromaa I, Bixo M, Wulff M, Bondestam K, Astrom M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189:148–154
Austin MP, Lumley J (2003) Antenatal screening for postnatal depression: a systematic review. Acta Psychiatr Scand 107(1):10–17
Bebbington PE (1990) Population surveys of psychiatric disorder and the need for treatment. Soc Psychiatry Psychiatr Epidemiol 25(1):33–40. Review
Barron WM, Mujais SK, Zinaman M, Bravo EL, Lindheimer MD (1986) Plasma catecholamine responses to physiologic stimuli in normal human pregnancy. Am J Obstet Gynecol 154(1):80–84
Bastani F, Hidarnia A, Montgomery KS et al (2006) Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes? A randomized controlled trial. J Perinat Neonatal Nurs 20(2):138–146
Beck CT (2004) Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 53:216–224
Bergman K, Sarkar P, O’Connor TG, Modi N, Glover V (2007) Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry 46(11):1454–1463
Bogetto F, Venturello S, Albert U et al (1999) Gender-related clinical differences in obsessive-compulsive disorder. Eur Psychiatry 14(8):434–441
Bowen RC, Senthilselvan A, Barale A (2000) Physical illness as an outcome of chronic anxiety disorders. Can J Psychiatry 45(5):459–464
Bryant C, Judd FK, Hickey M (2012) Anxiety during the menopausal transition: a systematic review. J Affect Disord 139(2):141–148. doi:10.1016/j.jad.2011.06.055
Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA, Boyce PM, Austin MP, Hayes BA (2002) To screen or not to screen--that is the question in perinatal depression. Med J Aust 177(Suppl):S101–S105
Calkins AW, Otto MW, Cohen LS, Soares CN, Vitonis AF, Hearon BA, Harlow BL (2009) Psychosocial predictors of the onset of anxiety disorders in women: results from a prospective 3-year longitudinal study. J Anxiety Disord 23(8):1165–1169. doi:10.1016/j.janxdis.2009.07.022
Canton J, Scott KM, Glue P (2012) Optimal treatment of social phobia: systematic review and meta-analysis. Neuropsychiatr Dis Treat 8:203–215. doi:10.2147/NDT.S23317, Epub 2012 May 3
Castle DJ, Deale A, Marks IM (1995) Gender differences in obsessive compulsive disorder. Aust N Z J Psychiatry 29(1):114–117
Chen YH, Lin HC, Lee HC (2010) Pregnancy outcomes among women with panic disorder – do panic attacks during pregnancy matter? J Affect Disord 120(1–3):258–262. doi:10.1016/j.jad.2009.04.025
Cohen LS, Sichel DA, Dimmock JA et al (1994) Impact of pregnancy on panic disorder: a case series. J Clin Psychiatry 55:284–288
Cuijpers P, Sijbrandij M, Koole S et al (2014) Psychological treatment of generalized anxiety disorder: a meta-analysis. Clin Psychol Rev 34(2):130–140. doi:10.1016/j.cpr.2014.01.002, Epub 2014 Jan 10
DiPietro J, Ghera M, Costigan K et al (2002) Measuring the ups and downs of pregnancy stress. J Psychosom Obstet Gynecol 25:189–201
Facchinetti F, Romano G, Fava M, Genazzani AR (1992) Lactate infusion induces panic attacks in patients with premenstrual syndrome. Psychosom Med 54(3):288–296
Fricchione G (2004) Clinical practice. Generalized anxiety disorder. N Engl J Med 351(7):675–682. doi:10.1056/NEJMcp022342
Gadalla TM (2008) Disability associated with comorbid anxiety disorders in women with chronic physical illness in Ontario, Canada. Women Health 48(1):1–20. doi:10.1080/03630240802131965
Glover V, O’Connor TG (2002) Effects of antenatal stress and anxiety: implications for development and psychiatry. Br J Psychiatry 180:389–391
Gould RA et al (1997) Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: a preliminary meta-analysis. Behav Ther 28(2):285–305
Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB, Huang B (2005) Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 35(12):1747–1759. doi:10.1017/S0033291705006069
Grigoriadis S, Vonderporten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Ross LE (2014) Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ 348:f6932
Guglielmi V, Vulink NC, Denys D, Wang Y, Samuels JF, Nestadt G (2014) Obsessive-compulsive disorder and female reproductive cycle events: results from the OCD and reproduction collaborative study. Depress Anxiety. doi:10.1002/da.22234
Hansen D, Lou HC, Olsen J (2000) Serious life events and congenital malformations: a national study with complete follow-up. Lancet 356(9233):875–880
Hedegaard M, Henriksen TB, Sabroe S, Secher NJ (1993) Psychological distress in pregnancy and preterm delivery. BMJ 307(6898):234–239
Heikkinen T, Ekblad U, Kero P et al (2002) Citalopram in pregnancy and lactation. Clin Pharmacol Ther 72:184–191
Heron J, O’Connor T, Evans J et al (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80(1):65–73
Hettema JM, Prescott CA, Myers JM, Neale MC, Kendler KS (2005) The structure of genetic and environmental risk factors for anxiety disorders in men and women. Arch Gen Psychiatry 62(2):182–189
Hettema JM, Kuhn JW, Prescott CA, Kendler KS (2006) The impact of generalized anxiety disorder and stressful life events on risk for major depressive episodes. Psychol Med 36(6):789–795. doi:10.1017/S0033291706007367
Hoog S, Cheng Y, Elpers J et al (2013) Duloxetine and pregnancy outcomes: safety surveillance findings. Int J Med Sci 10(4):413–419. doi:10.7150/ijms.5213, Epub 2013 Feb 28
Huizink AC, Mulder EJ, Buitelaar JK (2004) Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility? Psychol Bull 130:115–142
Hviid A, Melbye M, Pasternak B (2013) Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. N Engl J Med 369(25):2406–2415
Iqbal MM, Sobhan T, Ryals T (2002) Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv 53(1):39–49
Källén BA, Otterblad Olausson P (2007) Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol 79(4):301–308
Kalra S, Born L, Sarkar M et al (2005) The safety of antidepressant use in pregnancy. Expert Opin Drug Saf 4:273–284
Keller F, Griesshammer M, Haussler U et al (2001) Pregnancy and renal failure: the case for application of dosage guidelines. Drugs 61:1901–1920
Kessler RC, Demler O, Frank RG et al (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352(24):2515–2523
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 21(3):169–184. doi:10.1002/mpr.1359
Kossowsky J, Pfaltz MC, Schneider S, Taeymans J, Locher C, Gaab J (2013) The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry 170(7):768–781. doi:10.1176/appi.ajp.2012.12070893
Lensi P, Cassano GB, Correddu G et al (1996) Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry 169(1):101–107
Levey L, Ragan K, Hower-Hartley A et al (2004) Psychiatric disorders in pregnancy. Neurol Clin 22(4):863–893
Liber JM, Van Widenfelt BM, Utens EM et al (2008) No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial. J Child Psychol Psychiatry 49(8):886–893. doi:10.1111/j.1469-7610.2008.01877.x, Epub 2008 Mar 10
Little B (1999) Pharmacokinetics during pregnancy: evidence-based maternal dose formulation. Obstet Gynecol 93:858–868
Lochner C, Hemmings SM, Kinnear CJ et al (2004) Gender in obsessive-compulsive disorder: clinical and genetic findings. Eur Neuropsychopharmacol 14(2):105–113
Matthey S (2007) Using the Edinburgh postnatal depression scale to screen for anxiety disorders. Depress Anxiety 25(11):926–931
Menage J (1993) Post-traumatic stress disorders in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 11:221–228
Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Ericksen J, Ellwood D, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157
Mitte K (2005) A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 88(1):27–45
Murray CJL, Lopez AD (1996) The global burden of disease and injury series, volume 1: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Havard School of Public Health, Cambridge. MA
Mykletun A, Jacka F, Williams L, Pasco J, Henry M, Nicholson GC, Kotowicz MA, Berk M (2010) Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol 10:88. doi:10.1186/1471-230X-10-88
Noshirvani HF, Kasvikis Y, Marks IM et al (1991) Gender-divergent aetiological factors in obsessive-compulsive disorder. Br J Psychiatry 158:260–263
Nulman I, Rovet J, Stewart DE et al (2002) Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 159(11):1889–1895
Poromaa IS (2014) Physiological Correlates of Premenstrual Dysphoric Disorder (PMDD). Curr Top Behav Neurosci. doi:10.1007/7854_2014_296
Rai D, Lee BK, Dalman C, Golding J, Lewis G, Magnusson C (2013) Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case–control study. BMJ 346:f2059
Reif A, Weber H, Domschke K, Klauke B, Baumann C, Jacob CP, Deckert J (2012) Meta-analysis argues for a female-specific role of MAOA-uVNTR in panic disorder in four European populations. Am J Med Genet B Neuropsychiatr Genet Off Publ Int Soc Psychiatr Genet 159B(7):786–793. doi:10.1002/ajmg.b.32085
Rodebaugh TL, Holaway RM, Heimberg RG (2004) The treatment of social anxiety disorder. Clin Psychol Rev 24(7):883–908
Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298
Russell EJ, Fawcett JM, Mazmanian D (2013) Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry 74(4):377–385. doi:10.4088/JCP.12r07917
Polen K, Rasmussen SA, Riehle-Colarusso T et al (2013) Association between reported venlafaxine use in early pregnancy and birth defects, national birth defects prevention study, 1997–2007. Birth Defects Res A Clin Mol Teratol 97(1):28–35. doi:10.1002/bdra.23096, Epub 2012 Dec 26
Sanz EJ, De-las-Cuevas C, Kiuru A et al (2005) Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet 365(9458):482–487
Schneider ML, Moore CF, Kraemer GW, Roberts AD, DeJesus OT (2002) The impact of prenatal stress, fetal alcohol exposure, or both on development: perspectives from a primate model. Psychoneuroendocrinology 27:285–298
Sit DK, Perel JM, Helsel JC et al (2008) Changes in antidepressant metabolism and dosing across pregnancy and early postpartum. J Clin Psychiatry 69(4):652–658
Shear KM, Oommen M (1995) Anxiety disorders in pregnant and postpartum women. Psychopharmacol Bull 31(4):693–703
Sholomskas DE, Wickamaratne PJ, Dogolo L et al (1993) Postpartum onset of panic disorder: a coincidental event? J Clin Psychiatry 54:476–480
Stafford L, Judd F, Gibson P, Komiti A, Mann GB, Quinn M (2013) Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months. Psychooncology 22(9):2071–2078. doi:10.1002/pon.3253
Stein DJ, Bouwer C (1997) A neuro-evolutionary approach to the anxiety disorders. J Anxiety Disord 11(4):409–429
Stein MB, Schmidt PJ, Rubinow DR, Uhde TW (1989) Panic disorder and the menstrual cycle: panic disorder patients, healthy control subjects, and patients with premenstrual syndrome. Am J Psychiatry 146(10):1299–1303
Stein MB, Roy-Byrne PP, Craske MG, Bystritsky A, Sullivan G, Pyne JM, Sherbourne CD (2005) Functional impact and health utility of anxiety disorders in primary care outpatients. Med Care 43(12):1164–1170
Stika C, Frederiksen M (2001) Drug therapy in pregnant and nursing women. In: Atkinson AJ Jr, Daniels CE, Dedrick RL et al (eds) Principles of clinical pharmacology. Academic, New York, pp 277–291.17
Stinson F, Dawson DA et al (2007) The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 37(7):1047–1059, Epub 2007 Mar 5
Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H (2004) Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 19(8):459–463
Tanaka E (1999) Gender-related differences in pharmacokinetics and their clinical significance. J Clin Pharm Ther 24:339–346
Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R (2007) Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev 27(2):86–91. doi:10.1097/01.HCR.0000265036.24157.e7
Trumpf J, Margraf J, Vriends N, Meyer AH, Becker ES (2010) Specific phobia predicts psychopathology in young women. Soc Psychiatry Psychiatr Epidemiol 45(12):1161–1166. doi:10.1007/s00127-009-0159-5
Turk CL, Heimberg RG, Orsillo SM et al (1998) An investigation of gender differences in social phobia. J Anxiety Disord 12(3):209–223
Wadhwa PD, Glynn L, Hobel CJ, Garite TJ, Porto M, Chicz-DeMet A, Wiglesworth AK, Sandman CA (2002) Behavioral perinatology: biobehavioral processes in human fetal development. Regul Pept 108(2–3):149–157
Weinstein M (1980) Lithium treatment of women during pregnancy and in the post-delivery period. MTP Press, Lancaster
Weisberg RB, Paquette JA (2002) Screening and treatment of anxiety disorders in pregnant and lactating women. Womens Health Issues 12(1):32–36
Williams L, Jacka F, Pasco J, Henry M, Dodd S, Nicholson G, Berk M (2010) The prevalence of mood and anxiety disorders in Australian women. Australas Psychiatry Bull R Aust N Z Coll Psychiatrists 18(3):250–255. doi:10.3109/10398561003731155
Wisner KL, Peindl KS, Hanusa BH (1996) Effects of childbearing on the natural history of panic disorder with comorbid mood disorder. J Affect Disord 41:173–180
Wolitzky-Taylor KB, Horowitz JD et al (2008) Psychological approaches in the treatment of specific phobias: a meta-analysis. CIin Psychol Rev 28(6):1021–1037. doi:10.1016/j.cpr.2008.02.007, Epub 2008 Mar 7
Würtzen H, Dalton SO, Andersen KK et al (2013) Who participates in a randomized trial of mindfulness-based stress reduction (MBSR) after breast cancer? A study of factors associated with enrollment among Danish breast cancer patients. Psychooncology 22(5):1180–1185. doi:10.1002/pon.3094, Epub 2012 May 16
Yang YL, Liu L, Wang Y, Wu H, Yang XS, Wang JN, Wang L (2013) The prevalence of depression and anxiety among Chinese adults with cancer: a systematic review and meta-analysis. BMC Cancer 13:393. doi:10.1186/1471-2407-13-393
Yates WR (2009) Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry 21(2):95–102
Yonkers KA, Bruce SE, Dyck IR, Keller MB (2003) Chronicity, relapse, and illness-course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow- up. Depress Anxiety 17(3):173–179
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Sevar, K., Vythilingum, B., Castle, D. (2015). Anxiety and Related Disorders in Women. In: Stein, D., Vythilingum, B. (eds) Anxiety Disorders and Gender. Springer, Cham. https://doi.org/10.1007/978-3-319-13060-6_7
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