Anxiety Disorders

Last Update: 20 Nov 2024

Condition

Table of content

1. What is it? 2. Why Treating? 3. Breastfeeding 4. Non-Medical Options 5. Medications 6. How do I know which one to take? Key Takeaways Limits of Research

Welcome to our Fact Sheet on Anxiety Disorders. The information is based on current research and may be updated as new scientific knowledge emerges. It’s important to remember that the content shared here does not replace personalized advice from healthcare professionals.

1. What Is Anxiety and How to Recognize the Symptoms?

During pregnancy, it is normal and common to feel fear, stress, or worry about the occurring changes. Whether it is your 1^st or your 5^th pregnancy, adding a new member to the family requires some adaptation. However, if the worry becomes excessive and uncontrollable, resulting in important suffering, psychological distress, or disruption of daily activities such as sleeping, working, eating, or enjoyment, it could indicate an anxiety disorder.

Whether it is panic attacks, social phobia, generalized anxiety disorder, or other types of disorders associated such as obsessive-compulsive disorder, anxious symptoms may appear or evolve during pregnancy.

It can be difficult to distinguish between symptoms caused by the pregnancy and those of anxiety as they can be similar. The table below presents some red flags that can help you identify symptoms of an anxiety disorder. It is important to remember that anxiety is experienced differently from one person to another.

Often, seeking help is recommended when you have multiple symptoms that won’t go away, are having trouble understanding your own feelings, or when your loved ones are worried about you.

Let's talk about mental health during pregnancy.

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Table 1. Recognizing Anxiety Symptoms During Pregnancy Changes Through Your Body, Mind, and Actions.

Body	Mind	Actions
Increased heart rate or palpitations.	Imagining catastrophic scenarios for yourself or your unborn child.	Avoidance of situations, people, or places more than usual.
Pressure or discomfort in the throat or chest.	Excessive fears and worries about your health and safety or those of your unborn child.	Need to be in control more than usual.
Shortness of breath or accelerated breathing.	Images or thoughts that are obsessive, unwanted, disturbing, and intrusive about you or your baby.	Constantly seeking reassurance.
Changes in appetite, having more or less hunger.	Confusion or brain fog.
Changes in sleep patterns, sleeping more or less.	Sense of losing control or experiencing panic.
Digestive disruptions such as diarrhea or constipation.	Anger or irritability more than usual.
Tension, trembling, muscle pains, or soreness.	Loss of interest in your activities.

Some women are more at risk of developing anxiety during pregnancy due to a variety of factors. If you have one or more of these factors, you might be more vulnerable. For example, if you have a personal or family history of depression or anxiety or if you face complications with your health or your baby’s health during the pregnancy. Additional stressors at home like limited support from those around you, recent immigration, financial issues, housing instability, substance use, or experiencing violence or abuse can also make you more vulnerable.

It can be difficult to talk about mental health, but it’s important to reach out for support when needed. Your healthcare team is there to help you.

2. Why Is It Important to Treat Anxiety Disorders During Pregnancy?

Anxiety disorders are common during pregnancy. They affect about 1 in 5 pregnant women and up to 1 in 4 women in parts of the world where incomes are lower or during exceptional circumstances such as the COVID-19 pandemic.

Recent research highlights the importance of taking care of mental health during pregnancy for the well-being of the mother, the unborn child, and family (Table 2). Note that these possible risks vary from one person to another and depends on other factors such as genetics, other medical conditions, lifestyle choices, and severity of the symptoms.

Miscarriages, congenital malformations tooltip, premature birth, and other complications can happen in any pregnancy for many different reasons. This is the background risk. Here we compare this background risk with the risks associated with the untreated condition.

Table 2: Risks and Challenges of Untreated Anxiety Disorders.

For who?	What?	What does research say?
For the pregnant person	Depression	Anxiety symptoms are accompanied by depressive symptoms for about 1 in 2 people during pregnancy.
	Postpartum depression	After pregnancy, the risk of experiencing postpartum depression is also greater.
	Bond with the child	Stress and anxiety can make it more difficult to bond with the child.
For the unborn child	Premature birth	Increased risk of early delivery (before 37 weeks), which can cause respiratory issues and other health problems.
For the unborn child	Low birth weight	Small increased risk of low birth weight (less than 5 pounds, 8 ounces, or 2,500 grams) which may lead to hospitalization.
For future child/adult	Child development	Possible increased risk for delayed physical growth in early childhood. More research is needed to confirm.
For future child/adult	Child behaviour	Chronic and high levels of stress in the mother could impact brain behavior and development in the child causing difficulties with emotions, attention, or memory. More research is needed to confirm.
For the family	Ongoing research	Studies are ongoing to determine the impact of maternal anxiety on the family unit and how life partners, support persons, other children, and the surrounding environment can also play a key role in improving or worsening symptoms.

These are group approximations; other factors such as your genetics, other medical conditions, and your lifestyle can vary your own risk.

There are not enough studies to determine if anxiety disorders are associated with an increased risk of stillbirth, miscarriage, or infertility for the mother when compared with the background risk in the population. It is unlikely that anxiety alone increases the risk of birth defects compared to the background risk (3 out 100 pregnancies among healthy women might have a birth defect). However, measuring anxiety can be challenging, and people respond to chronic stress in various ways, making it difficult to know if the effects on pregnancy are caused by the medical conditions or other factors.

3. Will I Be Able to Breastfeed?

Breastfeeding can be a beautiful way to bond with your baby, and many women worry that anxiety might make it more difficult. The good news is that most women with anxiety disorders are still able to breastfeed if they wish to. When breastfeeding is in place and is not a stressor, it can even help reduce anxiety, thanks to the calming hormone oxytocin that’s released during nursing. It may even have a little plus since this hormone not only promotes a sense of relaxation but is one of the many factors that strengthens the bond between you and your baby.

However, anxiety might make breastfeeding feel more challenging at times. It’s important to know that you’re not alone, and support is available if you wish to continue or not.

If anxiety affects your breastfeeding experience, reaching out to a healthcare provider or lactation consultant can make a big difference to make a healthy choice for you and your baby or or to have access to diverse strategies to help you feel more confident and comfortable while breastfeeding, ensuring that both you and your baby can enjoy this time together. Remember, every step you take is progress, and seeking help is a sign of strength.

4. What Can I Do to Reduce My Anxiety Before Medications?

Whether you’re planning a pregnancy or already expecting, taking care of your mental health is just as important as preparing for childbirth. A great starting point is to sit down with your partner or a trusted support person to create a ‘mental health’ plan. Just like you would for labor, this plan helps you recognize early signs of anxiety and gives you strategies to manage them during stressful moments.

Incorporating daily habits can be incredibly beneficial in reducing anxiety. Maintaining a balanced diet, engaging in light to moderate exercise, and setting aside time for mindfulness activities—such as prenatal yoga, meditation, walking, or even listening to calming music—can help you stay centered. If you’re new to exercising, don’t worry—start gradually and build up over time. These small but consistent efforts can make a big difference.

Psychotherapy is another non-medication approach that’s been proven to help. Cognitive Behavioral Therapy (CBT), in particular, has shown to be effective in reducing anxiety for about 6 out of 10 pregnant women tooltip. Therapies, CBT or others, can be tailored to your specific needs, either alone or in combination, to support both your mental and emotional well-being during this important time. Moreover, non-pharmacological treatments like CBT are highly effective and carry no risk to the fetus, making them an ideal first-line treatment for many women.

It’s easy to overlook self-care during pregnancy, but remember, your mental health is crucial for your child’s health too. So, take the time to prioritize your well-being—it’s one of the best things you can do for both you and your baby.

5. Medications Prescribed for Treating Anxiety

Pharmacological treatments, such as Selective Serotonin Reuptake Inhibitor (SSRIs), are effective and often necessary for more severe anxiety but come with potential risks that need careful consideration.

There are several medications available in Canada to treat anxiety during pregnancy and/or breastfeeding.

In general, research has not shown a big increase in risk of birth defects, cognitive disorders, or long-term effects for most of these medications. For more information, consult the medication-specific Fact sheets.

There are many classes of medications used for treating anxiety, the most commonly used are referred to as antidepressants. These medications increase the amount of neurotransmitters tooltip available for communication between neurons tooltip, which decrease anxiety symptoms, among other things. The first class affects the neurotransmitter serotonin; these are SSRIs. The second class increases the amount of two neurotransmitters, serotonin and norepinephrine, these are serotonin and norepinephrine reuptake inhibitors (SNRIs).

We have fact sheets on different SSRIs

Learn more

Table 3. Medications Prescribed for Anxiety Disorders

Medication Types	Medication Names	Brand names
Selective Serotonin Reuptake Inhibitors (SSRIs)	Citalopram	e.g. Celexa®
	Escitalopram	e.g. Cipralex®
	Fluoxetine	e.g. Prozac®
	Fluvoxamine	e.g. Luvox®
	Paroxetine	e.g. Paxil®
	Sertraline	e.g. Zoloft®
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)	Duloxetine	e.g. Cymbalta®
	Venlafaxine	e.g. Effexor®

Sometimes, depending on your signs and symptoms, your preferences, your medical history, and the other medications that you might take, your healthcare provider might prescribed other medications such as ones from the benzodiazepines class to help treat your anxiety disorder.

6. How Do I Know Which One to Take?

The choice between non-pharmacological options and medications often depends on the severity of the anxiety, your preference, and the presence of any other medical conditions. A combination of both approaches can sometimes be the most effective strategy, particularly in more severe cases.

Each medication has its benefits and disadvantages, and your healthcare team is best equipped to guide you in making an informed decision adapted to your specific needs.

Many people consider changing or stopping their anxiety medication when they are planning a pregnancy or when they find out they are expecting. It is important to not make these changes by yourself. Similarly, stopping antidepressants suddenly can cause withdrawal symptoms, reappearance of anxiety symptoms and even worsen them.

Self-medication, such as taking someone else’s prescribed medication or consuming cannabis, to reduce anxiety is not recommended during pregnancy.

Always discuss with your healthcare team (pharmacist, nurse, doctor) before making changes to your medication.

Key Takeaways

Prioritizing the mother’s mental health is important for the well-being of the baby.
Feeling anxiety during pregnancy is normal, but it is important to seek help when symptoms disrupt daily life or you cannot recognize yourself.
Not treating anxiety disorders during pregnancy increases the risk of postpartum depression, premature birth, and cognitive disorders in children.
Lifestyle, physical activity, mindfulness activities, social support, and psychotherapy treatments such as CBT can help reduce anxiety.
Medications for treating anxiety, like SSRIs or SNRIs, have pros and cons during pregnancy; a conversation with your healthcare team is essential to determine the best option for you during your pregnancy.

Research Is Great, But It Is Not Perfect

Making informed health decisions also involves considering the current state of scientific knowledge. Here is an overview on what our committee of experts has concluded on the quantity and quality of studies conducted to date on anxiety disorders during pregnancy:

Small Studies: Many studies are done with only a few participants, so the results might not apply to everyone.
Different Types of Anxiety: Anxiety comes in many forms, like general worry, panic, or social anxiety. Since these are different, it’s hard to study them all together.
Inconsistent Tools: Researchers use different methods to measure anxiety, leading to mixed results that don’t always match up.
Pregnancy Complications: Pregnancy naturally brings a lot of changes—physical, emotional, and hormonal. These changes can make it tough to figure out if anxiety alone is causing certain effects.
Missing Long-Term Data: There aren’t many studies that follow women from before pregnancy until after birth, so we don’t fully understand how anxiety during pregnancy affects long-term health for both mom and baby.
Overlooked Influences: Factors like culture, income, and environment can impact anxiety during pregnancy, but they’re often not considered in studies.
Focus on Depression: Most research on mental health during pregnancy focuses on depression, not anxiety, so we don’t have as much information or targeted help for anxiety.

Understanding these limitations helps explain why more research is needed to better support pregnant women dealing with anxiety.

References

“Anxiety Fact Sheets.” MotherToBaby, 2023, https://mothertobaby.org/fact-sheets/anxiety-fact/. Accessed 9 Aug. 2024.
Clinkscales, Natalie, et al. “The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta‐” Psychology and Psychotherapy: Theory, Research and Practice 96.2 (2023): 296-327.
Dennis, Cindy-Lee, et al. “Cohort profile: Impact of Maternal and Paternal Mental Health–Assessing Concurrent Depression, Anxiety and Comorbidity in the Canadian Family (IMPACT study).” BMJ open 13.3 (2023): e071691.
Hofmann, Stefan G., et al. “The efficacy of cognitive behavioral therapy: A review of meta-analyses.” Cognitive therapy and research 36 (2012): 427-440.
Jeličić, Ljiljana, et al. “Maternal distress during pregnancy and the postpartum period: underlying mechanisms and child’s developmental outcomes—a narrative review.” International Journal of Molecular Sciences 23.22 (2022): 13932.
Misri, Shaila, and Elena Swift. “Generalized anxiety disorder and major depressive disorder in pregnant and postpartum women: maternal quality of life and treatment outcomes.” Journal of Obstetrics and Gynaecology Canada 37.9 (2015): 798-803.
Misri, Shaila, et al. “Perinatal generalized anxiety disorder: assessment and treatment.” Journal of women’s health 24.9 (2015): 762-770.
Nielsen-Scott, Maria, et al. “Prevalence of perinatal anxiety in low-and middle-income countries: A systematic review and meta-analysis.” Journal of affective disorders 306 (2022): 71-79.
Pull, Charles-Bernard, et al. DSM-5 – Manuel Diagnostique et Statistique des Troubles Mentaux. Philadelphia: Elsevier – Health Sciences Division, 2015. Accessed 17 July 2024. ProQuest Ebook Central.
Stuebe, Alison M., Karen Grewen, and Samantha Meltzer-Brody. “Association between maternal mood and oxytocin response to breastfeeding.” Journal of women’s health 22.4 (2013): 352-361.
Tucker, Z., and C. O’Malley. “Mental health benefits of breastfeeding: a literature review. Cureus 14 (9): e29199.” (2022).
Traylor, Claire S., et al. “Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review.” American Journal of Obstetrics & Gynecology MFM 2.4 (2020): 100229.
Yuen, Megan, et al. “The effects of breastfeeding on maternal mental health: a systematic review.” Journal of women’s health 31.6 (2022): 787-807.

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