Questions

I am a 32-year-old woman contemplating my first pregnancy. I have a sister who has been treated for schizophrenic illness for the past ten years. I am afraid that I might develop a severe problem such as hers during pregnancy or the postpartum period. What is your advice?

Because your sister had a schizophrenic illness, your risk of having a psychotic episode in the postpartum period is possibly higher than in the general population. The exact incidence of schizophrenic illness during the postpartum period is not known, but in general, about one in 1,000 women will become psychotic in the postpartum.

I would encourage you not to worry overly about this, but to educate yourself about the illness and to assure that you have proper professional attention in this regard after your baby is born. Your doctor can be of help with this and should be able to refer you to a specialist who will be involved in your care and monitoring your condition after the birth of your baby.

I am a married woman who is contemplating becoming pregnant. Both my 50-year-old mother and my 29-year-old sister have suffered from obsessive-compulsive disorder for several years. They are both under psychiatric care, take antidepressants and attend support groups for obsessive-compulsive behavior. Will I also develop obsessive-compulsive disorder once I've become pregnant?

Since two members of your family suffer from this disorder, your anxiety is quite legitimate and you are wise to seek advice. Doctors don't know the exact role of heredity in obsessive compulsive disorder; therefore, it's not possible to predict the chances that this disorder will affect you, although your risk of developing OCD is higher than someone whose relatives do not suffer from it. Although the question of whether you'll develop this condition in your lifetime remains open, we can say with some confidence that your risk of developing this disorder for the first time during pregnancy is not very high. Your family history is no reason to choose against pregnancy.

It would be a good idea for you and your husband to arrange a meeting to discuss your family history and concerns with your family doctor. Before pregnancy, it's always wise to be sure that those close to you and those involved in your medical care have a full picture of any possible risks. Should some problem develop, your doctor will have all the information to make the right diagnosis quickly. You might also want to request that you and your husband be referred for a consultation with a psychiatrist, you can clarify the symptoms of obsessive-compulsive disorder, reassure you as to your small chance of developing the problem during pregnancy, and then see you again during your pregnancy if this seems called for.

I've been receiving medical treatment for panic disorder, and now I've learned I'm pregnant with my second child. I'm quite happy about the pregnancy but concerned about the effects my medication might have on the baby. Are there other treatments for panic disorder?

The most important thing you can do immediately is to be sure that the doctors involved in your care - your family doctor and your obstetrician - are fully aware of your condition and the medications you are taking. Many women with panic disorder feel as you do, and some of them have been successful in doing without medication for the course of their pregnancy. You should not try to "go it alone," however. Your doctor will want to see you frequently to check on your status, and you might ask if this is a good time to be referred to a psychiatrist who can help monitor and advise you. Whether or not you need medication will depend on the severity of your symptoms. The effect on the baby depends on the type of medication you are on. As noted in Chapter 11 of "Shouldn't I be Happy?", though the long term effects of medication on the baby are not known, there is little danger to the baby if short-acting benzodiazepines are taken with caution. Also keep in mind that if you were already on medications at the time of conception, stopping them now will not change the fact that the baby was already exposed, and an abrupt stopping of medications may make your symptoms worse.

You can also make some lifestyle adjustments that are thought to minimize the intensity of panic attacks, and, coincidentally, are healthy choices for pregnant mothers in general. For instance, panic attacks can be brought on by consuming excessive sweets and caffeine, by drinking too much alcohol, and by heavy smoking. Of course, most pregnant women make efforts not to smoke or consume alcohol or excessive amounts of sweets or coffee. For the rest, it is helpful to get adequate rest, avoid cola soft drinks and excessive tea or coffee, and follow a sensible exercise routine. Keeping stress levels down helps control panic attacks. It's a good idea to discuss with your partner the contribution that extraordinary stress makes to panic disorder. While we can rarely control life's major events, we can control the minor ones. Remember, pregnancy is not the ideal time to renovate the house!