Panic disorder in pregnancy.
BACKGROUND: Some reports have suggested that panic disorder may go into remission during pregnancy. The universality of this finding, however, is questionable. In this retrospective survey, we examined the influence of pregnancy on the course of panic disorder in 46 women who developed panic disorder either before, during, or between pregnancies. METHOD: A questionnaire inquired about the clinical course of panic disorder before, during, and after each pregnancy. Additional questions were asked about symptom change following breastfeeding and about caffeine use during pregnancy. The questionnaire was mailed to 138 women with a DSM-III-R diagnosis of panic disorder who had been assessed in our Anxiety Disorders Clinic. RESULTS: Response rate to the questionnaire was 70%. Forty-six women reported a total of 67 pregnancies occurring after the development of panic disorder. Of these pregnancies, 43% were associated with improvement in panic symptoms, 33% with worsening, and 23% with no change. Furthermore, women were unlikely to experience the same outcome (i.e., worsening, improvement, or no change) in subsequent pregnancies. In contrast, the majority (63%) of pregnancies were associated with exacerbation of symptoms in the postpartum period. No association with weaning or caffeine use was detected. CONCLUSION: Our findings suggest that pregnancy may have a highly variable influence on the course of panic disorder. In contrast, postpartum worsening of panic may be a more consistent phenomenon. Implications for pregnancy counseling and management are discussed.