Gestational heebie-jeebies Part II : Knowledge is Power

WAKE UP EVERY MORNING AND TELL YOURSELF, “I CAN DO THIS!” 

Anxiety is a natural and very normal human emotion. We all experience anxiety of varying intensities on a daily basis. Everybody has different ways of dealing with it. In fact, for many, at low levels, anxiety can even serve as a stimulus for us to do better. However, when any emotion begins to impair one’s daily lifestyle, then it becomes a disorder. 

Pregnancy is an occasion to rejoice (for most!). A celebration! Any expectant mother would love to be happy throughout her pregnancy, to welcome the new life. It’s disturbing when one finds that their joyous moment is being marred by unexplained personality disturbances. Even more disturbing is, when we’re judged for it.

Perinatal anxiety can manifest in any woman, even those without any pre-existing personality disorders;Though why only certain women are susceptible to it, is unknown.

There are new concerns that arise with any pregnancy. That apart, there was nothing weighing my mind down. Hence, the panic attacks hit me like a bolt out of the blue. Initially, I blamed it on the bed rest that was forced upon me. It struck me much later that I experienced the first panic attack when I was still working!  Various physiological and psychosocial changes occur in pregnancy, including major hormonal alterations, that have reproductive implications and affects the maternal neuro-endocrine, stress  system and psychological functioning¹. Armed with the knowledge that this was normal, that it would settle with time, I was reassured, but had to keep reminding myself, from time to time. Unfortunately, rational thinking does not come easily, when in crisis.

Studies report a diverse prevalence of anxiety in pregnancy, ranging from 10% to almost as high as 45%. But most of these take pregnancy associated depression into account as well. Perinatal anxiety may also result in depression. Reasons cited for the diverse prevalence in these studies include lack of a uniform diagnostic questionnaire, improper patient selection and hesitation to acknowledge the condition, in view of the associated stigma. Maternal exposure to stress and anxiety may precipitate the release of catecholamines that can result in maternal vasoconstriction and ultimately a limitation of oxygen and vital nutrients to the fetus, which may affect the development of its central nervous system². Studies have also demonstrated an association between perinatal anxiety and increased incidence of pre-term births, low birth weight and behavioural disorders in the children later on.

If you are suffering from anxiety or panic attacks, that interferes with your daily functioning, then the first thing to do, would be, to visit your doctor. A thorough medical evaluation (including blood work-up, blood pressure, ECG, 2D ECHO etc.) will have to be done in order to rule out other disorders, like thyroid abnormalities, anemia etc. before your symptoms can be attributed to anxiety. You may consider meeting a psychiatrist for the same.

Below mentioned are the modes of treatment approaches for panic attacks: 

1.Cognitive behavioural therapy (CBT)

2. Pharmacotherapy (Anti-anxiety drugs)

I’m not going to go into the details. I only want to give you an idea about the options available. Enumerated here, is information that I’ve gleaned from scientific papers and articles online.

Cognitive behavioural therapy focusses on our Emotions, our body’s response to them, Thoughts and our Behaviour. The concentration is on:

• Increasing behaviours that decreases our anxiety.
• Decreasing behaviours that increase our anxiety levels.
• Identify patterns of self-talk or negative thinking that leads to upsetting thoughts and emotions.
• Learn ways to challenge negative thoughts when they arise and to replace them with more positive thoughts.

Your psychiatrist can help guide you through each technique. 

Give CBT a chance and the time to help you. Your patience will bear fruit. However, if the anxiety and panic attacks persist, then your psychiatrist, after consulting with your gynaecologist, may consider starting anti-anxiety medications for you. Strictly follow the instructions of your doctor regarding the dosing. Especially because, the goal during pregnancy is to expose the mother to as few medications as possible, lest it affect the growing fetus. Your doctor will evaluate the extent and severity of your condition, conduct a risk-benefit assessment and then you can make a joint informed decision.

Do not let this scientific mumbo-jumbo scare you. I only want to impress upon you the importance of getting help. If your doctor dismisses the anxiety as being a normal occurrence, and asks you to take it in your stride (like mine did), you would be wise to get another opinion. Anxiety and depression that disrupts one’s life, in any situation, is an issue that requires to be addressed. At this trying time, one needs support, one needs a ear and one needs to be given time. 

A plea to my esteemed colleagues in the field of medicine. Please do not dismiss distressed patients. We may not have the time that is required, to counsel them, but we can be empathetic and refer them to a psychiatrist who does. I, a doctor myself, was dismissed and left to fend for myself, despite having being referred by a common friend. Patients look to their doctor for support, strength and reassurance; And if we don’t give them that, we’re failing in our duty. I finally had to move in with my parents and change my doctor. I would not have had the strength and confidence to get back on my feet, had it not been for my family and friends.In the next post, I’ll share with you, the various methods I employed, which helped me regain normalcy and the clarity to reach out to all of you through this blog. Folks, I’d love to hear your stories, experiences and feedback of any kind. Feel free to drop in your comments!

Let’s not take life too seriously. Laugh all your worries away. :)

References:

1. Ross LE, McLean LM, Psych C. Anxiety disorders during pregnancy and the postpartum period: a systematic review. depression. 2006;6(9):1-4.

2. Copper RL, Goldenberg RL, Das A, et al. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. National Institute of Child Health and

Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1996;175:1286–1292