Depression and anxiety disorders

Because of a greater prevalence of depressive and anxiety disorders among women, a substantial part of an obstetrician gynecologist's practice is concerned with the management of these disorders. This article depicts how women with these disorders present to a primary care clinic and how the menstrual cycle, pregnancy and lactation may affect symptoms. General principles of management are discussed, including suicide assessment, medical evaluation, psychotherapy, pharmacologic treatment, and psychiatric referral. The selective serotonergic reuptake inhibitors (SSRIs) are described as first-line treatment for most depressive and anxiety disorders because of the overall efficacy and favorable side effect profile. Other pharmacologic agents are discussed for women who are unresponsive to or intolerant of the SSRIs. Although psychotherapy is preferred to antidepressants during pregnancy and lactation, guidelines for appropriate antidepressant use are provided.