Zusammenfassung
Fragestellung: Depressionen und Angststörungen stellen die häufigsten psychischen Erkrankungen dar
und sind in unserer Gesellschaft weit verbreitet. Eine beachtliche Anzahl an Frauen
leidet unter diesen psychischen Erkrankungen vor, während oder nach einer Schwangerschaft.
Eine Schwangerschaft kann durch eine bereits vorbestehende oder neu auftretende Erkrankung
erschwert werden. Im Gegensatz dazu haben sowohl die Angststörung als auch die Depression
in ihrer klinischen Präsentation während der Schwangerschaft wenig Aufmerksamkeit
erhalten. In diesem Artikel wird die aktuelle Literatur zu diesem Thema zusammengefasst
mit dem Ziel, eine Übersicht über die Prävalenz und die klinische Präsentation depressiver
Erkrankungen und Angststörungen im Prä- und Peripartalzeitraum zu geben. Klinische
Implikationen werden diskutiert. Um in der Praxis ein besseres Verständnis dafür zu
entwickeln, werden zuerst die Erkrankungen dargestellt, um dann auf die in der Literatur
aufgeführten Schwangerschaftskomplikationen einzugehen. Im Vordergrund steht dabei
die klinische Bedeutung dieser Erkrankungen. Des weiteren werden aktuelle Behandlungsoptionen
und ein einfaches Screeninginstrument, an dem man sich im Alltag orientieren kann,
vorgestellt. Methodik: Es wurde eine Datenrecherche in elektronischen Datenbasen (Medline, PubMed) in englischer
Sprache anhand der Schlüsselwörter „Schwangerschaft“ und „Depression“ oder „Angststörung“
sowie „niedriges Geburtsgewicht“, „Wachstumsretardierung“, „Frühgeburt“ oder „Behandlung“
durchgeführt. Insgesamt 59 englischsprachige Artikel, publiziert innerhalb der Jahre
1986–2009 blieben nach Durchsicht übrig und wurden ausgewertet. Ergebnisse: Als Auswirkungen hoher Level an Depressivität und Angst auf die Schwangerschaft werden
in aktuellen Studien besonders die intrauterine Wachstumsrestriktion sowie eine Frühgeburt
herausgestellt. Eine Reihe von Autoren konnten hier Zusammenhänge demonstrieren. Über
den Pathomechanismus herrscht Uneinigkeit. Am wahrscheinlichsten werden Regulationen
über die Cortisolachse angenommen, was im Tierversuch demonstriert werden konnte.
Die Diagnosestellung bedarf häufig der interdisziplinären Zusammenarbeit, um eine
reaktive Symptomatik von tatsächlichen Psychopathologien zu unterscheiden. Behandlungsoptionen
reichen von psychologischer Unterstützung bis hin zur Therapie mit Psychopharmaka.
Schlussfolgerung: Angststörungen und depressive Erkrankungen zählen bei Frauen in den reproduktiven
Jahren zu den häufigsten psychischen Störungen. Ihr Erscheinungsbild ist heterogen.
Gerade das Erkennen dieser Erkrankungen in der Schwangerschaft und der Umgang mit
ihnen ist erschwert. Unter der Annahme, dass sowohl die Erkrankung selbst durch Angst,
Depression und Stress, jedoch auch eine psychotrope Medikation den Feten in seiner
Entwicklung beeinflussen können, befindet sich der behandelnde Arzt in einem Dilemma.
Sowohl die Behandlung als auch die Nichtbehandlung kann negative Konsequenzen nach
sich ziehen. Eine frühzeitige Erkennung, Diagnosestellung und Zuführung zu Behandlungsangeboten
stellt eine Möglichkeit dar, bereits präpartal entstehende Komplikationen zu mildern
und postpartalen Störungen vorzubeugen.
Abstract
Purpose: Depression and anxiety disorders are the most common mental disorders and are widespread
in our society. A considerable number of women suffer from these mental disorders
either prior to, during or after pregnancy. They can cause severe complications during
and after pregnancy. However, the prevalence and clinical presentation of depression
and anxiety disorders during pregnancy have received little attention. In this article
we review the medical literature as it relates to the prevalence and clinical presentation
of depression and anxiety disorders during pregnancy. The aim of this study is to
investigate the growing body of literature on maternal depression and anxiety during
pregnancy. Its purpose is to present an overview of antenatal depression and anxiety
and the clinical issues and implications involved. To develop a better understanding
we describe the typical symptoms of these disorders and discuss the side effects on
pregnant women and the developing fetus afterwards. The treatment options in clinical
practice are explained, and the Edinburgh Postnatal Depression Scale (EPDS), which
can be used as a simple screening instrument, is shown. Material and Methods: A search for empirical articles indexed in electronic databases (Medline, Pubmed)
was conducted using combinations of the following search terms: pregnancy, childbirth,
depression, postpartum, panic disorder, anxiety disorder, low birthweight, growth
retardation, preterm birth or treatment. We included 59 articles published between
1986 and 2009. Results: A high level of depressive or anxiety symptoms during pregnancy were found in combination
with fetal intrauterine growth retardation or preterm birth. A few studies were able
to demonstrate an association. The pathomechanism remains partly unclear. Most likely
those symptoms cause a change in the signalling pathway of cortisol, which has been
demonstrated in animal research. It is not easy to establish a diagnosis during pregnancy.
To differentiate between reactive symptoms and real psychopathology a psychiatrist
or psychotherapist would often need to be involved. Treatment options range from supportive
psychotherapy to treatment with antipsychotic drugs in severe cases. Conclusion: Depressive and anxiety disorders are the most common mental disorders in women during
their reproductive years. The appearance of these disorders is heterogeneous. Making
a diagnosis and treatment of the disorder is difficult during pregnancy. Given the
growing evidence that depression, stress, anxiety and psychotropic medications all
involve fetal exposure, pregnant women with depression or anxiety and their gynecologists
face significant treatment dilemmas. Both treating and not treating the disorder can
have negative side effects. Early detection of depression and anxiety disorders, confirmation
of the diagnosis and early initiation of treatment options could limit prenatal complications
and prevent their postpartum exacerbation.
Schlüsselwörter
Schwangerschaft - Depression - Angststörung - Geburtsgewicht - Retardierung - Frühgeburt
- Behandlung
Key words
pregnancy - depression - anxiety disorder - birthweight - growth retardation - preterm
birth - treatment
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Dr. Stephanie Gawlik
Universitätsfrauenklinik Heidelberg
Voßstraße 9
69120 Heidelberg
eMail: stephanie.gawlik@med.uni-heidelberg.de