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Ask the Mental Health Expert Archives 2001-2004

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Panic Attacks While Pregnant

Q. I experience severe panic attacks while flying. Sometimes they even begin the day before I have to fly. Consequently, I do not fly unless in an emergency and when I do I take prescription Xanex. I am 5 weeks pregnant. I already know I will have to travel in April and the only way to get there is to fly. Can I still take my medication? If not, what can you suggest? Will the panic attacks pose any threat to my baby?

A. Your situation is not uncommon, especially in today's stressful, post 9-11 environment. While I can't advise you what to do about medication, I can tell you that the risk of taking a benzodiazepine (such as Xanax, Klonopin, etc.) is quite small with respect to effects on the developing fetus, once the first trimester is over. Though the older literature does note an increased risk of cleft palate and other oral abnormalities in babies exposed to benzodiazepines during the first trimester, the most recent research suggests that this risk, if present at all, is very small.

That said, I would certainly recommend discussing this issue with your obstetrician, and looking at some alternative or adjunctive treatments for your panic attacks, including cognitive-behavioral therapy (CBT). Many of the airlines also have classes aimed specifically at those with a fear of flying. Some of the latest therapy techniques include the use of flight simulators or virtual imaging, as well as actual exposure to flying scenarios. A behavioral psychologist with special expertise in CBT would be a good place to start.

Your last question is difficult to answer with scientific evidence. Indeed, in my literature search, I found no studies looking specifically at the question of whether panic attacks can affect the development or delivery of the fetus/baby. Some experts in the field (e.g., Lee Cohen MD) have theorized that repeated panic attacks might have a negative effect on uterine blood flow, and thus, might adversely affect the fetus-but, so far as I can tell, this has never been proven.

Finally, you might be interested in seeing "The Anxiety and Phobia Workbook", by Dr. EJ Bourne, though this is no substitute for professional counseling.

February, 2002

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