Postpartum Panic Disorder in a New Father

Mr. A was a 33-year-old man who developed panic disorder with agoraphobia at age 19 and was treated with benzodiazepines by his general practitioner for several years. After enrolling in graduate school at age 27, he experienced a severe relapse into panic disorder with agoraphobia and was unable to attend his classes. He took a leave of absence while he sought psychiatric treatment. Mr. A began treatment with sertraline, 100 mg/day, and alprazolam, 0.5 mg b.i.d., and experienced a full remission of symptoms within 6 weeks. Over the course of 7 months, alprazolam was discontinued, and Mr. A remained well while taking sertraline, 100 mg/day. After 3 years of this drug regimen, Mr. A reduced his dose of sertraline to 50 mg/day and continued to stay well.

Two years later his wife gave birth to a healthy infant daughter. Although his wife was the primary caregiver for the baby, Mr. A experienced frequent nightly sleep interruptions. Within 2 weeks of the birth, Mr. A’s panic disorder had recurred. The panic attacks occurred daily, and agoraphobia prevented him from leaving the house unaccompanied. He took leave from work while he sought help. A resumption of treatment with alprazolam, titrated to 0.5 mg t.i.d., and an increase in his sertraline dose, to 100 mg/day, led to substantial improvement within 2 weeks. Mr. A was able to return to work at that time. By the fourth week of treatment, he had recovered fully. Over the subsequent 4 months, he stopped taking alprazolam. Mr. A continued to be well while receiving sertraline monotherapy over the subsequent 6 months.