Throughout history pregnancy has been considered universally positive. After the baby is born, most cultures point to this as a joyous time to celebrate the miracle of life.
But for so many, the realities of pregnancy and postpartum are challenging and vulnerable periods, particularly for women who suffer with clinical depression.
The rosy outlook and dismissiveness of pregnancy “blues” is finally changing. The notion that perinatal depression or depression in pregnancy or postpartum is an increasing public health issue has finally received validation.
The recent recommendation by the U.S. Preventative Service Task Force is to update the recommendation for depression screening in adults from 2009 to include screening for pregnant and postpartum women who were previously left out.
Depression affects up to 1-in-5 women in pregnancy and 1-in-7 women postpartum. Yet, too often pregnant and postpartum women have been dismissed from the conversation and then are not considered for new medical health care practices and clinical research.
As a perinatal psychiatrist, I often treat women who have been suffering for several months and, on some occasions, years before they are diagnosed with postpartum depression. Although postpartum screening has been implemented in some states and is a growing practice, many more states have yet to recognize the need to address this public health concern. Screening allows these women to be identified earlier and ideally receive the necessary treatment.
Unfortunately, a recommendation to implement screening is just the beginning. The recommendations advise the screening of women across the United States. But they do not address how frequently women should be screened in pregnancy and postpartum.
Major Access Barriers
The recommendation is also not designed to address access to treatment such as that afforded by insurance coverage or local availability of perinatal mental health care specialists. These are currently major barriers. Furthermore, some may be concerned that medications will be forced upon women who screen positive and that this could be detrimental to the fetus or the breastfeeding baby.
What the recommendations did not detail is the risk for both the child and woman if depression remains untreated in pregnancy or postpartum. During pregnancy, untreated depression has been linked with low birth weight, preterm birth, poor prenatal care and suicide. Postpartum, untreated depression has been linked to behavioral problems, cognitive difficulties and poor emotional regulation in the children.
Treatment with medication and-or psychotherapy will remain a decision between a woman and her physician based on a woman’s individual needs. Considering the risks to Mom and baby when depression goes unnoticed and untreated, it is plausible that screening will lead to treatment that is optimal for the overall wellness for both. Screening will further aide in women feeling more supported and less stigmatized.
We have taken a step towards understanding and treating women for depression at a vulnerable time in their lives. But it is a baby step.