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On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.
The recommendations, published in the Journal of the American Medical Association, suggest: "All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults."
"Depression is among the leading causes of disability in persons 15 years and older," the task force statement said. "It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. ...The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women."
The government-appointed panel found that the harms from such screening are "small to none," though it did cite potential harm related to drugs frequently prescribed for depression:
The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.
Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations "are an incredibly important step to have depression care become a routine part of obstetrical care."
She added: "Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes."
Dr. Ruta Nonacs, who's in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women's Mental Health, sent her thoughts via email:
In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.
While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.
Unlike the so-called “baby blues” — the feelings of exhaustion, worry and unease that impact about 80 percent of new moms but are often short-lived — postpartum depression can be extreme and longer-lasting. The condition occurs in nearly 15 percent of births, according to the National Institute of Mental Health, and can often require treatment, from psychotherapy to medications.
The New York Times' report Tuesday says the health panel's new recommendations are "expected to galvanize many more health providers to provide screening," particularly as emerging evidence suggests "maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children."
And here's what Mark DeFrancesco, M.D., president of the American College of Obstetricians and Gynecologists, said in a statement on the new recommendations:
The American College of Obstetricians and Gynecologists (ACOG) is pleased that the USPSTF recognizes that screening for depression is appropriate for all adults, including pregnant and postpartum women. ACOG has long recommended depression screening for all women, both as a part of the well-woman visit and during the perinatal period. Specifically, ACOG's Committee Opinion on Screening for Perinatal Depression recommends routine screening for depression for all women at least once during the perinatal period.
ACOG's Committee Opinion also adds that women at high risk of depression – for example, with a history of depression or anxiety – warrant especially close monitoring.
Perinatal depression – or depression that occurs during pregnancy or in the first 12 months after delivery – is estimated to affect one in seven women, making it one of the most common medical complications associated with pregnancy. Because fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms, routine screening by physicians is important for ensuring appropriate follow-up and treatment. Fortunately, we have a variety of treatment options – such as lifestyle changes, therapy, and medication – that help women control depression and enjoy their growing families.
Of course, depression also impacts women who aren't pregnant. Because of the open, close nature of our relationship with our patients, ob-gyns have a unique role to play in identifying depression in the women we treat. That's why routine mental health screening is an important part of the well-woman visit.
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