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Pregnant women and new mothers need more attention when it comes to screening for depression, according to recommendations issued Tuesday by the U.S. Preventive Services Task Force.
That came as part of the panel's recommendation that all adults should be screened, in a situation where they can be provided treatment or get a referral if they are clinically depressed.
The announcement follows similar recommendations in 2002 and 2009. What's new this time is the special shout-out for pregnant women and new moms. They need special recognition, the task force says, because of evidence showing that they can be accurately diagnosed and successfully treated, and because untreated depression harms not only the mother, but her child as well.
Depression is the leading cause of disease-related disability in women around the world. Nine percent of pregnant women and 10 percent of new moms will go through a major depressive episode, according to evidence cited by the task force. And studies have shown that babies and toddlers with depressed moms are subject to lots of problems. They may be more difficult to console, be less likely to interact or have more sleeping problems.
The independent panel's recommendations are influential — many health insurers and health systems follow their suggestions. But the announcements often come with controversy. Recent and recurring recommendations against automatic annual mammograms for women in their 40s have generated multiple headlines.
But concerns among mental health researchers who got an early glimpse of the advice about testing for depression have been mild — mostly questions about the best depression screening test to use and the importance of emphasizing more research on treatments.
There's no argument about the task force's call for recognizing the needs of pregnant women and new moms. "Historically, depression in these populations has been underrecognized and undertreated," says Evette Ludman, a clinical psychologist who studies behavioral science for Group Health Research Institute in Seattle.
Most important, she says, is the recommendation that there be access to some sort of effective care when someone is diagnosed.
Heidi Koss got no screening with the birth of her first child 20 years ago, not even an open ear when she mentioned symptoms of depression to her obstetrician at her six-week checkup. "He said 'Oh, this is typical of a lot of moms; perhaps you should get out more, maybe buy a new dress.' "
"It just added to a sense of helplessness, hopelessness and isolation," she says now. In 2011, she told NPR about several attempts to commit suicide before finally finding a sympathetic mental health counselor about a year after her first child was born.
Her experience with postpartum depression inspired Koss to get a degree in counseling. She now practices in Kirkland, Wash., and is the Washington state coordinator of a nonprofit education group, Postpartum Support International.
"Pregnancy is not from the neck down," she says, pointing to studies that show that more women suffer from mental illness during pregnancy and after pregnancy than develop gestational diabetes or pre-eclampsia, or go into preterm labor.
And she singles out a small British study done in the late 1990s that claimed that psychiatric disorders, and suicide in particular, were the leading cause of maternal death.
The task force report notes that one of the biggest challenges is treatment.
"Because hopelessness and inertia are often part and parcel of depression, it can be challenging for persons living with depression to keep at it until finding the treatment that is right for them," says Ludman of Group Health Research Institute. The task force notes that talk therapy (specifically a kind called cognitive behavioral therapy), drug therapy or a combination of medication and therapy may be necessary.
But the group backs off on recommending drug treatment for pregnant women with depression because of the possibility of problems associated with certain drugs called SSRIs. Some studies have shown a small risk of increased problems that include miscarriage and preterm birth. Instead, the suggestion for pregnant or breastfeeding women is for cognitive behavioral therapy or some form of counseling.
The task force's recommendations for pre- and post-term moms appear in the current issue of JAMA, the journal of the American Medical Association. They track with advice from other groups, including the American Academy of Family Physicians, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
Legislation introduced in Congress last July would authorize the federal government to fund screening and treatment for pregnant women or women who have given birth within the past year.
Joanne Silberner, a former health policy correspondent for NPR, is an artist in residence at the University of Washington's department of communication.
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