Mental Healthcare Looks Brighter for Pregnant Women and New Moms With Depression
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After my first child was born, I found myself occasionally having alarming thoughts that I would hurt him. I never did. These thoughts would pop into my head out of nowhere. I ignored them, but their existence made me feel that I was a terrible mother. I did not understand what was happening to me. I loved my child. He brought me and my husband great joy, and I was happy to be a mother, doting on his smile and every move. What I did not know then and what I realize now is that I was experiencing post-partum depression.
I came to this realization recently after reading that one of the symptoms of post-partum depression is having these kinds of intrusive, unwanted thoughts. According to estimates, 1 in 7-8 women (or 10-15 percent) develop “perinatal” depression, that is, significant mood or anxiety symptoms during pregnancy or after childbirth. The symptoms of the illness are varied, ranging from enormous anxiety and ruminating thoughts to feeling sad and blue. Women are not routinely screened for depression, so many suffer alone, quietly, in the darkness of ignorance, without even knowing they are ill.
Panel Recommendation a 'Game Changer'
But the landscape of mental health care for pregnant women and young mothers appears to be growing brighter. In January, a prestigious panel of national experts — the U.S. Preventive Services Task Force — announced for the first time that women should be screened for depression both during pregnancy and after giving birth. In making its recommendation, the task force noted that depression is “common in postpartum and pregnant women and affects not only the woman but her child as well.” The panel found “adequate” evidence that programs combining depression screening with support systems leads to a reduction or remission of depression symptoms in pregnant and postpartum women.
That recommendation is a “game changer” in the lives of women and their children, says Samantha Meltzer-Brody, a physician, associate professor and director of the perinatal psychiatry program at the University of North Carolina at Chapel Hill. Currently, screening for depression in pregnancy women and new mothers is “very, very spotty,” and depending on where women go for medical care, they may never be asked about their mental health, she says. Historically, once the U.S. Preventive Services Task Force makes a recommendation, she says it has a “meaningful impact on insurance company coverage of whatever they are recommending.
“It forces the issue because if you screen and you don’t provide adequate services then you are really in a bit of a bind,” she says. “Once you mandate screening, it will hopefully force the issue and, hopefully, galvanize support for people to develop and implement appropriate and effective interventions.”
The good news for women suffering post-partum depression is that there are a wide variety of effective treatments, from psychotherapy to medication, that have been tested in a wide variety of populations. “It’s just a matter of integrating these [treatments] into different systems,” Meltzer-Brody, noting that this will be one of the challenges ahead.
Research Underway at UNC-Chapel Hill
Meltzer-Brody is among a group of researchers at UNC’s Center for Perinatal Mood Disorders and Perinatal Psychiatry Program focusing on examining both the underlying biology — including genetics and other biomarker predictives — of who gets postpartum depression.
“We are interested in novel treatments,” she says. “We are interested in service design, implementation and delivery. So we are really approaching this in a really multifaceted manner to try and improve how we take care of our mothers from head to toe, so to speak.”
So why do some women develop perinatal depression?” Melzer-Brody says research suggests that the perinatal period is a time of enormous hormonal fluctuations, with levels of estrogen and progesterone soaring during pregnancy and plummeting in the postpartum period. While that rise and fall occurs naturally, researchers suspect that in a vulnerable or susceptible group of women, the rapid falling levels of these hormones cause the mood and anxiety symptoms that are commonly seen.
Although it’s unclear why some women are particularly vulnerable to those hormonal fluctuations, Melzer-Brody says it is suspected that “multiple layers of things,” including genetic loading, previous psychiatric history — which may change the way a body responds — are possibilities.
“There are many different theories behind it, it is not known, but we don’t have a solid biomarker now that we can hang our hat on,” she says. “Although we do know from a genetic perspective that perinatal depression is more heritable than depression outside of the perinatal period, leading us to think that there probably is a genetic vulnerability that plays an important role.”
As research continues, Melzer-Brody is urging any woman who is suffering mood or anxiety symptoms during pregnancy or postpartum to talk to a health care provider and get the help she deserves.
“So this is not something that people should suffer in silence with,” she says. “There are effective treatments and getting help really does make a huge difference in the quality of life of the mom as well as her life of her baby and family.”
As someone who never got help for post-partum depression 22 years ago, I also urge women to seek help. I came through my struggle with post-partum depression, but understanding what was happening to me and getting help would have made a big difference to my life back then. You have no need to be embarrassed to seek help.
As Melzer-Brody put it, perinatal depression is not anyone’s fault. “This is not about whether they wanted the baby or they aren’t a good enough mother. This is a biologic issue, just like other biologic issues. And the more we understand the biology, the more we are able to discuss this the way we discuss an infection or hypertension and get it out of the closet, where we have the shame and stigma that often comes unfairly with any mental health concern.”