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This week, one of America’s leading independent preventive medicine panels—the U.S. Preventive Services Task Force—updated its guidelines for screening adults for depression to specifically include pregnant and postpartum women.
It's the first time that the panel has recommended that women undergo depression screenings both during and after pregnancy. Depression is a condition that can lead to a great deal of fear and confusion for new and expectant mothers, and it often goes untreated, says Dr. Samantha Meltzer-Brody, the director and founder of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill.
“I think this is a terrific and critically important step forward,” Dr. Meltzer-Brody says of the new guidelines. “We’ve known for a long time that the prevalence of depression and anxiety during pregnancy and postpartum is the highest of a woman’s lifetime, and in particular during the first month postpartum.”
Dr. Meltzer-Brody is hopeful that the recommendations from the the U.S. Preventive Services Task Force will not just lead to concrete policy changes, but to mindset changes among doctors and other professionals in the medical community. For several years, primary care providers and OB-GYNs have avoided this issue.
“Like with anything, there are culture changes that occur,” she says. “Sometimes they occur because there’s a mandate that forces the issue. I think that, over the last decade in the United States, there has been an enormous shift by most of the professional medical organizations towards seeing screenings as important. But now that something like the U.S. Preventive Services Task Force has come forward, this then will allow it to be changed in such a way so that there’s no longer an excuse not to screen.”
An estimated one in seven women experience postpartum depression symptoms, including Molly Peryer, a mother of two. After experiencing depression during pregnancy and after the birth of her first child, she co founded Brooklyn PPD Support 10 years ago. She says there’s no difference between the symptoms of depression and postpartum depression, except with the latter there’s one crucial aspect thrown into the mix.
“With postpartum depression there’s a baby involved so there’s no option of hiding under the covers and really withdrawing,” says Peryer. “My symptoms started, I’d say, in the last month of my pregnancy. I had trouble sleeping, I was anxious, and I had obsessive thoughts. Things just went from bad to worse when my son was born.”
Preyer had planned her pregnancy and gave birth to a “healthy, bouncing baby boy.” But she says that she was unprepared for the realities of being a parent.
“I thought I was just going to have these instincts that were going to kick in as soon as he was born,” she says. “I felt adrift right off the bat because that didn’t happen—I didn’t feel like I knew what I was doing.”
Preyer founded her local support group because she said that the issue of postpartum depression was something that had not been talked about among the other parents in her neighborhood.
“It’s just something that’s not discussed,” she says. “When I started Brooklyn PPD Support, my partner and I at the time spoke to pediatricians about putting pamphlets in waiting rooms. There was resistance because there’s this false notion—even within the medical community—that if it’s discussed or brought up that it’s somehow going to cause symptoms. I think quite the opposite is true. The less we discuss it the more scary it is.”
Dr. Meltzer-Brody regularly collaborates with pediatricians and OB-GYNs at the UNC Perinatal Psychiatry Program, which she founded back in 2004. However, she says that Preyer’s experience with postpartum depression both in her community and with physicians is “absolutely classic.”
“It is enormously frustrating to see people suffer,” says Meltzer-Brody. “I applaud what Molly has done, and so many other women across the country who have worked to start advocacy organizations. We don’t think it’s acceptable for any other organ or disease system in the body to ignore [a problem] the way we ignore mental health. It would never be acceptable to say, ‘It really makes us uncomfortable to screen for a heart issue or high blood pressure so we’re just not going to do it.’ Unfortunately, this is the story of mental health and the stigma of mental health. And then you add a women’s health issue into the mix and it just gets magnified.”
When it comes to actually treating depression, many argue that doctors over prescribe medications. But Meltzer-Brody says that prescribers are much more cautious about doling out pharmaceuticals to expectant mothers carrying developing fetuses, and new moms that are nursing infants.
“There are some women that need to take medication because of the severity of their symptoms, their histories, or whatever it may be,” she says. “But there are many other available therapies—there are all types of psychotherapies—and one of the challenges of our field is going to be figuring out how we deliver care with a broad range of therapies.”