A government-appointed health panel is calling for all pregnant women to be evaluated for depression while they’re pregnant and after their babies are born.
The recommendations, published by the US Preventative Services Task Force on Tuesday in the Journal of the American Medical Association, are based on new research indicating that mental illness during pregnancy may be more common than has previously been suggested.
A type of depression that affects new mothers, known as postpartum depression, is known to cause feelings of extreme sadness, anxiety, and exhaustion.
As many as one in seven mothers may experience this disorder, the New York Times reports. And mums aren’t the only ones affected — studies suggest mums with depression pay less attention to their own health before and during pregnancy, which not only can cause problems for themselves but for their children as well.
In addition to depression, pregnant or postpartem women can also experience problems like anxiety, bipolar disorder, and obsessive-compulsive disorder.
“It’s very significant that the task force is now putting forth a recommendation that’s specific to pregnant and postpartum women,” Katy Kozhimannil, an associate professor of public health at the University of Minnesota, told the Times, calling depression screening and diagnosis “an enormous public health need.”
Benefits of screening
The USPSTF, an independent panel of experts appointed by the Department of Health and Human Services, weighed the benefits and harms of depression screenings and treatments in adults — including pregnant or postpartum (post-birth) women — as well as the accuracy of these screenings.
The panel found evidence that combining depression screening with support services reduced the symptoms of depression in adults including pregnant women or new mothers.
Antidepressants, psychotherapy, or a combination of the two were also effective in reducing the incidence of depression.
In addition, a type of therapy called cognitive behavioural therapy, which involves identifying negative thought patterns to help sufferers respond to them more clearly, was found to be an effective treatment for postpartum depression in particular.
Overcoming a stigma
In addition, the panel found very few drawbacks of the screenings in postpartum women and adults. That’s significant since one of the initial concerns about recommending the screenings was that it could increase the stigma that currently surrounds mental illness by drawing attention to it.
Doctors were worried that if a pregnant woman was diagnosed with depression and anxiety, it would make her feel more scared or stigmatised, Wendy Davis, the executive director of Postpartum Support International, told The Times.
But in fact, studies suggest the screening may do the opposite. “Screening tools actually can give a language for both the providers and the patients to feel comfortable talking about it and prevent the stigma,” Davis said.
The risks of depression drugs
Once someone is diagnosed with depression, treatment options can include medication, therapy, or some combination of the two.
It’s important to note that some depression drugs — primarily selective serotonin reuptake inhibitors (SSRIs) — have been found to increase the risk of suicidal behaviours in young people. In 2007, the FDA issued a “black box” label warning (the most serious type of prescription drug warning) for children and adolescents.
These drugs also slightly increase the risk of gastroinstestinal bleeding in adults over the age of 70.
However, these risks are relatively small, the panel reports. It did find evidence that depression drugs could cause serious harm to an unborn baby, but this risk was also low.
Based on these findings, the panel concluded that there was a “moderate net benefit” to screening for depression in pregnant and postpartum women whose healthcare providers offer cognitive behavioural therapy or other counseling services.
The panel gave its recommendations a “B” rating, which requires the screening to be covered under the Affordable Care Act, according to The New York Times.
The recommendations are an updated version of depression guidelines released in 2009, which called for people be screened if health providers had the staff to provide support and treatment. The new guidelines extend those recommendations to pregnant and postpartem women.
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