Impatient

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Impatient asks: Have you experienced postpartum depression?

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This week, the U.S. Preventive Services Task Force for the first time specifically included pregnant women and new mothers in its  recommendation that all adults get screened for depression. The guidelines, published Tuesday in JAMA, say screening should be accompanied with effective treatment or referral to someone who can provide care.

Dr. Emily Dossett, an associate clinical professor in the psychiatry and obstetrics and gynecology departments at Los Angeles County-USC Medical Center, described the move as "wonderful."

"We're hoping [the recommendation] will encourage primary care doctors, pediatricians working with postpartum moms, and OB-GYN's working with pregnant women, to really take these recommendations to heart and start implementing them in their practices," says Dossett, who also runs a program at County-USC that offers prenatal care and psychiatric treatment to low-income women.

I turned to Dossett and another expert, Sherman Oaks psychotherapist Dr. Diana Barnes, to learn more about how Southern California health care facilities screen pregnant women and new moms for depression.

What are the symptoms of depression during pregnancy and after birth?

"Postpartum depression doesn't look the way we expect depression to look," Barnes says. "It looks like anxiety."

Other common symptoms include an inability to sleep and a sense of disorientation, she says, adding, "women will talk about feeling foggy, they'll talk about going through the motions, feeling robotic."

How do doctors screen for depression? How often should this be done?

At her clinic at County-USC, Dossett says women undergo two tests: One that screens for symptoms of major depression and another that screens for anxiety.

The Task Force didn't specify when adults or pregnant women should first be screened for depression, or how often they should be screened, noting there's not enough evidence to formulate a recommendation. But at the Women's Mental Health Clinic at County-USC, Dossett says women are screened for depression multiple times, beginning with their first prenatal visit.

If the tests show they are at moderate or high risk for depression, they'll get a more thorough mental health exam and will be connected with treatment if needed, she says. They will also be screened monthly after that.

Women not exhibiting symptoms of depression will be screened at least once a trimester, says Dossett.

Screening shouldn't end after birth, says Barnes. While women often visit their OB-GYN about six weeks after giving birth, Barnes says symptoms of postpartum depression can emerge within the first three months of a baby's life and up to one year after birth.

"We know the whole first year is clinically significant," Barnes says. "We need to be paying attention to women's mental health during this entire first year, because not every woman presents [symptoms] in the first month."

What is the benefit of screening pregnant women and new moms for depression?

Both a mother and her baby - while it's developing and once it's born - benefit significantly if a woman gets treated for depression.

If a woman is depressed during pregnancy, it affects her ability to care for herself: to eat properly, sleep properly, and make it to doctor's appointments, Dossett says.

In turn, that affects a developing baby's health, Dossett says, adding, "when a woman is depressed or anxious in pregnancy, her own stress management hormones can become dysregulated and affect the developing child, and then the infant is born with their own stress management system a little bit dysregulated."

Untreated depression is also associated with a higher risk of preterm delivery and having a low birth weight baby, she says.

If a mother's depression remains untreated after birth, it could affect her ability to connect with her child, Dossett says, and "that really affects a baby's sense of attachment or security and that… really affects that child's whole life, in terms of ability to form relationships and be resilient to trauma."

Share your story

Have you or someone you know experienced depression during pregnancy or after birth? We'd love to hear how the depression was diagnosed, how it was treated, and how it affected you and your family. You can share your experience in the comments section below or e-mail us at Impatient@scpr.org.

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