An influential health panel in the U.S. has recommended for the first time that pregnant women be screened for depression during and after pregnancy, in recognition of the high incidence of maternal mental illness and the importance of treating it.
The United States Preventive Services Task Force issued the recommendation that screening be put in place for pregnant women, as well as effective treatment and followup.
Canadian experts applaud the move, and say such a measure would be welcome in Canada.
“This puts the issue of mental health in pregnancy and postpartum on everyone’s radar,” said Dr. Ariel Dalfem, head of the perinatal mental-health program at Toronto’s Mt. Sinai Hospital. “Depression is a common and debilitating illness. Women should not be scared to come forward or fearful of being judged.”
For many years, doctors have shied away from screening pregnant women for depression out of fear of stigmatizing them or not being able to offer treatment. But the U.S. task force reviewed the medical literature and concluded there is new evidence pointing to the benefits of screening and treating pregnant and postpartum women for depression and other mood disorders.
“There is so much pressure from society to be the perfect mother, the perfect parent. Having a newborn is a challenging time for anyone, but if it is complicated by depression, it is even more challenging,” said Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and a member of the task force.
In Canada, there are no national standards for screening for depression and anxiety during pregnancy or after birth. Most provinces do, however, screen for postpartum mood disorders and offer varying levels of treatment, says Dr. Simone Vigod, psychiatrist and program lead for the reproductive life stages program at Women’s College Hospital in Toronto.
One of the primary risk factors for postpartum depression is untreated depression during pregnancy. “Sometimes practitioners are afraid to screen because they worry it might be upsetting for the woman. But research has shown this to be false,” said Vigod.
The number of women who may be depressed or suffer from a mood disorder in pregnancy is about one in 10, while the number who may have postpartum mental-health issues is about one in seven, according to experts.
Many women worry about taking antidepressants while pregnant or breastfeeding, as there is evidence of a potential risk to a fetus, even if the likelihood of serious harm is low. Vigod says it is important for women to know about alternate therapies, including counselling, cognitive behavioural therapy and even transcranial direct current stimulation, a form of neurostimulation that sends a low current to an area of the brain.
The U.S. task force noted that risk factors for depression during pregnancy and postpartum include: worries about child care; lack of social support; history of depression; difficult infant temperament; unintended pregnancy and poverty. The task force, an independent group of experts appointed by the U.S. government, recommends that doctors consider using cognitive behavioural therapy or counselling when managing depression in pregnant or breastfeeding women.
“We leave the individual treatment decision up to the patient and their doctor, or an outside consultant like a psychiatrist,” said Pignone.
Dalfem applauds the U.S. recommendation, and hopes Canada will follow suit. “People are aware of postpartum mood disorders but they need to know issues can arise in pregnancy too,” Dalfem said. “It’s a myth that it is an easy, blissful time.”
“Depression can have significant consequences for the woman, her child and her family.”
Mothers who are unwell cannot take care of their children properly, and their children can in turn suffer from emotional instability.
She encourages all women to speak up if they are suffering from a mood disorder, although she concedes that access to treatment can be problematic depending on where you live in Canada. Fortunately, there are innovative treatment options including video-conferencing therapy and online therapy.