Identifying pregnant and post-partum women with depression is extremely important because untreated perinatal depression and other mood disorders can have devastating effects on women, infants, and families. Perinatal depression, which includes depressive episodes and mood disorders that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women.
Depression, the most common mood disorder in the general population, is approximately twice as common in women as in men, and usually begins during the reproductive-age years. Regular contact with an obstetrician during the perinatal period should provide an ideal circumstance for women with depression to be identified and treated. Mental illness often has a negative stigma making it very difficult for women to seek help or acknowledge depressed or anxious feelings. Perinatal depression and other mood disorders, such as bipolar disorder and anxiety disorders, are associated with maternal suicide, which exceeds maternal hemorrhage and hypertensive disorders as a cause of maternal mortality (death). Studies reveal less than 20% of women in whom postpartum depression was diagnosed had reported their symptoms to a health care provider. Therefore, it is important that we shed as much education and enlightenment as we possibly can to increase awareness and reporting of depression and mood disorders in our pregnant and postpartum women.
Perinatal depression often goes unrecognized because of changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes. Hormone shifts, body image, transition of families, and medical health are also major contributors to a women’s mental health. Expecting a newborn should be an amazing and beautiful time for every mother, however, some women find this period to be stressful, anxiety-filled, and extremely difficult. As obstetricians, we must encourage women to listen to their feelings and acknowledge them, promote self-help/relaxation techniques, and seek counseling. Women with a history of depression and/or mood disorders should be monitored carefully and co-managed with a behavioral health consultant (psychologist) for behavioral modifications. Symptoms of mania or bipolar disorder in women warrant a referral to a psychiatrist.
One of the most common screening instruments for identifying patients with perinatal depression is the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire 9 (PHQ-9). The EPDS includes anxiety symptoms, which are a prominent feature of perinatal mood disorders, and excludes changes in sleeping patterns, that are common in the pregnancy and the postpartum period. The PHQ-9 includes constitutional symptoms, such as changes in sleep patterns, and is less specific for perinatal depression. Both questionnaires only take approximately 5 minutes and should be taken in the perinatal period by all women.
We love our mothers, our babies, and the entire family. As obstetricians, we want to prevent the potentially devastating consequences of perinatal depression and mood disorders if they go unrecognized and untreated. Every woman should be tested at least once in the perinatal period, and have systems in place for initiation of treatment and/or referral if needed. Counselors should be readily available and access unlimited with barriers. Collaboration with pediatricians for identifying mothers with issues with maternal-baby bonding and nurturing is extremely beneficial and helpful. Helping women to experience their best pregnancy and an amazing postpartum period is a high priority for obstetricians. Developing a trusting and meaningful patient-physician relationship may provide an avenue to help a woman at one of the most vulnerable moments in their life and potentially save a mother and her newborn from an adverse outcome.
Vonda R. Ware, MD, FACOG
Gwinnett Gynecology and Maternity
1800 Tree Lane, Suite 300 Snellville, GA 30078