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Postpartum depression is defined as intense feelings of sadness immediately following pregnancy and it can last up to one year. Oftentimes, there is a stigma around mental health so women might not realize that they are at risk or might be too embarrassed to discuss their symptoms. In this second part of the Healthful Woman podcast on perinatal and postpartum depression, Dr. Miller and Dr. Fox discuss the importance of recognizing risk factors and screening for postpartum depression early on in a woman’s pregnancy care plan.

Who is at Risk for Postpartum Depression?

A history of depression, other mental health conditions, or a diagnosis of PMS are common risk factors for developing postpartum depression. People from disadvantaged populations might also be more at risk, but that is not proven. Although it might be nerve-wracking to hear you are more at risk, this knowledge can help you prepare for the possibility of having postpartum depression. Dr. Fox explains that “the people who truly suffer are the ones who don’t know it’s coming… And so, they’re just like, ‘Well, yeah, this is normal that I haven’t gotten out of bed for three weeks and I haven’t eaten for two weeks, and I haven’t showered for a week. So yeah, this is what happens to moms.’”

It can take a long time for women who don’t realize they were at risk to realize that those are not normal feelings for new moms (or anyone). If you have these symptoms of intense sadness, lack of motivation, or other feelings that don’t seem, always ask your OB so that they can screen for postpartum depression. Simple treatments like medication and/or therapy are effective for about 90% of patients and they are safe for pregnant and breastfeeding women.

Mental Health Screening for Postpartum Depression

At your prenatal visit, your OB-GYN can ask questions and screen for the risk of postpartum depression. People often don’t outwardly tell their doctors that they have anxiety or depression until they are asked, but it’s important to know that history in case symptoms of perinatal or postpartum depression occurs.

Questions that might be asked include when you were diagnosed and what medications worked or didn’t work so that an effective treatment plan can be made in preparation for depressive symptoms during and/or after pregnancy. EPDs or PHQ-9 can also be used to gain objective data about how a patient is feeling. These are simple tests that ask various questions relating to mood and a numerical score is obtained for a positive or negative depression screening.

How to Prevent Postpartum Depression

Some people are more at risk for postpartum and perinatal depression which can make it difficult to fully prevent. However, Dr. Miller discusses a few recommendations that were published in JAMA a few years ago. Both are psychotherapy-based interventions proven to reduce the risk of postpartum depression. One is called Roses and it’s based on interpersonal therapy. The other is Mothers and Babies, based on cognitive behavioral therapy. A large problem, according to Dr. Miller, is that “they’re not being used on the ground the way that we would hope that they could be.”

Dr. Miller’s research focuses on preventative strategies for postpartum depression. She and her team are “looking at changes in the brain…in pregnant people that have depression compared to pregnant people that don’t have depression and seeing these increased inflammatory cytokines, or these markers where there’s extra inflammation around the brain in people that are experiencing depression.” By analyzing these markers, she hopes to determine whether they cause depression or are an effect of depression.

Incorporating Mental Health Care and Pregnancy Care

One of the main barriers to mental health care is simply accessing the necessary resources and this is a complex issue. Psychiatrists often charge a lot so that they can be reimbursed beyond insurance coverage. Additionally, it’s nearly impossible to find a psychiatrist with next-day or short-term availability. Dr. Miller recognizes that short-term care for people with chronic mental health conditions like bipolar disorder is not feasible, but she does strongly believe that short-term care and better accessibility are possible.

Dr. Miller is currently working on an intervention strategy called collaborative care. Patients have access to a care manager who communicates between the primary care physician and supervising psychiatrist. Dr. Miller explains that “instead of the psychiatrist seeing every single person, the psychiatrist along with the care manager, they meet every week and describe everyone in the registry and how they’re doing on their treatment.” This allows psychiatrists to simultaneously care for hundreds of patients by quickly reviewing the care manager’s notes instead of seeing individual patients for 60-minute sessions.

Learn More About Postpartum Depression

At Carnegie Women’s Health, we are committed to our patients’ overall health and wellness. To learn more about perinatal and postpartum depression, check out the Healthful Woman podcast or schedule an appointment at our New York City office.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!