Depression Screening for Pregnant Women

IRA FLATOW: You’re listening to Science Friday. I’m Ira Flatow. Millions of people suffer from depression. I’m sure you know that. You probably know people who do, but many of us don’t even know that we do.

This week, the US Preventive Services Task Force, a government health panel, released its recommendations suggesting that all adults be screened for depression. However, the panel singled out one specific group for regular screening, and that was pregnant mothers. We’ve all heard of postpartum depression, but that could be a misnomer, because between 14% and 23% of expected mothers experience depression during or after their pregnancy according to the American Congress of Obstetricians and Gynecologists.

Could that number be much higher than we think? Will these recommendations get more women treated, and how do we treat depression in this population? Samantha Meltzer-Brody is the director of the Perinatal Psychiatric Program, or the Psychiatry Program– University of North Carolina at Chapel Hill. Welcome to Science Friday.

DR. SAMANTHA MELTZER-BRODY: Hello, thanks for having me.

IRA FLATOW: How are most pregnant women screened for depression now? Is it at the discretion of the individual physician?

DR. SAMANTHA MELTZER-BRODY: Yes, so unfortunately right now it’s very, very spotty. And there are some places that do it quite well, and women are screened throughout pregnancy and the postpartum period. Unfortunately, in many, many places, there is absolutely no screening that occurs at all. And I think what’s great about the current recommendations, the new recommendations, is that it will hopefully change that practice.

IRA FLATOW: Give us an idea what a depression test is like.

DR. SAMANTHA MELTZER-BRODY: Well, there’s many short forms that are very easy. They often include somewhere between 9, 10 questions. They ask people about mood, anxiety, functioning. They generally screen for thoughts of wanting to hurt oneself, or suicidal thoughts. And it’s very low risk.

It’s easy to administer. It takes a few minutes. One of the most common used instruments is the Edinburgh Postnatal depression scale. That’s translated into 58 languages and is used internationally. It’s also used widely in the United States, but it’s certainly not the only one. It’s not a matter so much of which one you use, it’s just a matter of making sure it is used.

IRA FLATOW: Is it something that if you go for a yearly, bi-yearly, whatever checkup, your normal physician will do, or do you need to go to someone trained at how to do this?

DR. SAMANTHA MELTZER-BRODY: That’s a great question, Ira, and unfortunately it is not consistent. And I think that’s one of the biggest problems is that mental health is often left off the table. So again, there are some places– and many internal medicine folks, OBGYN, places that do it quite well, and have it integrated into usual care.

But unfortunately, at least half the time or more, women are not screened at all. It’s not talked about. They don’t realize it’s a problem. They’re reluctant to bring it up, and so they suffer unnecessarily which causes poor outcomes for them, their children, and their families.

IRA FLATOW: All right, so let’s say that you get– your doctor does do the screening, now what happens? OK, we’ve determined that, what’s the next step?

DR. SAMANTHA MELTZER-BRODY: Well, I think what’s been interesting in the field and watching it evolve over the last 15 years is that there was such concern about screening for it at all. And we know there are effective treatments for depression. There’s a wide variety of effective treatments for depression, both during the perinatal period and outside the perinatal period. And screening is the first step to identifying who is sick, and then moving towards effective treatment.

If we don’t screen them, we essentially just decide we’re going to turn our head the other way and pretend it’s not there. And we would find that unacceptable for any other organ system in the body. We wouldn’t say, we don’t have a cardiologist around, so let’s just not check someone’s blood pressure, or check for heart disease. And so one of the excuses has been there’s inadequate mental health providers in many places, which is true.

But I think as a society, we have to embrace the fact that mental health is critical to health in general. And that for pregnant and postpartum women, it’s particularly critical because it’s such a profound and vulnerable time. And that screening is the first step to figuring out who is sick and who needs treatment. I hope these new recommendations by the US Services Preventative Task Force will force the issue so that it’s no longer acceptable for us to ignore this for our mothers.

IRA FLATOW: Let me go to the phones, see if I can get a call or two. Let’s go to Dallas. Tina, welcome to Science Friday.

TINA: Yes, thank you. Thank you for having me.

IRA FLATOW: You’re welcome.

TINA: When I had my first child, I went in for a regular appointment afterward. And we went through the regular check up procedure, and then she asked me, so any crying? And I immediately started crying, and said, yes, a lot of crying. I thought that that was kind of normal. And she goes, no, no. A little bit, but not a lot.

And so she gave me a survey and some questions that I answered, and I scored low enough to where she was concerned, or bad enough to where she was concerned. And I went on medication, and the next time I came in, she kind of asked me, so how are you doing? I thanked her profusely, because I didn’t realize how badly I felt until I felt better after having started taking medication.

And I just was so thankful for that question, so any crying? I’m so thankful for that question that whenever I have a friend that has had a child, I always say, so any crying? Because it just is such a simple question, but it really, I think, really changed my life. I don’t know that I would be OK today if I had continued to struggle with depression after my pregnancy. And so I’m just so– and I didn’t know I had it, so I’m just so very thankful for that question.

IRA FLATOW: Well, thank you for your call out. You’re also saying, though, Dr. Meltzer-Brody, that this could happen during the pregnancy, not just after– in her postpartum story.

DR. SAMANTHA MELTZER-BRODY: Absolutely, and I’m so glad that you called in and shared that, because that’s exactly how we hope it will go. So the prevalence of depression for women at any time in their life is at least 10%. There seems to be the highest point prevalence is in the first month after delivery. But women get depressed during pregnancy. Women get depressed postpartum. And it is such a vulnerable time, so when people get sick it can have devastating consequences.

And what we want to have happen is that people are screened throughout pregnancy and postpartum so that they can be identified, and then affective treatments can be offered. One of the lines of research that we’re doing at UNC is that we’re really interested in moving beyond just screening of who’s already sick to moving towards a prevention model. And a lot of our research is focused on genetic and underlying biomarkers.

Ideally, we hope one day to be able to prospectively predict who is at risk of getting sick, and then to intervene before they do. And so while screening is great, moving towards a prevention model one day would be even better.

IRA FLATOW: You know, you’re talking about– she was talking, a caller, about medication after she was– after she had delivered. People are afraid to take anything while they’re pregnant, from alcohol to anything else. Are there safe medications for depression to give pregnant women?

DR. SAMANTHA MELTZER-BRODY: Well, it is always a risk benefit ratio, and so untreated depression has many unfortunate consequences. I would say that treatment during pregnancy is always something that must be carefully considered. You always need to review the severity of symptoms, past history. But there are effective treatments for depression, certainly psychotherapy. There’s many different kinds.

And yes, medications can be used during pregnancy, and women for whom the severity, their history, or other factors dictate that that is the right thing for them. We give antibiotics. We give many other medications for other health conditions, and there are always risks associated with taking a medication. That has to be weighed against the risk of not being treated.

IRA FLATOW: What if you say to your doctor, you know, I’m not feeling well, and I feel depressed. And the doctor says, oh, you’re just pregnant. You’re not feeling good. You’re not sleeping– that sort of stuff. What’s a woman to do then?

DR. SAMANTHA MELTZER-BRODY: Well, unfortunately women are often, for lack of a better expression, blown off or patted on the head historically, and said, now, now, this is just normal. Pregnant women have these concerns, or new mothers have these concerns. And it’s devastating. I just saw someone recently who lives in a different state who was given that information and continued to get sicker and sicker and felt that there was something the matter with her.

So I think that if the task force by– if the recommendations of the task force will make that no longer acceptable behavior, and that I hope it will force all providers caring for pregnant and post-partum women to screen, which will then hopefully force the issue that there have got to be effective treatments offered. And there’s many people doing brilliant research across the world, looking at all different kinds of effective interventions.

We are now at a really exciting time, because of mobile technology and digital tools. We have the ability to reach people and deliver both interventions using digital technology, but also to conduct research in a large scale international way to understand all kinds of things, including understanding the underlying biology or the genetic signature to deliver treatments to people who are living in places for which there is not a local mental health provider. So I think that given the amazing tools we now have, there’s really no excuse for us to not move forward in a really productive way.

IRA FLATOW: Well, let’s hope this new study recommendation does help women move forward and help doctors help them. Thank you very much–

DR. SAMANTHA MELTZER-BRODY: Absolutely.

IRA FLATOW: Thank you very much for taking the time to be with us today, doctor. Samantha Meltzer-Brody is director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill.

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