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Doctors can and should do more to prevent depression among pregnant women and new mothers by targeting them to counseling. This is the recommendation of the US Preventive Services Task Force, an influential panel of clinicians and researchers who makes recommendations for patient care.
"We can prevent this devastating disease and it is time to do it," says clinical psychologist and researcher Carina Davidson, a member of the working group, and helped write the recommendations posted on Tuesday at JAMA.
Surprise is often depression during pregnancy and in the year after birth. It is believed that 1 in 7 pregnant women will suffer from depression during pregnancy or after birth.
The consequences of maternal depression can be severe, according to Davidson, who describes a "cascade of problems", including premature birth, low birth weight and failure. After birth, new mothers who are depressed can be careless and careless of the newborn, putting children at risk for an even greater number of problems.
In 2016, the Working Group recommended screening for depression among all adults, including pregnant women, and if depressive symptoms are found, adults, including pregnant women, are being treated. This year, the Task Force went on to make their recommendation by focusing on perinatal depression – depression before, during and after pregnancy – and recommending evidence-based interventions aimed at preventing it first.
"We actually have evidence now that if you find women who are not currently depressed but are at risk of depression during pregnancy or within one year of giving birth, counseling can help them avoid this illness, says Davidson.
The Task Force examined 50 studies that looked at various treatments, including counseling, physical activity, education, and medications such as antidepressants and omega-3 fatty acids. They found that there is convincing evidence that counseling interventions such as cognitive behavioral therapy and interpersonal therapy are effective in preventing perinatal depression.
In fact, both types of therapy reduce the risk of depression by 39%.
"That's a big deal," says Davidson. In both approaches, risky women received five to eight groups of treatment sessions during pregnancy followed by one to five sessions after the baby was born.
Interpersonal therapy focuses on shifting roles and responsibilities after childbirth, and how to communicate or deal with these changes and stress factors. For example, Davidson says new parents often have delegation problems that will be in the middle of the night or who will care for a baby who has not settled in 15 or 20 minutes. Therapy basically functions as a "rehearsal," she says, so that new mothers can practice what to say and how to deal with a stressful situation to minimize conflicts.
Cognitive behavioral therapy focuses more on individual thoughts, feelings and behaviors and is equally effective in preventing depression, Davidson says.
While Davidson says more research is needed to develop a checklist for doctors and health care providers that specifically examine pregnant women for depression, there are some known factors that put women at greater risk. This includes a previous history of depression or depressive symptoms, a family history of depression or social tensions such as teenage or unwanted pregnancies, low incomes, unemployment and partner violence.
"There are a number of problems that predispose women to depression," she says.
Davidson says the new recommendations are well in line with the 2016 recommendations. If primary care physicians, obstetricians or nurse practitioners examine pregnant depressed patients and find they are at risk, they can determine whether they have training for providing advice, or can refer them to providers who offer this type of behavioral counseling.
In the editorial accompanying the recommendations, Harvard Medical School psychiatrist Marlene P. Freeman writes that providing effective care for pregnant women at risk would require creative decisions. This is a "difficult task," she says, especially since now, the US is not adequately serving women who are currently suffering from mental health problems during pregnancy.
Many women face numerous obstacles to effective treatment, including socio-economic status, health insurance status and geography. As a result, Freeman notes that for many women, receiving effective treatment will be difficult given that clinicians who provide obstetric care have time or expertise to make psychological assessments and focus on adaptation, whether women actually participate in treatment and whether there is some kind of follow-up to determine if treatment is working.
Freeman says that because there is no prescription drug to be used as a checklist for perinatal depression, it may be a "complex task" for the average healthcare provider to determine whether a woman is really at risk.
Future research, she says, could develop easy-to-use screening tools to make suppliers more likely to recognize who should be targeted for preventive treatment. This study may include detecting biomarkers that show stress, inflammation or genetic variables that suggest vulnerability.
Freeman adds that the new recommendations for examining and directing women to counseling promise to improve the lives of many, as about 400,000 women in the United States have perinatal depression. Effective prevention of perinatal depression, Freeman says, may lead to a "trajectory of better lifetime outcomes for both mother and child".