Health

How New Recommendations on Perinatal Depression Might Change Your Next Prenatal Appointment

It's estimated that up to one in seven pregnant people will experience perinatal depression, depression that develops during pregnancy or after childbirth. Now, a government task force has come up with new recommendations they say can drastically help lower those numbers.

The new recommendations come from the U.S. Preventive Services Task Force (USPSTF).

To formulate the guidelines, published in JAMA this week, a panel reviewed previous research on the benefits and harms of preventative interventions for perinatal depression. The process involved looking at the evidence for how effective a range of potential prevention methods for perinatal depression actually are, including physical activity, education, sleep advice for the baby, yoga, expressive writing, omega-3 fatty acids, and antidepressants. But there was only convincing evidence to show that counseling was significantly beneficial for preventing depression, particularly among those with certain risk factors, such as a history of depression.

The panel cited the combined results of 20 trials, which included data for 4,107 participants, looking at the potential benefits of counseling. About a third of the trials (six out of 20) only looked at people who were already known to be at risk for perinatal depression. Two-thirds of the trials (13 out of 20) excluded people who already met the criteria for major depression, meaning that prevention methods wouldn't do much for them, and another two-thirds of the trials (13 out of 20) only looked at two forms of therapy—cognitive behavioral therapy (CBT) and interpersonal therapy.

Looking at all of the data together, the panel concluded that those who were at-risk and received one of those two forms of counseling were 39 percent less likely to develop perinatal depression than those who didn’t undergo counseling. Ultimately, the recommendations state—with "moderate" certainty—that providers should give pregnant and postpartum people who are at an increased risk for perinatal depression counseling interventions or refer them to those services.

Technically, your doctor should already be screening you for perinatal depression.

The 2016 USPSTF recommendations included that all patients—including pregnant and postpartum people—should be screened for depression. But Task Force member Karina Davidson, Ph.D., a professor of behavioral medicine at the Zucker School of Medicine at Hofstra University/Northwell Health, acknowledges that isn’t always done.

The hope with this new recommendation, she tells SELF, is that doctors will take it more seriously. “It’s going to take a village for everyone to start feeling that this is part of standard prenatal and postpartum care,” she says. “Together we can all work to prevent perinatal depression in women who are at risk.”

And, as mentioned, the new recommendation also means that your doctor should now have a more concrete next step for you, by recommending and helping you access therapy interventions (this specific treatment recommendation was not part of the previous guidelines).

Screening is especially important for those who have certain risk factors.

The new recommendations specifically say that people who meet the following criteria should be considered at risk:

  • You have a personal or family history of depression.
  • You have symptoms of depression.
  • You’re young.
  • You’re a single parent.
  • You have a history of physical or sexual abuse.
  • Your pregnancy was unplanned or is unwanted.
  • You’re going through stressful life events, like a divorce or trauma.
  • You have gestational diabetes.
  • You have pregnancy complications.
  • You don’t have social or financial support.

If you meet these criteria, your doctor should recommend that you consider counseling to help you through your pregnancy and postpartum period, Davidson says. Based on what the recommendation says, that generally means recommending that you pursue CBT (which helps you identify and modify problematic thought patterns or behaviors) or interpersonal therapy (which focuses on your relationships with other people).

But, again, your doctor should be screening you during pregnancy and the postpartum period whether you meet these criteria or not.

Experts applaud the recommendations, but with some caveats.

“It’s fantastic that this is being highlighted because it is such a problem,” Tamar Gur, M.D., a women's health expert and reproductive psychiatrist at The Ohio State University Wexner Medical Center, tells SELF. “Shining a light on the issue is the only way we can hope to eradicate it.” Perinatal depression can be particularly tough because it hits at a time when people are supposed to be happy and excited about a new baby, she points out. Add that to the already present stigma around seeking help for a mental health issue, and it can make grappling with the issue especially challenging.

“The recommendations are wonderful,” Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. “In order to have a good pregnancy and bonding with the baby, a mom needs to be healthy.” Pregnant people and new parents see their ob/gyn a lot during this time, making their providers a good starting place for mental health screening, she says. “It’s important as part of the physician/patient relationship to address mental health as well,” Dr. Greves says.

But while this is a “great recommendation,” it still “needs to be worked on,” Jessica Shepherd, M.D., a minimally invasive gynecologist at Baylor University Medical Center at Dallas, tells SELF. For starters, the USPSTF recommendation even says that “there is no accurate screening tool for identifying women at risk of perinatal depression.” The counseling sessions in the research the panel reviewed ranged from four to 20 sessions that lasted between four and 70 weeks, so there's a lot of variability within that, and it's unlikely that one specific plan will work for everyone. “As a clinician, [that lack of a specific recommendation] can make it difficult to figure out how to make screening effective,” Dr. Shepherd explains.

Even with specific guidelines, people may face many barriers to therapy due to a lack of resources, time, and health care coverage, Dr. Shepherd adds. “The course of how to actually get these patients treated correctly is not really addressed,” she says. Still, Dr. Shepherd says, the recommendations further the conversation around perinatal depression, and that’s always a good thing.

Not every doctor asks about your risk factors, so you may need to advocate for yourself.

Every provider and health care system is different. Some make mental health discussions a priority, while others just don’t bother. If you feel like you’re experiencing symptoms of depression or are concerned that you might experience a change in your mental health after having a baby, it’s important to speak up to your doctor, Davidson says. At the very least, they should be able to refer you to someone who can help.

And, if your doctor isn’t helpful or seems dismissive of your concerns, you may need to seek out counseling on your own, or it may be time to find a new provider. “We have treatments that work,” Dr. Gur says. “You shouldn’t be afraid to ask for help.”

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