Jun 9, 2016 5 min read

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Your yearly physical checkup with the family doctor could soon include a routine screening for depression. That’s the new recommendation from a federal government advisory group.

The U.S. Preventative Services Task Force approved new guidelines this year that call for all adults, including pregnant women and new mothers, to be screened for depression.

Mental health advocates applaud the move, but will doctors heed the recommendation, and what happens when a patient exhibits symptoms of depression and requires further treatment or referral?

The National Institute of Mental Health estimates nearly 7 percent of Americans go through a depressive episode each year. The problem is it often goes unrecognized and undiagnosed, especially if patients don’t seek help or confide in their doctors.

We all have our ups and downs, but depression is more than normal blues. Symptoms include persistent sadness or irritability, feeling hopeless, anxious, guilty or helpless, difficulty concentrating, change in sleep patterns and loss of interest in activities you usually enjoy.

Depression also can manifest itself in physical symptoms like headaches or back pain. If you have experienced these most of the day, nearly every day, for at least two weeks, you may be suffering from depression.

The new recommendation specifically includes pregnant and postpartum women, a step that Dr. Rebecca Weinberg, clinical psychologist with Allegheny Health Network Women’s Behavioral Health, believes is a step forward.

“Pregnant and postpartum women are a vulnerable population,” explained Weinberg. “One in seven women will experience some type of depression during pregnancy or the postpartum period. Maternal depression affects more than just the mom and is associated with adverse pregnancy outcomes such as prematurity.”

Licensed marriage and family therapist Brittany Edge knows exactly what it’s like to struggle with depression because she’s been there as a patient.

“Depression and anxiety were not new to me before pregnancy,” explained Edge, owner of Family Matters Center for Relational Therapy in Greensburg. “I had periods of depression in high school and anxiety in graduate school, but nothing could prepare me for what I felt when I was pregnant with my first child.”

While many new mothers don’t experience postpartum depression symptoms until after giving birth, Edge said her struggle began immediately after finding out she was pregnant.

“I would cry for hours at a time, often waking up sobbing,” she said. “I was grieving the loss of who I was because I could remember feeling happy, but it felt like that was gone and this crazy, angry woman who couldn’t handle anything was my new normal.”

Edge said family, friends and even doctors said this was normal, but something inside told her differently. “My first meeting with my midwife, she took two hours to talk to me and validated my feelings,” Edge remembered. “I starting seeing a therapist, too, so once I got help things became more manageable.”

Edge battled another round of depression during her second pregnancy and finally found help attending a workshop on perinatal mood disorders. “These were the mood and anxiety disorders associated with pregnancy and the postpartum period,” she said. “Once I knew what it was, once I connected with the support, and once I heard all the other mothers’ stories, I began to heal.”

Will doctors and hospitals follow the new guidelines? Some have already started. Allegheny Health Network recently launched a pilot program started with a grant from the Alexis Joy D’Achille Foundation for Postpartum Depression, formed in memory of a Pittsburgh woman who took her own life during a battle with the disease.

Now, AHN’s three obstetrics/gynecology practices screen all expectant mothers for depression in the first and third trimesters and after giving birth. If a patient screens positive, Weinberg or a social worker is paged and sees the patient immediately.

“I think the new screening recommendations will help move toward mandated screening of pregnant and postpartum women,” said Weinberg. “We know screening is very good at identifying depression, bipolar disorder and other psychiatric issues. The bigger issue is getting doctors to do it.”

Physician education will play an important role as will access to psychiatric resources and Weinberg stressed there’s a shortage of psychiatric providers that have experience treating pregnant and postpartum women. “Because of this,” said Weinberg, “it’s incredibly important to educate OB/GYNs and pediatricians who have contact with pregnant and postpartum women about how to recognize symptoms of depression and other psychiatric illness and how to connect them to appropriate mental health treatment.”

The task force recommends follow-up be available to accurately diagnose all patients who screen positive for any type of depression. Treatment options include psychotherapies such as cognitive behavioral therapy, a variety of antidepressants or some combination.

A bigger challenge is getting people to talk to their doctors about their symptoms without feeling embarrassed. Edge said she sees this with postpartum cases.

“I think there is still so much shame around the struggles for new mothers,” she said. “I think that many women, like me, do speak up but are dismissed as exaggerating or that the concerns aren’t valid. I think the expectation that it is supposed to be difficult sets us up to feel like a lot of it is normal and shared experience for all mothers so it’s not recognized for what it is until the symptoms are really severe.”

Edge said the best way to treat perinatal mood disorders is through individual, couple and group therapy but admitted there are limited resources in our area.

“There are not many people who have training in working with women during this time,” she added. “There are even less opportunities for support groups.”

Edge is an area coordinator for Postpartum Support International and also recommends www.therapistlocator.com as a resource for anyone seeking treatment for depression.