Show 49: Postpartum Mood Disorders

Reply from Margi Clifford to Anders:

"Yeah Anders! Thank you! One of the most effective ways to prevent the suffering caused by PPD is to identify women at risk as early as we can. Research tells us that the earlier that these women engage in treatment, the more quickly they will recover and the less likely that their children will suffer negative consequences. Fortunately, most women interact with healthcare providers more often during this time in their life than any other.

Unfortunately, there is also a shift in clinical focus postpartum from care for the mother to care for the baby. Because of this gap many women are not screened and are not referred for appropriate follow-up care.

Because of the importance of early detection and the effectiveness of treatment, we now screen every woman admitted to our Maternity Center at Providence for depression and anxiety. Based on this screening families may be offered education or a meeting with a hospital social worker or psychiatrist. Even if you don’t have in-house psych resources you can still provide acknowledgement and education and can refer families for counseling, group support and, if necessary, medication management.

There are a multitude of screening tools that providers can use. The gold standard is the Edinburgh Postnatal Depression Index (which you can find on-line at www.mededppd.org). At Providence we use the Patient Health Questionnaire-4 which is an abbreviated version of this scale. There is also a PHQ-9, a PHQ-2 and a number of others that may meet the unique needs of providers in different settings.

It is our hope that PCPs (including pediatricians) routinely screen their patients (and primary caregivers) for depression and anxiety, especially during the perinatal period. And, that legislators recognize the importance and the benefit of such screening and make moves to support providers who provide them. Specifically, we would like providers to receive reimbursement for screening.

Any of you out there who have contacts and/or influence in the policy arena, and in primary care settings, please help to advocate for universal screening. As part of our outreach and advocacy efforts I may be available to help you choose and implement the use of an appropriate screening tool. Contact Margi at: Margaret.clifford - at - providence.org"

Comment via email from M:

"As a new mother, a goal of mine was breastfeeding. I was determined to get breastfeeding off to a good start. I was sort of obsessed with this goal for the first 2 months after my son was born. I luckily did not have a post-partum mood disorder, but I'm wondering how taking anti-depressants or sleeping medications would affect ability to breastfeed. I know I was terrified of anything interfering with that goal. Thank you!"

Comment via email from Anders:

I spent a great deal of time over the last 10 years trying to help primary care providers provide screening. PCP's are often a first line of defense and their involvement is important.

Also, there are numerous benefits for getting treatment, not least of which is much better health outcomes for children. For this reason some places, like Illinois, will provide PPD screening as part of the child's Well Baby visits.

I would love to hear your guests' thoughts on screening, and public policy or other solutions that could help increase treatment for this important disorder.

~Anders

Co-Founder, AuroraMD