Postpartum Depression
No Woman in Pittsburgh Should be Left Unscreened

Depression was a debilitating mental illness long before celebrities such as Brooke Shields and Marie Osmond began speaking out. Women are at greatest risk for depression between the ages of 25 and 44, the primary age window for pregnancies. Depression during childbearing is a common problem that often is undiagnosed and untreated. In a recent report by the Agency for Healthcare Research and Quality (http://www.ahrq.gov/clinic/epcsums/peridepsum.pdf), 14.5% (one out of seven) women have a new episode of depression during pregnancy, and a similar percentage of women have a new episode in the initial three months after birth. Postpartum depression emotionally exhausts its victims at a time when they are struggling to adjust to the role of motherhood.

What is postpartum depression? Postpartum onset means that the episode begins in the first month after birth, but most investigators use the term for an episode that begins within three months of birth. Many women have mild symptoms during or even prior to pregnancy, which increase after the baby's birth. From a public health standpoint, depression during childbearing is a heavy burden for the woman and her family. In the mental health profession, symptoms of major depression are defined in the Diagnostic and Statistical Manual, 4th Edition (called the DSM-IV), which has been developed by the American Psychiatric Association. As you read the following symptoms, consider that they represent a whole-body physiological problem with regulation of physical functions, not just sadness. This is not the baby blues, which subsides by ten days after birth.

Criteria for a Depressive Episode

Five (or more) of the following symptoms have been present during the same 2-week period (most of the day nearly every day) and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.

• Depressed mood most of the day
• Markedly diminished pleasure in all, or almost all, activities most of the day
• Significant weight loss or weight gain, or decrease or increase in appetite.
• Insomnia or hypersomnia (too much sleep)
• Physical agitation or physical slowness
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without specific plan, or a suicide attempt or a specific plan for committing suicide

Can women be screened for postpartum depression? Yes, and the most commonly used measures to screen for depressive symptoms during childbearing is the Edinburgh Postnatal Depression Scale (EPDS), which was developed in the United Kingdom. It takes about five minutes to answer the ten questions on this questionnaire. An elevated score on a screening questionnaire warrants diagnostic evaluation to confirm depression and consider treatment. Many types of treatment are effective for postpartum depression, such as several types of brief psychotherapy, antidepressant medication, and bright morning light therapy.

Editorial provided by Katherine L. Wisner, M.D., M.S., Director, Women's, Behavioral HealthCARE, Professor of Psychiatry, Obstetrics and Gynecology, Epidemiology and Women's Studies with Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine.

ADDITIONAL RESOURCES
General information on depression in childbearing women:
www.womensbehavioralhealth.org, www.nimh.nih.gov, www.4woman.gov/mh
Light therapy: www.cet.org
Bennett SS, Indman P. Beyond the Blues: Prenatal and Postpartum Depression. A Treatment Manual. Moodswings Press, 2002.