By Emily Ortman, SWHR Director of Communications
The most common, most underdiagnosed, and most undertreated pregnancy-related complication in the United States is perinatal depression — depression that occurs during pregnancy or within the first year after delivery. An estimated 10 to 20 percent of new mothers experience perinatal depression (a more inclusive term than postpartum depression), with half of these women going undiagnosed and untreated.
According to the American Academy of Pediatrics, untreated perinatal depression “can increase the risk for costly complications during birth” and contribute to “long-lasting, and even permanent, consequences for the physical and mental health of parents and children.” For example, maternal stress and depression can negatively affect fetal development, and infants of depressed mothers tend to demonstrate poor behavioral regulation, less explorative play, and lower activity levels.
Symptoms of perinatal depression may include intense feelings of sadness or hopelessness, suicidal ideation, anxiety, and fatigue, preventing mothers from bonding with their baby and taking care of their baby and themselves. Perinatal depression is different from the “baby blues,” a normal, short-lived period of sadness that affects up to 80 percent of new mothers for a few days or weeks after delivery.
Despite the heavy burden of perinatal depression on expecting and new mothers, their babies, and their families, screening for this disease is not a standard practice and there are currently no drugs available that are designed specifically to treat it. With expert groups recommending increased screening and new therapies in development, hopefully, this may soon change.
All pregnant and postpartum women should be screened for depression, according to recommendations from the American College of Obstetricians and Gynecologists , the American Academy of Pediatrics, and the U.S. Preventive Services Task Force. However, this has not yet become a widespread practice among health care providers.
Without proper screening, it falls to women, their family and their friends to recognize the disease and pursue treatment. “A lot of moms are busy with their baby and they don’t seek care for [their depression],” Dr. Bassem Maximos, a board certified obstetrician-gynecologist, said in a recent interview on Doctor Radio. Some mothers are afraid to come forward because of the stigma around depression and fear of being separated from their child, he added.
“Health care providers should be more proactive in questioning new moms about the disease,” Maximos said, noting that most screening involves just a simple series of questions that takes less than 10 minutes. Screening women during pregnancy in order to identify and treat symptoms as soon as they appear is critical, he explained, as about 50 percent of women diagnosed with perinatal depression may have begun experiencing symptoms before delivery. In addition, women with perinatal depression have a twofold increased risk for depression with a subsequent pregnancy, Maximos said.
Treatments in Development
There are no drugs on the market specifically designed and approved for the treatment of perinatal depression. The two main treatment options — antidepressants and cognitive behavioral therapy — do not offer rapid relief from depression’s crippling symptoms. Antidepressants take several weeks before they begin to work, and their success rates vary widely. The trial-and-error process of finding an antidepressant at the right dose that works can be time-consuming and costly, forcing women to spend months suffering at a time when they should be focused on their child. Cognitive behavioral therapy is also effective in treating depression, but requires time for attending routine sessions.
New treatments developed specifically for postpartum depression aim to provide faster relief. Currently in clinical trials, these treatments include a one-time, 60-hour intravenous infusion (likely to require an inpatient clinic stay) that provides symptom relief in a matter of days and a pill form of this same drug that provides relief in a few weeks. Both treatment options have shown promising results from companies Sage Therapeutics and Marinus Pharmaceuticals.
These therapies take a new approach to treating depression by targeting receptors for GABA, a neurotransmitter in the brain that plays a role in mood disorders. Maximos, principal investigator of the Marinus infusion study, said the therapy is “similar to a molecule naturally produced by human body” and called the new approach “promising.”
The implementation of universal screening and the development of innovative treatments explicitly targeting perinatal depression will provide much needed support for new and expecting mothers and their families.