New protocol to tackle postpartum depression

Up to 80 percent of women experience depressive symptoms postpartum, with one in eight reporting the emergence of major depression within weeks of delivery. Caused by multiple factors, including stress and hormone changes in the body, postpartum depression ranges from a minor presentation, known as postpartum blues, to major depression and in rare circumstances, the most severe form, postpartum psychosis. To better identify and address postpartum depression, Prentice Women's Hospital has implemented a new protocol to standardize screening and education of depression for patients and their families.

"Postpartum depression is under-recognized and under-treated," says Jacqueline Gollan, PhD, clinical psychologist at Northwestern Memorial Hospital and the Northwestern Medical Faculty Foundation Women's Behavioral Health Services Program. "By establishing a clinical protocol to screen all obstetric patients for depression, we can better detect the emergence of mood disorders, offer treatment and improve the clinical outcomes of these patients."

Experts from the Department of Obstetrics and Gynecology and Department of Psychiatry and Behavioral Sciences developed a partnership to spearhead this effort, which included the adoption of a reliable patient health questionnaire to be used by all physicians who provide pre and postnatal care at Prentice. The group also provided extensive staff education to address how and when to screen women for mental health disorders during prenatal and postnatal care, and how to interpret and follow up on the screening results. As part of the new evidenced based, standardized protocol, expectant mothers are screened for depressive symptoms at the first prenatal visit, again in the third trimester (28-32 weeks), and again at the postnatal visit (6-8 weeks after childbirth) using the patient health questionnaire.

"For many, pregnancy and childbirth is a wonderful time full of joy, however it is also a time when our bodies change rapidly, hormones rage and emotions run high," says Ann Borders, MD, maternal fetal medicine specialist at Northwestern Memorial's Prentice Women's Hospital. "It's important for women to know that postpartum depression is not something they can control and it's not their fault. It is however something that can be addressed. Through better communication, we can help more women receive the treatment they need, as well as educate others to break down societal stigmas and improve patient care," adds Borders.

Postpartum depression can manifest in several ways and can range in severity. The most common form is known as postpartum blues, a mild and temporary condition that affects up to 80 percent of new mothers. Postpartum blues typically strike soon after pregnancy, peaking around day five and normally resolve on their own within ten days of delivery. Symptoms include tearfulness, irritability, loss of appetite, feelings of anxiety or being overwhelmed, low energy and insomnia. All too often, women succumb to depression without realizing that they are struggling with a medical condition.

Postpartum depression, characterized as major depression that typically occurs within four weeks of delivery, however can present months later and affects an estimated one out of every eight new mothers (12-15 percent of women). While major depression can strike anyone, studies show a higher level of occurrence among mothers who are young, have a low-socioeconomic status or lack social support. Women with a previous history of mood disorders are also at greater risk for postpartum depression - as high as a 25 to 40 percent chance. Symptoms can include depressed mood, lack of interest in pleasure or activities, physical agitation, fatigue, feelings of worthlessness or inappropriate guilt and decreased concentration or ability to make decisions.

The most severe, and also most rare, perinatal mental health disorder is known as postpartum psychosis. Symptoms typically occur within two weeks of childbirth and can include hallucinations or delusions, confusion, poor judgment and impulsiveness. There are high rates of suicide and infanticide associated with postpartum psychosis. Women who suffer from bipolar disorder are at increased risk.

"Treating postpartum depression requires a careful diagnosis, which starts with clear communication between patient and doctor," says Gollan. Use of the patient health questionnaire in regular pre and postnatal care will help doctors identify patients experiencing some form of postpartum depression. We also hope it will help women who experience symptoms understand the prevalence of postpartum depression so they can realize they are not alone and acknowledging their feelings in order to receive treatment."

When left untreated, depression can lead to obstetric complications such as premature birth and low birth weight. In addition, postpartum concerns can also occur, including disturbed mother-infant bonding, failure to thrive and infant irritability.

"There is a serious need for more emphasis and education surrounding postpartum depression," says Borders. "We believe the implementation of these tools will help address this matter and enhance care for both mother and baby."

Women who experience symptoms associated with postpartum depression should talk with their doctor and be proactive about their health and the health of their baby. Prentice Women's Hospital offers a full range of services to help, including comprehensive behavioral evaluations, one-on-one counseling, support groups for new moms and a full health information library that is open to the public. For more information or to schedule an appointment, patients can call 312-926-8400. For more information, visit www.nmh.org/prentice.