About 15 percent of women experience depression sometime before, during or after pregnancy, researchers from the Kaiser Permanente Center for Health Research report. They urge doctors to more closely monitor pregnant patients with a history of the condition.

Kaiser’s study of 4,398 women in western Oregon and Washington state found that about 54 percent of those who experienced postpartum depression also had a depression diagnosis either during or before pregnancy. The study looked at women over the 39 weeks before they became pregnant through the 39 weeks following delivery. Its findings are reported in The American Journal of Psychiatry.

The finding confirms those of other researchers studying depression in women of childbearing age. The prevalence of depression highlights the need for doctors to screen patients for the condition both during pregnancy and postpartum, said Evelyn Whitlock, a doctor and one of the study’s authors, and to treat depression as a chronic condition rather than a temporary one triggered or relieved by getting pregnant or giving birth.

“The message would be to be candid with your physician when you’re not feeling well, rather than being the heroic supermom,” Whitlock said.

About 13.2 percent of all people experience depression during their lifetime, Whitlock said. In general, women are two to three times more likely than men to experience depression.

In some ways, women with a history of depression may be more apt to notice its symptoms postpartum. That was the case for Chelsea Beck of Portland, Ore., who delivered a healthy baby girl three months ago. Newborn Emily lay calmly in her hospital bassinet, but her mother’s overwhelming doubt already had worn a deep groove in her brain.

“Oh my God. I have this life to take care of,” Beck remembers thinking. “I just got her out of the bassinet and into bed and cried and cried. I’m the mom, the person who’s supposed to feel so excited and joyful, and that excitement just wasn’t there.”

Because she’d lived with depression for seven years, Beck immediately sought help.

Jillian Romm, director for mental health for Oregon Health & Science University’s Center for Women’s Health, said pregnancy once was viewed as something that prevented depression. Doctors now know that’s not the case. But not all doctors routinely screen pregnant women and new mothers for depression.

Symptoms of postpartum depression include feeling withdrawn or isolated; having difficulty sleeping; having uncomfortable thoughts about the baby; a loss of concentration, interest or pleasure; and feelings of shame, worthlessness or guilt.

“All women need to be screened during pregnancy,” Romm said. “Women who are treated for depression during their lifetime need to have a conversation with their caregiver about how their pregnancy and depression will be managed. All women who we know are vulnerable for postpartum depression should be screened soon after delivery, within the first month and again within the next couple of months.”

Among the most important issues to discuss is whether the mother will take antidepressants during her pregnancy. Whitlock cited a 2006 study that concluded 68 percent of women who stopped taking antidepressants during pregnancy had a relapse of depression, compared with 26 percent of women who continued taking their medication.

Doctors and patients need to weigh the health of the mother and the health and development of the baby. Antidepressants’ long-term risks to the fetus are not known. Some medications might be safe to take during one phase of pregnancy and less so during another phase.

Beck decided to cut her dose of antidepressant in half during pregnancy and then quickly increased it after Emily’s birth. She also talked a handful of times to a social worker and felt her confidence as a mother grow as she mastered the routines of feeding and caring for Emily. Her depression lifted after about a month.

Romm said the lack of depression screening may stem from doctors’ discomfort with the condition and society’s “fantasy that pregnancy and motherhood is just good and wonderful, and we should feel wonderful about it.”

“Women are uncomfortable having these feelings and don’t report them,” Romm said. “The women collude with their doctors, and they suffer in silence.”


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