For Medical Professionals
Pediatricians, OB/GYN doctors, and Primary Care Physicians, as well as other healthcare providers, are a major point of contact for women suffering from Perinatal Mood and Anxiety Disorders (PMADs). However, mental health is not the primary focus of your practice and it can be difficult to identify mothers who are suffering from a PMAD. Many new mothers show no clear signs of mental illness. Common indicators of PMADs are sadness, anxiety, irritability and insomnia, but mothers may hide signs of distress or their appearance may not differ significantly from other sleep-deprived, stressed new parents.
The Risks of Untreated PMADs
The risks of untreated perinatal mental illness are significant for both the mother and her children. Suicide is now the leading cause of death to mothers in the first year after childbirth, and there are significant developmental impacts on children of untreated maternal depression. For more information, see this article in the American Journal of Clinical Medicine.
Screening for PMADs
The most reliable brief screening tools for PMADs are the Edinburgh Postnatal Depression Screening Scale (EPDS) and the Patient Health Questionnaire (PHQ-9). It is our recommendation that every new mother be screened at 36 weeks gestation, at the two week and six week postpartum office visits, and at three month and six month pediatrician well-baby visits, or at other times when there is a suspicion of a PMAD. Mothers who say they are doing “fine” will generally answer truthfully if given one of these screening tools.
If a significant probability of a PMAD is indicated, a referral to a mental health caregiver is warranted. Treatment with medication may be appropriate as well. The following is an informative article on the safety of psychiatric medications during pregnancy and breastfeeding.
Where to Refer
Postpartum Support International (PSI) is a good resource to give to mothers who are suffering from a PMAD or who are at risk of developing one. PSI provides a warm line to provide support, information and referrals to mothers, as well as their families and caregivers. Mothers can visit the PSI California Resource Page or call the PSI warm line at 1.800.944.4PPD.
Mt. Diablo Perinatal Psychotherapy Associates therapists work with mothers and their families to diagnose and treat mothers with PMADs. You can reach one of our therapists at 925-298-2070 or Contact Us. You can download our reprintable, trifold PMAD Brochure to provide information to your patients about these disorders and how to get help.
Visit this link for more detail on Screening and Treatment Options for Postpartum Depression,
A recent Journal article providing a Concise Review of Research on Postpartum Depression for physicians.