Should we screen for prenatal depression?

Q: Researchers in the U.S. have recommended women be screened for depression during pregnancy. How common is prenatal depression? How should it be treated?

We talk a lot about postpartum depression, but U.S. studies have shown that prenatal depression is also quite prevalent, affecting one in 10 women — and not just those with a history of mental health issues. Women grappling with this condition are more likely to smoke and have poor eating habits, and their babies are more likely to have a low birth weight. Also, women who aren’t treated adequately for depression during pregnancy are at high risk for postpartum depression.

Canadian health care providers are increasingly embracing the idea of screening for depression during pregnancy, but it won’t help unless we can also offer a pathway to treatment, and appropriate treatment depends on the severity of the symptoms. Generally speaking, women suffering from mild depression can be helped by support groups and what we call “guided self-help,” such as books and online support. Women with more moderate symptoms should be offered access to a psychotherapist (and in these cases, the best outcomes have been found with cognitive behavioural therapy). For someone suffering from moderate to severe depression, antidepressant medication should also be considered.

What is postpartum depression?

There are plenty of barriers to these treatments — the stigma of mental illness, for instance, or the prohibitive cost of psychotherapy. Among my patients, I have seen significant self-judgment around using medications of any kind during pregnancy, and that is especially true when it comes to mental health. But the consensus in the medical community is that it is critically important to treat the illness, because the impact of untreated depression can be severe, for both the woman and the baby.

Pregnancy can be a wonderful experience for lots of women, but it can also drain your energy, mess with your sleep and change the way you feel physically and emotionally. Some of those changes are par for the course. But if your ability to function is being impacted by the way you’re feeling, then something more may be going on. If low mood is making it hard to work, to parent your other kids or to enjoy the things that usually give you pleasure, and if the quality of your social interactions is suffering, raise it with your health care provider.

With files from Dr. Simone Vigod and the Reproductive Life Stages Program at Women’s College Hospital.

Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto. 

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