6 answers to your questions about postpartum depression

Postpartum depression is a condition that has been affecting new mothers for centuries, but there are still a lot of questions surrounding how we diagnose and treat it. Here are answers to some frequently asked questions about postpartum depression so that you can be more confident in your knowledge about the condition, especially if you or a loved one is experiencing it.

Is postpartum depression a prevalent medical condition?

Postpartum depression is a common mental health condition, according to the American Psychiatric Association. Hector Chapa, MD, a board-certified OB-GYN and clinical assistant professor of obstetrics and gynecology at the Texas A&M University College of Medicine, has seen it in his own practice.

“I’ve had women dying on my table from conditions such as postpartum hemorrhage or hypertension, which is horrible in its own right, but maternal suicide takes more women than those two combined,” he said.

This is a medical condition that has both physical and social implications for the new mother and baby alike. Saving the life of a woman by treating this condition impacts the entire family, because when postpartum depression is treated, the mother is able to care for herself, the new baby and others who depend on her.

Who is affected by postpartum depression?

One in seven women is affected by postpartum depression, according to the American College of Obstetrics and Gynecology (ACOG). It is very well documented that there are social factors—such as lower education, lower socioeconomic class, poor social connectivity, lack of support in the home and history of domestic violence—that raise the risk of developing postpartum depression. Postpartum depression has a neurobiological component, but “neurobiology is impacted by multiple factors, including genes, environment, hormones and stress,” said D. Samba Reddy, PhD, RPh, a professor in the department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine.

Social determinants and neuroendocrine factors affect the risk of postpartum depression, but it doesn’t preclude somebody who doesn’t have those risk factors from developing this condition. Anyone can be impacted by postpartum depression—this is an equal opportunity illness.

How is postpartum depression diagnosed?

The American College of Obstetrics and Gynecology recommends that physicians screen their patients for depression at least once during the postpartum period. Postpartum depression is diagnosed using a validated screening tool that asks questions about the patient’s physical, mental and social health and safety.

“Here in Bryan-College Station, where I practice, we’ve incorporated a baseline perinatal depression screening into maternity care as part of the discharge instructions, and new mothers can’t walk out of the hospital without it,” Chapa said. “Now, we know that it’s not always accurate—it’s a snapshot in time, especially since they’re fatigued and just delivered a child. Even if that score is normal, it doesn’t mean that they won’t develop postpartum depression later. However, if they score within an at-risk range, they’re immediately put in contact with a case manager, a social worker or somebody from mental health just to get them connected.”

How is postpartum depression treated?

Postpartum depression is a complex medical condition that requires an equally complex treatment plan including medication, counseling and clinical care.

There is a drug called brexanolone that has been approved by the Food and Drug Administration (FDA) to treat postpartum depression, but it has yet to be adopted into standard practice of care. Chapa said there are three major criteria for a medication to be incorporated into the treatment plan of a condition: awareness, familiarity/ease of use of medication and affordability. Brexanolone needs to become more accessible and affordable, as the treatment currently requires an in-patient 60-hour continuous intravenous (IV) drip and is expensive for both the patient and the hospital. Reddy and his team are working on addressing some of these concerns by developing oral pills so patients don’t have to stay in the hospital for three days for treatment. They envisage developing a rapidly acting antidepressant for alleviating the symptoms of postpartum depression within few hours or days of taking the medication.

Medication is one tool in the treatment of postpartum depression, but Chapa said that medication can only be effective in treatment of postpartum depression in conjunction with other approaches such as “counseling and cognitive behavioral therapy. It’s rethinking your thought process, because what we are now finding out is that a lot of postpartum depression isn’t even depression—it’s posttraumatic stress disorder, or PTSD, especially after things like failed epidural pain treatment, a death, a stillbirth or postpartum hemorrhage. We know that all of these issues raise the risk for depression and PTSD.”

Is postpartum depression treatment covered by Medicaid?

ACOG coined the term “fourth trimester,” which describes the 12-week period immediately after giving birth that is a time of great physical and emotional change for the new mother and baby. Postpartum depression is covered by Medicaid, and up until recently, OB-GYN care was only covered for up to eight weeks. A Texas law that took effect in September 2021 extends access to postpartum care for Texan women covered by Medicaid from two months to six months.

However, this six-month timeline is not the complete solution for improving access to postpartum depression care. According to the Mayo Clinic, symptoms typically develop within the first few weeks after giving birth, but they can begin up to a year after birth. “To think that we’re done, and for us to get comfortable thinking that we’ve arrived at the solution is a great disservice,” Chapa said.

What can I do if my loved one is dealing with postpartum depression?

New mothers are generally not in the hospital for very long after childbirth, and during the few days they are there, they may or may not show symptoms of postpartum depression. It’s normal to experience some mood swings and difficulty adjusting to new life circumstances, but if the new mother starts showing signs of depression, insomnia or difficulty bonding with the baby, it is important to have a conversation with the new mother and encourage her to seek a follow-up visit with her OB-GYN.

“Oftentimes, the follow-up visit is to a pediatrician for the baby, not back to the gynecologist,” Reddy said, “so if the mother is showing symptoms of postpartum depression, a follow-up with the gynecologist is essential. There is a treatment available that can help, and new moms are encouraged to seek if needed.”

It is also critical to alleviate any stigma the new mother may be experiencing in regards to her symptoms, because it can be really difficult for new moms to ask for help. They may fear that if they admit they are dealing with postpartum depression, their social circle will think they are not a good parent. There are also many cultures in which postpartum depression is seen as a weakness, so the best way to help new moms dealing with this condition is to let them know that it is okay to ask for help and direct them to a health care provider for treatment.

Article written by Sunitha Konatham