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Doctors can and should do more to prevent depression among pregnant women and new mothers by referring them to counseling. It is the recommendation of the US Preventive Services Task Force, an influential panel of clinics and researchers who provide recommendations for patient care.
"We can prevent this devastating disease and it is time we did it," says clinical psychologist and researcher Karina Davidson, who is a member of the working group and helped write the recommendations that were released Tuesday in JAMA.
Depression during pregnancy and years after birth is surprisingly common. It is estimated that 1 in 7 pregnant women will suffer depression during pregnancy or postpartum.
The consequences of maternal depression can be difficult, according to Davidson, describing a "cascade set of problems," including premature birth, low birth weight and failure to thrive. After birth, new mothers who are depressed may be negligent and inattentive to their newborn, which means that the children risk an even greater number of problems.
In 2016, the working group recommended examining depression among all adults, including pregnant women, and if depressive symptoms are detected, the adults, including pregnant women, are treated. This year, the working group has received its recommendation further with a focus on perinatal depression – depression before, during and after pregnancy – and recommends evidence-based efforts to prevent it in the first place.
"We actually have evidence now that if you find women who are currently not depressed but who are at risk of becoming depressed during pregnancy or within one year of birth, behavior can help them prevent this disease," Davidson said. 19659008] The business group reviewed 50 studies that examined a variety of treatments, including counseling, physical activity, education and medication, such as antidepressants and omega-3 fatty acids. They determined that there was convincing evidence that counseling measures such as cognitive behavioral therapy and interpersonal therapy were effective in preventing perinatal depression.
In fact, both types of treatment reduced the risk of depression by 39 percent.
"This is a very big thing," says Davidson. In both approaches, women received at least five to eight group treatments during pregnancy, followed by one to five sessions after delivery of their baby.
Interpersonal therapy focuses on moving roles and responsibilities after having children and how to communicate or manage these changes and stressors. For example, Davidson says that new parents often have problems delegating who is going to get up in the middle of the night or who is to take care of a baby who has not sat down for 15 or 20 minutes. The therapy works mainly as a "rehearsal", she says, for new mothers to really exercise what to say and how to handle a stressful situation to minimize the conflict.
Cognitive behavioral therapy focuses more on individual thoughts, emotions and behaviors and is equally effective in preventing depression, Davidson says.
While Davidson says more research is needed to develop a checklist for doctors and caregivers to accurately show pregnant women for depression, there are some known factors that put women at greater risk. This includes a previous history of depression or depressive symptoms, a family history of depression or social stress such as teenager or unwanted pregnancies, low income, unemployment, and partner violence.
"There are many problems that predispose women to depression," she says.
Davidson says the new recommendations go well with the recommendations from 2016. If primary care professionals, obstetricians or nurses sharpen pregnant patients for depression and find that they are in danger, then they can decide whether they have training to give advice themselves or, They can refer them to suppliers that offer this type of behavioral advice.
In an editorial accompanying the recommendations, the psychiatrist at Harvard Medical School, Marlene P. Freeman, writes that the delivery of effective care for pregnant women will require creative solutions. It is a "daunting task," she says, especially since it is now not the United States serving women who currently have mental health problems during pregnancy.
Many women face many barriers to effective treatment, including socio-economic status, health insurance and geography. As a result, Freeman states that for many women it will be effective recommended treatment, which will be difficult, depending on whether clinics providing obstetric care have the time or skills to perform psychological assessments and tailored references, whether women themselves part of the treatment and if there is any form of follow-up to determine if the treatment worked.
Freeman says that since there is no standard screening tool for doctors to use as a checklist for perinatal depression, it can be a "complex task" for the average caregiver to determine if a woman is really in danger.
Future research, she says, can develop user-friendly screening tools to make it more likely for suppliers to discern who should be referred to preventive treatment. This research may include the discovery of biomarkers that indicate stress, inflammation or genetic variables suggesting vulnerability.
Freeman adds that the new recommendations to show and refer women for counseling are allowed to improve many lives since an estimated 400,000 women in the United States have perinatal depression. Effective prevention of perinatal depression, says Freeman can lead to a "path of better results for the lives of both mother and child".