While pregnancy has traditionally been considered a time of emotional well-being, recent data indicate that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy. Furthermore, women with a history of major depression appear to be at high risk for recurrent illness during pregnancy particularly in the setting of antidepressant discontinuation. In a recent study researchers from the University of Michigan report that while depression affects many women during pregnancy the majority of women suffering from this illness do not receive adequate treatment.

In this study, 1837 pregnant women from several hospital-based obstetrics clinics were surveyed using a standardized questionnaire screening for depression, the Center for Epidemiological Studies-Depression Scale (CES-D). 294 of the women were identified as being at risk of depression. High risk was defined as: (a) having a CES-D score of > 16, a score suggestive a major depression, (b) reporting depressive symptoms with the last six months, or (c) recent use of an antidepressant. 276 women were assessed using the Structured Clinical Interview for DSM-IV to confirm the diagnosis of major depression and the Beck Depression Inventory-II to assess depression severity. Information regarding current and past psychiatric treatment was also collected.

Among the women at high risk for depression, only 20% were receiving some type of depression treatment. About half of the women received a combination of medication and psychotherapy/counseling, 21% took antidepressants alone, and 31% were treated with psychotherapy alone. Only 43% of those taking antidepressant medications received adequate treatment – antidepressant used at the recommended dose for at least six weeks. Among women meeting criteria for major depression at the time of interview, 33% were receiving depression treatment. In this group, only 11% received adequate treatment with an antidepressant. Women were more likely to receive treatment if they had a history of major depression prior to conception, a history of psychiatric treatment or greater depression severity. Having a current episode of depression did not predict use of treatment.

These findings indicate that while depression is relatively common during pregnancy most women at risk for this illness do not receive any type of treatment. Of greater concern is the fact that even when depression is suspected most women do not receive adequate treatment. Low rates of treatment may reflect concerns regarding the use of antidepressants during pregnancy; however, women receiving psychotherapy alone did not receive treatment of adequate intensity. The mean number of sessions received in the preceding three months was two. Most studies demonstrating the efficacy of therapy recommend treatment to occur on a weekly basis during the acute phase. This study underscores the need for effective strategies for the detection of depression during pregnancy but also points to the need for greater efforts to ensure adequate treatment of women at high risk for depression.

Ruta Nonacs, MD PhD

Flynn HA, Blow FC, Marcus SM. Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. General Hospital Psychiatry, Vol, 28, No. 4, July-August 2006, pp 289-29.