This is a relatively small study but I think it underscores the importance of screening for and treating depression during pregnancy. Previous studies have indicated that about 10% to 15% of women experience clinically significant depressive symptoms during pregnancy; however, depression that emerges during pregnancy often goes untreated.
A recent naturalistic study from Turkey followed 78 women diagnosed with depression during the first trimester of pregnancy. All of the patients were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and all were referred to a psychiatric specialist for treatment. Of the 78, 73 were reassessed during the postpartum period.
Only 21 of the 73 women (28.7%) received treatment for their depression during pregnancy. The following treatments were administered: interpersonal psychotherapy (n=5), antidepressant medication (mostly SSRIs, n=14), and therapy plus medication (n=2). In the treated group, no women reported postpartum depression (0%). However, in the untreated group, 92% (n=48) of the women met criteria for a major depressive episode during the postpartum period.
It is disheartening to see that, despite our efforts over the last several decades to increase awareness of perinatal depression, rates of treatment remain low. Of the women referred to a psychiatric specialist, only a third of the women received some kind of treatment. Furthermore, this study clearly demonstrates the continuum between pregnancy and the postpartum period. Depression that emerges during pregnancy tends to persist after the baby is born. Among the women who did not receive treatment, 92% of those women had postpartum depression.
On the positive side, when treatment (either medication or psychotherapy) was delivered during pregnancy, the risk of postpartum depression was dramatically reduced with no women in the treatment group meeting criteria for postpartum depression.
Consistent with other larger studies, this report demonstrates that depression during pregnancy is a robust predictor of postpartum depression. This study also shows us that treatment delivered during pregnancy can have a dramatic effect. But we still need to bridge the gap. While we can effectively screen for depression during pregnancy, we still have a long way to go to make sure those women get adequate treatment.
Ruta Nonacs, MD PhD