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In January, the U.S. Preventive Services Task Force (USPSTF) released an important update to their depression screening recommendations. As an obstetrician, I was particularly pleased that the recommendations now include screening pregnant women or those who have recently given birth, because 10% of these women suffer from depression.
How new moms can benefit from enhanced depression screening
The prior recommendations did not include pregnant and postpartum women. The USPSTF also found that treatment with a type of talk therapy called cognitive behavioral therapy alone, without the use of antidepressants, benefits pregnant and postpartum women with depression. While some pregnant women will need medication for serious depression, there are rare but serious risks to the fetus if the mother takes antidepressants, so it is not a decision that women or their obstetricians should make lightly.
And there are other good reasons to avoid antidepressants with pregnant and postpartum women. According to Alice Domar, a psychologist in my department and author of the soon-to-be-released Finding Calm for the Expectant Mom,
“Screening pregnant and postpartum women for depressive symptoms is a wonderful way to improve care and a terrific example of integrative medicine. However, I am concerned that this may be interpreted as an effort to get more young women on medication. Yes, there are some young women who need to be on medication in order to be safe and live a normal quality of life. However, counseling, specifically cognitive behavioral therapy (CBT), has been shown to be as effective in treating depression as medication and has no risks. There are other effective approaches, including exercise, social support, and more partner involvement. We do need to screen pregnant women for depressive symptoms, but all options to treat depression need to be presented and discussed.”
Guideline updates hold benefits for everyone else, too
There are other important elements of the new recommendations. The Task Force now recommends regular depression screening for all adults, a change from the last time it updated its depression screening guidelines (in 2009). In the previous version of the recommendations, screening for depression was recommended only in clinics or by doctors who already had adequate support systems to provide mental health care for anyone the screening identified as having depression. Since that time, multiple studies have found that mental health care in primary care settings works very well, and probably just as well as treatment by a psychiatrist. Psychiatric care is still important for many people, particularly those with severe depression. But those with mild to moderate depression might do just as well receiving treatment through their primary care doctors.
In fact, one size does not fit all when it comes to mental health, and tailoring care to each person’s preferences with regard to how and where to receive mental health care actually improves depression treatment. While some people might prefer a psychiatrist, for example, others would rather get this kind of care from their primary care doctor or a trained nurse specialist. Similarly, some people might prefer counseling and other behavioral therapies, while for others, medication may be the right answer.
Another important benefit from the USPSTF’s strong recommendation is that the Affordable Care Act specifies its recommendations be covered by health insurance. As a physician, one of the most vexing problems I’ve had with the health care system is access to affordable mental health services for my patients. Because mental health care is poorly reimbursed, many mental health providers don’t accept health insurance and instead only accept payment directly from patients. This greatly limits the pool of available health care providers for those who can’t afford standard fees. It is my hope that this recommendation may provide greater access to mental health services, especially for those who can’t currently afford it.