Follow Up Support

Depression is easily detected by screening during antenatal and postpartum visits. A study by Katon et al found that a program of collaborative depression care adapted to obstetrics and gynecology setting had a greater impact on depression outcomes than usual care. For screening to be effective, systems must be in place to ensure accurate diagnosis and effective treatment and follow-up for women with positive screening results. If collaborative care is not an option, clinicians should have appropriate mental health referrals available.

Data from the Medicaid Perinatal Care Study indicate that depression is addressed by health care providers for the vast majority of women identified who have symptoms. However, there is a need to improve follow-up. Of the 18% of women identified with depression symptoms at the initial prenatal care visit, 87% were addressed in practice or referred, but only 28% received follow-up care. Of the 21% identified with depression symptoms at the third trimester visit, 100% were addressed in practice or referred, and 42% were followed up. Of the 12% identified during the postpartum visit, 89% were addressed in practice or referred, and 17% were followed up.

Treatment Options

• The two most common forms of treatment for maternal depression are psychotherapy and antidepressant medications. ACOG and the American Psychiatric Association (APA) issued joint recommendations for management of depression during pregnancy in 2009.

Currently, there are no national guidelines specific to the treatment of postpartum depression, and treatment should be tailored to the individual patient based on symptom severity, treatment history and breastfeeding status. Treatment may be provided by a primary care provider and/or a mental health professional. A number of resources including guidelines, toolkits and trainings are available to help clinicians incorporate screening and management of maternal depression within their practices. A review for physicians and other clinicians conducted by Bobo and Yawn has been published.

Various psychotherapy methods have been found to be effective in treating mild to moderate depression. Interpersonal Psychotherapy (IPT), Cognitive Behavioral Therapy (CBT) and psychodynamic therapies have all demonstrated efficacy for postpartum depression. If possible, a combination of medication and psychotherapy is most beneficial. Pharmacotherapy is the treatment of choice in women with moderate to severe depression, particularly in women with a history of depression. Clinical trials have found that SSRIs are e effective with fewer side effects and less sedation for nightly infant feedings than other treatment options. The clinician must be guided by patient preferences, patient treatment history and breastfeeding status. Some antidepressants are found in small amounts in breast milk. A guide to using specific medications during breastfeeding may be found at the National Institutes of Health, Health and Human Services, Drugs and Lactation Database (LactMed). For women who are pregnant or breastfeeding, consultation with a perinatal psychiatrist or clinician knowledgeable about the latest research on the use of psychotropic medications during pregnancy and breastfeeding is warranted. One important caveat to treatment is that 15% of mothers with PPD are misdiagnosed, and later diagnosed with bipolar disorder. Antidepressants must be added cautiously and the patient should be monitored for symptoms of hypomania.

Non-clinical interventions such as rest, exercise, and social support strategies (such as support groups) may also be helpful. Psychoeducation is an important aspect of treatment. Social support for the mother should include communication with the other parent and other family members, as appropriate and consistent with patient confidentiality. Asking the partner to attend one or two therapy sessions can provide psychoeducation and help address problems between the couple, including those resulting from maternal depression. Community organizations such the Postpartum Resource Center of New York provide important education and support for mothers and their partners.

A number of resources – including guidelines, toolkits and trainings – are available to help clinicians incorporate screening and management of maternal depression within their practices.

The Office of Mental Health (OMH) operates psychiatric centers across the state, and regulates, certifies and oversees more than 4,500 programs operated by local governments and nonprofit agencies. These programs include various inpatient and outpatient programs, emergency services, community support, and residential and family care programs.

A directory of OMH-licensed providers by county is available through the OMH Website

The directory is a searchable list of programs licensed or funded by OMH. Users can:

• Search for mental health programs by county or program category
• View program details such as program name, address and phone number
• Click on any county on the map to view all programs in that county

To schedule an appointment for a program in your county, please contact the program directly. For further information or assistance, you may also contact your County Department of Mental Hygiene.

In addition, Non-governmental organizations in New York State provide information, referrals and other resources specific to maternal depression, and may be a useful resource for health care providers and families. The Postpartum Resource Center of New York, Inc. isa nonprofit organization that promotes maternal depression awareness in New York State, and provides resources for parents, families, healthcare providers, and communities to help address mental health and parenting with psychiatric disabilities. The Center also provides services, training and support for women and families dealing with or are at risk for prenatal or postpartum depression.