New York – Should All Mothers Be Screened for Postpartum Depression?

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    New York – A month after Melanie Blocker-Stokes gave birth, she stopped eating and sleeping. She had convinced herself that she was a terrible mother, and she was paranoid that the neighbors thought so too. Over two months, Blocker-Stokes was repeatedly hospitalized for postpartum psychosis; prescribed a cocktail of antipsychotic, antianxiety and antidepressant drugs; and treated with electroconvulsive therapy. Despite her family’s efforts to help, Blocker-Stokes leaped to her death from the 12th story of a Chicago hotel in 2001, when her daughter was 3½ months old.

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    Now the Melanie Blocker-Stokes Postpartum Depression Research and Care Act, familiarly known as the Mothers Act, has passed the House and is headed for the Senate. If it becomes law, it will mandate the funding of research, education and public-service announcements about postpartum depression (PPD) along with services for women who have it.

    The legislation has sparked surprisingly heated debate, dividing psychologists and spurring a war of petition drives aimed at either bolstering the bill or blocking its passage. “I just can’t understand it,” says Carol Blocker, Blocker-Stokes’ mother. “It breaks my heart that women would be against a bill that would help mothers.”

    But not everyone agrees that the Mothers Act is destined to help. At the root of the dissent is the issue of screening: Does PPD screening identify cases of real depression or simply contribute to the potentially dangerous medicalization of motherhood?

    Although the current version of the Mothers Act does not specifically include funding for PPD testing, an earlier one did (it was based on a New Jersey law that mandates universal PPD screening), and critics say the new act will naturally lead to greater use of screening if it passes. Opponents of the bill contend that mental-health screens are notoriously prone to giving false positives — research suggests that as few as one-third of women flagged by a PPD screen actually have the condition — and say testing is a gambit by pharmaceutical companies to sell more drugs.

    But clinicians and researchers say screening is intended not as a diagnostic tool but as a way to identify patients who need further evaluation. Studies suggest that PPD affects as many as 1 out of 7 mothers and that failing to treat it exposes women and their babies to unwarranted risk. “Postpartum depression is not a benign, uncommon thing. We screen all infants for [the genetic disorder] phenylketonuria, which is extremely rare. Why don’t we screen women for this?” asks University of Pittsburgh Medical Center psychiatrist Katherine Wisner.

    Why? Because increased screening could lead to an increase in mothers being prescribed psychiatric medication unnecessarily. That concern lies close to the heart of Amy Philo, 31, of Texas, who has become a leader of the anti-Mothers Act movement. In 2004, shortly after her first son was born, he choked on his vomit and needed emergency treatment. Her son recovered, but after the incident, Philo became preoccupied with his safety and felt severe anxiety about protecting him — a common symptom of PPD. “After a one-minute conversation with my doctor, he gave me Zoloft and said it would make me and my baby happy,” she recalls. But Philo says she started having suicidal and homicidal thoughts, which got stronger when another doctor raised her dosage. Eventually, Philo says, she weaned herself off the drug, and her violent feelings disappeared. (Zoloft, like other antidepressant drugs in its class, carries a black-box warning that it can increase suicidal ideation in patients ages 24 and under but not in adults of Philo’s age.)

    Some psychologists argue that universal PPD screening misses the point because the greatest risk factor for postpartum depression is not giving birth, in fact, but previous depression. Women develop depression at the same rate whether or not they have given birth, according to Stony Brook University psychology professor Marci Lobel. “Women who have been healthy all their lives, who haven’t suffered lots of anxiety and depressive symptoms, are unlikely to have problems in the postpartum period — not even close to likely,” says Michael O’Hara, a University of Iowa professor of psychology. Further, say experts, while pregnancy hormones may impact a small subgroup of vulnerable women, they have little to do with PPD in most cases. In a study published in the American Journal of Psychiatry in 2000, researchers used drugs to mimic the postpartum decline of pregnancy hormones in 16 women, eight with histories of PPD and eight without. Five of the eight women who had previously experienced PPD developed mood symptoms. But none of the women who had never been depressed postpartum were affected.

    Still, there’s no denying that the postpartum period is a difficult one for many women. Some new mothers contend with clinical depression, but many more experience the normal feelings of “baby blues,” the short-lived postpartum sadness that affects at least half of all mothers. “[We] should be addressing the social factors causing women to be upset after they give birth, not locating the problem within the women,” says Paula Caplan, a clinical and research psychologist.

    On either side of the screening debate, experts agree that mothers need help, says Ingrid Johnston-Robledo, director of women’s studies at the State University of New York at Fredonia. She adds that opposing arguments over PPD screening need not be mutually exclusive. “The problem with women’s reproductive-health issues is that they tend to be ignored or exaggerated,” she says. “We need to find a way to come down in the middle: acknowledge women’s depression but not assume that all women who struggle with the transition to motherhood are depressed.” Ensuring the proper support of mothers, however — whether that means treating depression or caring for women in their new roles — would require an effort much more ambitious than a single law.


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    16 Comments
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    davetherave
    davetherave
    14 years ago

    yes- plain and simple. Its easier to resolve and will keep more shalom bayis if you catch it right away

    Anonymous
    Anonymous
    14 years ago

    its a desiese like most others . so why not?

    anonymous
    anonymous
    14 years ago

    Yes, in some mothers it maybe latent , the mother may be able to suppress it and not be fully functional. The question which I have who will do,the evaluation . A psychiatric nurse or a fully trained psychiatrist. The most important fact is that a young mother preferably has her mother or a good friend in whom the can confine

    Anonymous
    Anonymous
    14 years ago

    There’s a jewish organization that does exceptional work with women dealing with PPD they r based in boro park but they help any one!!!! They are caleed sparks the # to reach them is 718 2-sparks! Great great organization!!!!

    Postpartum Depression Survivor
    Postpartum Depression Survivor
    14 years ago

    As a woman who has suffered from PPD with 2 of my children, I can personally tell you of an incredible organization in the Jewish community that deals specifically with Postpartum Depression (in men and women) as well as any other woman-related issue. This organization called SPARKS treats all who seek their help with the utmost dignity, respect and expertise. Visit their website at http://www.sparkscenter.org, you’ll be happy you did

    Anonymous
    Anonymous
    14 years ago

    First, there’s a wonderful organization in Israel called Nitza that deals with post partum. Also, if a big indicator for PPD is previous depression, then why not screen those women to see if they are at risk for suffering from PPD? That way you don’t open up the possiblity of treating someone for something that will pass.

    ali
    ali
    14 years ago

    Heeelp my wife is making me crazy.. seriously I think she needs help however she will never ever let me get any for her.. so I just suffer through it.. hoping it will get better..

    Elisheva
    Elisheva
    14 years ago

    I have had a few conversations with Mrs. Blocker, and she is doing good work.
    Above someone complained about what is called the large proportion of false positives in the screening. This is an instrumentation issue. First, if you are screening, and not assessing, you want to make a wide sweep, and err by including more people, so you do not leave out people who do need assessment. That is why it is called “screening”.
    One needs to know how many women with PPD are NOT picked up to really review the situation.
    Try comparing it to learning disabilities. But here, if you don’t screen them in, it could cost them their life, G-d forbid.
    Perhaps there is a need for a more precise screening instrument. This could be done, or might exist and not be used.
    My experience in the Jewish community is that ignorance about mental health issues, and especially about medications, is a raging virus.
    Carol is trying to raise awareness, and she has done a good job.

    Anonymous
    Anonymous
    14 years ago

    never knew how serious it is. I know now. I have 2 kids & don’t want anymore cuz of what I go through as a ‘kimpeturen’

    Anonymous
    Anonymous
    14 years ago

    The best way to avoid PPD is LOTS AND LOTS OF SUPPORT. Help with the kids, help with the baby, help with cleaning, cooking, moral support, emotional support – all of those go a long way to avoiding post-partum depression.

    Also, if you’ve had PPD in the past and you’re worried about getting it again, taking capsules made from your placenta is a risk-free option that helps many people considerably.

    Anonymous
    Anonymous
    14 years ago

    When exactly will the screening take place? PPD usually emerges 2-4 months after birth