Debate is ongoing about the best way to treat women who are depressed, or have a history of depression, when they are pregnant. Should they continue or start using antidepressants? Was the depression diagnosed early enough? How will the depression affect their babies and the relationships they have with them?
To help make a dent in the mountain of unknowns, a team of Stanford researchers led by obstetric anesthesiologist Alexander Butwick, MBBS, FRCA, decided to take a step back. Treating depression while a woman is pregnant can be challenging, in part because decisions must take into account the well-being of both the mother and the fetus, so it's important to that it be identified, and that care is optimized, before pregnancy, he said.
"Identifying women with depression well in advance of pregnancy allows sufficient lead time to plan care before conception occurs," Butwick told me.
The researchers, including research analyst Nan Guo, PhD; psychiatrist Thalia Robakis, MD, PhD; and undergraduate Claire Miller; examined the prevalence of both major and minor depression in women ages 20 to 44, the pool of potential future mothers.
Their findings appeared in Obstetrics & Gynecology.
In a group of 3,705 nonpregnant women who provided health information to the National Health and Nutrition Examination Survey between 2007 and 2014, about 5 percent had major depression and 5 percent had minor depression, distinctions that were identified using a standardized nine-item questionnaire.
The study also showed that fewer than a third of women with major depression and one-fifth of women with minor depression were taking antidepressants.
When women are diagnosed with depression early enough, clinicians can counsel them and coordinate care before they become pregnant. Early diagnosis also allows for better monitoring and treatment during pregnancy and after their babies are born, Butwick added.
Armed with the knowledge about the prevalence of depression in women, researchers, clinicians and others can work to provide better outcomes for them, regardless of whether they have children.
"What I hope for the future is that we can develop a system of better coordinated care between primary care, psych and women's health," Butwick said. "Using a multidisciplinary approach will ensure that depression treatment is maximized and individualized for each patient, especially if she is planning to conceive and once she gets pregnant."
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