Depression screening should include all pregnant, postpartum women
By Dennis Thompson
(HealthDay News) -- All U.S. adults, including pregnant and postpartum women, should be screened for depression by their family doctor, the nation's leading preventive medicine panel recommends.
Further, doctors need to follow through and get treatment for anyone who tests positive for depression, the U.S. Preventive Services Task Force concluded in an update of its depression screening guidelines.
This is the first time the panel has specifically advocated depression screening in pregnancy and shortly after giving birth. It cited a U.S. study that found that 9 percent of pregnant women and more than 10 percent of postpartum women exhibited signs of major depression.
Depression can harm both the child and mother, interfering with their interactions and affecting social relationships and school performance, the panel noted. Risk factors during pregnancy and after delivery include poor self-esteem, child-care stress, prenatal anxiety and decreased social support, the report said.
The new report -- published Jan. 26 in the Journal of the American Medical Association -- updates a similar recommendation the panel issued in 2009 that called for routine screening of adults.
In general, primary care physicians should be able to treat most cases of uncomplicated depression, and refer more complex cases to a psychiatrist, said Dr. Michael Pignone, a member of the task force and director of the University of North Carolina's Institute for Healthcare Quality Improvement.
"That's part of our job," Pignone said.
Options for treatment include therapy with a psychologist or licensed clinical social worker or antidepressant medications.
The task force is an independent, volunteer panel of national experts in preventive medicine. It issues recommendations, and revisits them on a regular basis to make sure that medical evidence still supports the guidelines.
Depression is among the leading causes of disability in persons 15 years and older, the panel noted.
Millions of adults suffer from depression and don't know it, said Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.
At any given time, between 5 percent and 10 percent of U.S. adults suffer from a depressive disorder, but half receive no treatment for their depression, Thase said.
The task force's depression guidelines are aimed at detecting and helping those adults who unknowingly have depression, Pignone said.
"This is about screening, not about diagnosing people who come to a doctor's office saying, 'I feel depressed.' The potential value of screening is in those people who would not be found as part of regular clinical care," he said.
Some people may not want to acknowledge they are depressed because there is a stigma around mental illness, Pignone said. Others might just think they are feeling blue, and will get over it.
"In some people, their symptoms may seem more physical to them," he added. For example, depression might cause stomach pain, headaches or sleeping problems.
The task force did not recommend any particular questionnaire for depression screening, because "there are many good tools and there's no single tool that should be recommended above others," Pignone said.
The most common screening tool, the Patient Health Questionnaire, consists of 10 simple questions that can be answered in minutes, according to the U.S. Department of Health and Human Services.
The task force also could not recommend how regularly people should be screened, because not enough research has been done in that area, Pignone said.
"The task force recommendation is that people should be screened at least once," he said. "For the meantime, clinicians should use their judgment about the risk of depression in their patients, in deciding how often to screen."
However, the task force did emphasize the need to follow up a positive screening with treatment.
Dr. Michelle Riba, a former president of the American Psychiatric Association, agreed that primary care doctors should be able to treat most patients with depression.
However, Riba added that doctors should develop a relationship with a psychiatrist they can consult on cases of depression. The psychiatrist could talk with the practitioner on the phone, review patient charts, and help decide the best course of action.
Doctors also should be open to other forms of treatment for depression, such as cognitive-behavioral therapy or light therapy, said Elizabeth Saenger, a psychologist in private practice in New York City.
Light therapy affects the body's production of the hormone serotonin, and studies have shown it can help alleviate depression symptoms, Saenger said.
It makes sense for primary care doctors to lead the way on depression screening because they see patients most often, said Dr. Alan Manevitz, a psychiatrist with Lenox Hill Hospital in New York City.
Treating depression can help patients face other health problems with which they are struggling. "As depression gets worse, so many other chronic illnesses also get worse," Manevitz said. "People don't take care of their health as well when they are depressed."
For more on depression, visit the U.S. National Institutes of Health.
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