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Postpartum Depression: Do All Moms Need Screening?

6 minute read
Catherine Elton

Clarification Appended: July 12, 2009

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.

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.

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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.

(Read “The Risks — and Rewards — of Pills and Pregnancy.”)

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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The original version of this article stated that after Amy Philo’s newborn suffered an accidental choking incident, Philo’s preoccupation with his safety included fear of hurting her baby herself. However, Philo says that particular feeling did not intrude until later, after she began taking antidepressant medication.

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