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The Medical Director’s Message
The Family Mental Health Institute is calling
upon the health care system of the United States to effectively
combat the grave epidemic of Perinatal Psychiatric Disorders (PPD).
There will be 800,000 new cases this year. This is the single most
frequent serious complication of pregnancy.
Less than 15% of affected mothers will receive any treatment at all. This is devastating
not only to the affected mother but her newborn or even unborn child,
her spouse and all the other members of her family. The tragedy
is that with good treatment over 90% of these patients will get
completely well.
Conventional efforts at diagnosis and treatment fail. Primary caregivers,
including OB/GYNs, pediatrician, family practitioners, etc., do
not have the time or training to address this problem. Even the
best of them will only identify 40% of cases. In turn, the mothers
are secretive unwilling to reveal what they feel is proof of their
inadequacy as mother, is going to get them labeled as mentally ill,
be incarcerated or lose custody of their children.
Fortunately there is a way around this seemingly insurmountable
roadblock. It is universal screening for depression. The Edinburgh
Postpartum Depression Scale is a free ten item questionnaire that will
detect almost all cases. It does not have false negatives. If it
is identified as a "health questionnaire" rather than
having a psychiatric implication, 998 out of 1,000 women will take
it.
All mothers scoring 12 or above should be considered at risk. This
test result should be on their primary care taker’s chart. They
can either provide treatment themselves or refer the patient to
a mental health specialist.
Two thirds of patients given a standard beginning dose of a modern
antidepressant will get better, with no further treatment. In moderate
cases the same results can be obtained with brief psychotherapy.
Combine the two and over 90% of the patients will get better.
One of the greatest problems with this group of patients is the
reluctance on the part of the caregiver to treat them. The danger
of harm to the fetus or infant from the mother taking the medicine
is based on a completely flawed risk-benefit analysis. A baby is
in much more immediate danger of harm if his or her mother becomes
depressed than the very slight risk of fetal malformation which exists only during the
first three weeks of gestation. In large population studies, sixty
thousand or more, there is no detectable difference in the rate
of fetal malformation no matter what medication is given during
the first three weeks of gestation.
Drug treatment is relatively simple and can be easily taught. A
few principles are all that are necessary to have reliable, safe
and successful outcomes.
Women who have survived PPD make excellent volunteers to help new
mothers. Their most valuable assets are that they are no threat
to the patients and actually understand, profoundly, what the patient
is going through. They are truly empathic. PPD peer support groups
have even been shown to be therapeutic.
The Family Mental Health Institute sounds a call to action to change
the standard of care of all women who are pregnant or new mothers.
We have proven that this works as routine depression, screening and treatment are now the standard of care throughout the United States Navy, the Eastern Shore of Maryland (a rural location) and the inner city of Washington, DC, We have the knowledge and the tools to bring about a major inroad
into this catastrophe of mothers that if untreated, destroys their
lives, their baby’s and their families.
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