Women's health

"I lost it in the post-partum depression"

An early high score for the "baby blues" predicts
who's most likely to need help later

By Elsie Wagner

Should new moms be screened for postnatal depression within the first week after giving birth? Two new studies using the Edinburgh Postnatal Depression Scale (EPDS) say yes. In fact, Dr Cindy-Lee Dennis at the University of Toronto recommends that clinicians should consider testing every woman who's just had a baby.

Postpartum depression, defined by the DSM-IV as a major depressive episode, becomes evident in about 10-15% of women within a few weeks of delivery. The underlying causes of postpartum depression aren't apparent -- theories include a complex of hormonal and other biologic factors, mixed with a slew of probable psychologic dynamics. A history of depression and a difficult birth also come into play. Its negative long-term repercussions have been well documented, with the mother's passive neglect of her newborn being a relatively benign outcome of potential consequences. More common are the "baby blues," a precursor state that strikes over 50% of mothers, characterized by teary low moods usually peaking at days three and four after giving birth.

Although the EPDS is a well-validated diagnostic tool in common use since 1987 (see the EPDS factsheet), researchers have been tinkering with the parameters of its timing: When and how often should the questionnaire be given? At which points along that trajectory do high scores for low mood tell who'll be diagnosed with major depression? Dr Dennis's report, to be published in the February 2004 issue of the Journal of Affective Disorders, took a population-based sample of 594 women and gave them the EPDS at one, four and eight weeks postpartum. Using a cutoff of 9/10, the one-week EPDS score accurately assessed mood in 85.4% mothers at four weeks and 82.5% at eight weeks. Women diagnosed with the "baby blues" were 30.3 times more likely at four weeks -- and 19.1 times more likely at eight weeks -- to experience postpartum depression.

Another study by Drs Teissedre and Chabrol, published in the January 2004 issue of the Canadian Journal of Psychiatry, concurs, finding that there's a strong correlation between initial high "blues" scores and an ongoing, deeper depressive state. The research, conducted in France, had 1,154 women complete the EPDS at two to three days after giving birth, and again four to six weeks later. Results at both times dovetailed: early postpartum scores of 10 and 11 showed good specificity, sensitivity and positive predictive values for the diagnosis of postpartum depression from the four-to-six week EPDS score. The authors recommend that the EPDS "could be used routinely while mothers are still in the maternity ward to identify women at risk for postnatal depression both quickly and cheaply." Moreover, "in Canada, mothers are typically discharged within 48 hours postpartum. Thus, the EPDS should be administered even earlier." The report notes that it didn't account for socioeconomic status, often cited as a variable in calculating who's more likely to experience postpartum depression -- poverty and lack of support being the biggest elements. Still, it's well documented that affluent women are just as susceptible.

Postpartum depression too often goes unrecognized and undertreated, according to Dr Dwenda Gjerdingen, in the December 2003 issue of the Journal of the American Board of Family Practice. Concern about antidepressants showing up in breast milk is a big factor. Evidence shows, however, that treatment with these drugs is effective and safe -- with long-term benefits to mom and baby -- with only fluoxetine contraindicated in breastfeeding. All these latest research results argue that a simple well-timed questionnaire can effectively spot which women are likely to need help, and that treatment for postpartum depression should be offered as soon as possible.