Postpartum Depression: Do All Moms Need Screening?

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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