Postpartum Depression: Do All Moms Need Screening?

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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.)

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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.