What the Segment About Postpartum Depression Missed

By Joy Burkhard, MBA, Executive Director

It was an honor to share why U.S. women aren’t being diagnosed and treated routinely for postpartum depression on CBS Sunday Morning - the most-watched weekend television show; I am incredibly grateful for the national coverage.

Like so many news interviews, only a fraction of what is shared is actually published. Here are my reflections regarding what the story missed - important insights necessary for progress:

It’s not just postpartum depression (PPD). During the interview, Tracy Smith, the correspondent, asked me, “Postpartum Depression is a misnomer, isn’t it?” I answered yes. There are a range of maternal mental health disorders like anxiety, OCD, and psychosis, for example, and postpartum depression was the first to be researched. I explained that new onset of depression happens almost as frequently in pregnancy as in the postpartum period and is the leading cause of pre-term birth, which can impact children over their lifetimes, is traumatic for families and is a top driver of health care costs. I also shared that untreated depression and anxiety in pregnancy can, of course, spill over into the postpartum period.
It’s more like ‘roughly 1 in 5 women suffer.’ CBS chose to use the count of 1 in 7 from the CDC’s survey of women after birth called the Pregnancy Risk Assessment Monitoring System (PRAMS). The survey asks, “Since your new baby was born, how often have you felt down, depressed, or sad?” If a mother answers “often” or “always,” she is considered as having experienced postpartum depression. However, research points to much higher rates (1 in 5), and we know some women still don’t speak up for a variety of reasons (stigma, cultural nuances, fear of the baby/children being taken away).
It’s time for a diagnostic tool other than a questionnaire like the PHQ-9 to diagnose PPD. We don’t use questionnaires to diagnose other brain disorders like Alzheimer’s and concussions; we use brain scans. As the CBS segment illustrated, brain scans can pick up abnormalities relative to postpartum depression when comparing scans to healthy women. However, more research is still needed to support the use of scans for diagnosis. We are advocating for such precision diagnostics through the new women’s health research initiative established this year through the White House. These more precise diagnostic tools legitimize mental health disorders, provide doctors with much-needed medical diagnostic tools, and *bonus* combat stigma.
Patients won’t pay $16,000 for Zurzuvae. That is the wholesale cost, but that’s not what patients pay. And yes, $16,000 is a lot, but not really...The FDA approved 51 “novel drugs” this year that are the first of their kind. Like any new technology, they are expensive to develop due to high research and development (R&D) budgets. See this list for other FDA-approved novel drugs and notice the price tag. However, insurers negotiate lower rates, and patients just pay a copay or coinsurance/deductible. Uninsured patients can gain access through Sage Therapeutics’ assistance programs. Check out my blog post about what patients are likely to pay with insurance coverage.
If families are falling through the cracks because no one provider is responsible for detecting and developing treatment plans, then which provider should be responsible? The obstetric provider (Ob/Gyns and midwives). As the providers responsible for a mother’s health during pregnancy (and now for all women through 12 months postpartum), it’s critical obstetric providers (Obs) test for these disorders starting before pregnancy or early in pregnancy and throughout pregnancy and the postpartum period. The American College of Obstetricians and Gynecologists and American College of Nurse Midwives recommend their providers screen, and this year ACOG also released treatment guidelines for Ob/Gyns.
Patients can be empowered with tools and insights to support diagnosis and treatment. Though we have named obstetric providers (Obs) as the providers that should be screening and developing treatment plans, not all Obs will routinely screen (this could take years and additional oversight, like patient reporting of providers who don’t screen). In the meantime, patients can take a completed risk assessment and our menu of prevention and treatment options to their Obs to prompt screening and discussion. No copay/payment can be collected by the provider for such an appointment as it is a preventive service per the U.S. Preventive Services Task Force. Patients can also proactively seek mental health counseling (therapy) to prevent maternal depression, and this therapy must also be covered by insurance companies and at no charge to the patients. Patients can take additional steps to prevent/treat these disorders: exercising, expanding social connections, and more.
It’s time to aggressively address the “Child Protective Services” policies that prevent parents from reporting their symptoms. The mother who shared her story so clearly articulated that she worried her baby would be taken away from her if she spoke up. These concerns are real; babies have been taken away from mothers when women speak up. Women of color and those with Medicaid coverage are likely to face higher rates of bias among providers. “Mandatory Reporting” for child protective services is a topic we will address head-on at the annual Maternal Mental Health FORUM this March.
Finally, in the segment, I mention, “Women deserve and need the pill [Zurvuvae], and they also deserve much more support.” The interview was cut for brevity, so what I went on to say was not included: “Like affordable and available infant and child care, paid family leave to heal from birth and care for their babies, child tax credits, and postpartum doulas and night nurses to support sleep, feeding and more, as well as parenting classes and postpartum support groups (promoted by and covered by insurance) as women in particular learn, heal and thrive best in community.

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