Psychotherapy Treatment for Postpartum Depression

I am an obstetrician practicing in China and I am interested in mental health care for reproductive aged woman, especially care of postpartum depression. In China, postpartum depression is poorly recognized and treated currently. I am sad to find quite a lot of women could not cope with the life after delivery and most of them and their relatives could not understand and tried to hide the fact of depression and anxiety.

It was due to social reasons and limits in well acceptation of such disease and such disease was simply thought to be a kind of psychological disease. Woman and their relatives were afraid of to be thought as a “strange” person by the others. Meanwhile, poor support from the communities or other resources worsened this condition. High divorce rate, especially in women after delivery and this has been noted along with poor treatment or recognition of such disease is part of the reason. What I learnt from RCOG and ACOG guidelines has introduced me to this field and further study from this Open College UK Ltd course enriched me with the skills in psychotherapy.

Actually, postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Estimates of prevalence of PPD with most studies suggested the rate between 10%–15%. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development.

The first task for me to do is to spread out the importance of screening of PPD. Screening for depression in the prenatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. Unfortunately, most of the hospitals or obstetric clinics in China are lacking of such screening settings. I want to set up the screening system in the clinic and hope I can detect more women who need help earlier. It will be the first step to move on for the better mental health care of post-partum women.

Edinburgh Postpartum Depression Scale (EPDS) would be the screening tool. I have read thought the article-prenatal depression screening: tools for obstetrician-gynecologists, published by American College of Obstetricians and Gynecologists. It has taught me in detail the steps and counseling skills on prenatal depression. I will use techniques taught in my current course, combined with these steps in my practice of consultation.

After recognition of women who are in high risk of PPD, triage should be done according to their risks. Psychologists will be referred if suicide tendency or severe depression is detected. The rest of women at risk will be offered different treatment including psychotherapy, medication or combination.

In order to determine the best treatment for a depressed woman, the patient and her doctor must evaluate
the benefits, risks, and alternatives of treatment options. This evaluation must include both the effects of specific treatments on the woman and the baby.

The two most common forms of treatment
for prenatal depression are psychotherapy and/or medication. In fact, management of PPD will be a tough work in China. Reluctance of taking medication and fears in seeing psychotherapists will be the most common barriers due to lack of knowledge in such disease among these women. Work should be done on spreading out the information of PPD, and what I plan to do is to form forums in small groups, focusing on postnatal women and families, talking about the necessity of PPD treatment and support.

Different types of psychotherapy have been successfully used to treat depression. Psychotherapy focuses on changing faulty behaviours, thoughts, perceptions, and emotions that may be associated with specific disorders. Psychotherapy can be utilized either by itself or in conjunction with medications. Psychotherapy should be provided by a qualified mental health professional. Providers should have knowledge about their local mental health resources and their accessibility to ensure appropriate patient referrals. At the meantime, quite a lot of psychotherapists in China may not get proper training and cannot offer proper treatment to their patients.

Over usage of medication and poor communication skills in psychotherapy should be avoided and improved, and benefits of psychotherapy will be established if more therapists get proper training further on. I fully accept overseas training and hope more and more colleagues and friends of mine are willing to get such training and help more families in China.

Appropriate pharmacological treatment is available for most pregnant and breastfeeding women as well. The benefits, risks, and alternatives of the medications need to be discussed with the patient. As majority of my patients are women in postpartum period, interaction between antidepressant medication and breastfeeding should be discussed in depth on pros and cons.

It is important for me to become a qualified provider who is knowledgeable about antidepressant medications and consult the patients prior to prescribing medications, by weighing the risks, benefits, and alternatives of medication. All these work need to be based on further study on mental health care of postnatal issues, such as good practice guideline from RCOG.

Mental disorders are no less common in pregnancy than at other times in a woman’s life. Care can be expanded into prenatal care and early detection of mental health issues will be achieved if such a work is carried on. All women who are in their early pregnancy can be good candidates in screening of potential mental disorders. Screening system and early intervention will be imported into prenatal care for better outcomes.

Women and, with their consent, their partners and families should be active participants in plans for management of risk and current mental disorders in pregnancy and the postpartum period. Effective care can be delivered for the best, when there is good communication, information sharing and joint working between all professionals involved in caring for childbearing women, so links among effected women and their family, communities and professionals should be achieved.

All the above will be major points of my plan in delivering mental care into my practice. It could not be done alone and help and support from societies and colleagues will be needed to achieve the aim. Further study and discussion into small groups will be continued to maintain the quality of patient’s care. Superiors from psychologists and help from overseas communities will be a great help in my practice to modify my treatment and enrich my knowledge.

Open College Student – Author Dr. Helen Yang /杨春 Obstetrician and Gynaecologist (M.D)

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