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Depression During Pregnancy: Common and Often Undetected

But Why Isn't Research Talking About the Thyroid/Pregnancy Connection?

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Updated January 10, 2009

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(Source: AHRQ Research Release, May 2005) According to a new report by the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ), depression is as common in women during pregnancy as it is after giving birth. Health care providers and patients may fail to recognize depression during pregnancy because signs of depression like tiredness, trouble sleeping, emotional changes, and weight gain may also occur simply as a result of being pregnant.

According to the report, roughly 1 in 20 American women who are pregnant or have given birth in the previous 12 months are suffering from major depression. When episodes of major and minor depression are combined, as many as 13 percent of women experience depression. The report defines perinatal depression as occurring during pregnancy and up to 12 months after childbirth.

Major depression lasts 2 weeks or longer and is accompanied by five or more symptoms that substantially impair a person's ability to fully carry out normal, everyday activities. Minor depression is impairing but less severe than major depression and is accompanied by fewer symptoms.

"This report should serve as a wake-up call to health care providers as well as women and their family members," said AHRQ Director Carolyn M. Clancy, M.D. "The belief that depression is mostly a problem for women following childbirth is a myth stemming from the fact that postpartum depression has been studied more thoroughly. Enhanced detection of depression by primary care doctors and obstetrician-gynecologists can help improve women's quality of care."

According to the report, evidence shows that psychotherapy and/or antidepressants can be effective treatments for women with perinatal depression. Currently there are only a small number of high-quality studies to support this treatment claim. The report suggests that women who are pregnant or breastfeeding talk with their doctors about the advantages and risks of taking antidepressants.

The evidence review also looked at the accuracy of screening instruments. Despite limited research on the topic, the available evidence suggests that screening instruments can identify perinatal depression but are more accurate at identifying major depression. These screening instruments detect depression in pregnant and postpartum women as well as the instruments used to detect depression in the general population in primary care settings. Whether used for major or minor depression, tests are relatively accurate in identifying women who do not have depression, but are less precise in identifying those who do.

Read more about "Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes":

  • AHRQ's web site features a summary of the report
  • The full report is available in PDF format online
  • Print copies may be requested by calling AHRQ's Publications Clearinghouse at 1-800-358-9295 or sending an e-mail to ahrqpubs@ahrq.gov

Commentary from Mary: Why is Thyroid Disease Not Mentioned in this Report?

Surprisingly, the report does NOT discuss hypothyroidism or thyroid disease during pregnancy or post-partum.

Pregnancy -- and in particular, post-partum hormonal changes -- can trigger a variety of thyroid and hormonal problems, even among women who have never had any thyroid problems prior to pregnancy. In fact, as many as 10 percent of all new mothers may suffer from post-partum thyroid problems, including the thyroid inflammation called postpartum thyroiditis. And one of the more crippling symptoms of thyroid problems during or after pregnancy is depression.

Any woman who has depression during or after pregnancy should have a comprehensive evaluation done of her thyroid -- and that includes TSH, T4, T3, free T4, free T3, and thyroid antibody levels -- in order to rule out an underlying thyroid condition as a cause of or contributor to the depression.

If a thyroid problem is found, treatment can be started, and even if psychotherapy and/or antidepressants are required, they are likely to work more quickly and effectively if the underlying thyroid problem is treated. And if the thyroid problem is the direct cause of the depression, some women may find their depression resolves, and further treatment, beyond their ongoing thyroid treatment, is not necessary.

For more thyroid-specific information for women who are pregnant, or considering pregnancy, read the Thyroid Guide to Fertility, Pregnancy and Breastfeeding Succcess.

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