New depression screening guidelines…

In January, the U.S. Preventive Services Task Force (USPSTF) released an important update to their depression screening recommendations. As an obstetrician, I was particularly pleased that the recommendations now include screening pregnant women or those who have recently given birth, because 10% of these women suffer from depression.

How new moms can benefit from enhanced depression screening

The prior recommendations did not include pregnant and postpartum women. The USPSTF also found that treatment with a type of talk therapy called cognitive behavioral therapy alone, without the use of antidepressants, benefits pregnant and postpartum women with depression. While some pregnant women will need medication for serious depression, there are rare but serious risks to the fetus if the mother takes antidepressants, so it is not a decision that women or their obstetricians should make lightly.

And there are other good reasons to avoid antidepressants with pregnant and postpartum women. According to Alice Domar, a psychologist in my department and author of the soon-to-be-released Finding Calm for the Expectant Mom,

“Screening pregnant and postpartum women for depressive symptoms is a wonderful way to improve care and a terrific example of integrative medicine. However, I am concerned that this may be interpreted as an effort to get more young women on medication. Yes, there are some young women who need to be on medication in order to be safe and live a normal quality of life. However, counseling, specifically cognitive behavioral therapy (CBT), has been shown to be as effective in treating depression as medication and has no risks. There are other effective approaches, including exercise, social support, and more partner involvement. We do need to screen pregnant women for depressive symptoms, but all options to treat depression need to be presented and discussed.”

Guideline updates hold benefits for everyone else, too

There are other important elements of the new recommendations. The Task Force now recommends regular depression screening for all adults, a change from the last time it updated its depression screening guidelines (in 2009). In the previous version of the recommendations, screening for depression was recommended only in clinics or by doctors who already had adequate support systems to provide mental health care for anyone the screening identified as having depression. Since that time, multiple studies have found that mental health care in primary care settings works very well, and probably just as well as treatment by a psychiatrist. Psychiatric care is still important for many people, particularly those with severe depression. But those with mild to moderate depression might do just as well receiving treatment through their primary care doctors.

In fact, one size does not fit all when it comes to mental health, and tailoring care to each person’s preferences with regard to how and where to receive mental health care actually improves depression treatment. While some people might prefer a psychiatrist, for example, others would rather get this kind of care from their primary care doctor or a trained nurse specialist. Similarly, some people might prefer counseling and other behavioral therapies, while for others, medication may be the right answer.

Another important benefit from the USPSTF’s strong recommendation is that the Affordable Care Act specifies its recommendations be covered by health insurance. As a physician, one of the most vexing problems I’ve had with the health care system is access to affordable mental health services for my patients. Because mental health care is poorly reimbursed, many mental health providers don’t accept health insurance and instead only accept payment directly from patients. This greatly limits the pool of available health care providers for those who can’t afford standard fees. It is my hope that this recommendation may provide greater access to mental health services, especially for those who can’t currently afford it.

Below are spiritual recipe for health and wellness: Matthew E. McLaren

Genesis 39:23 The chief jailer did not supervise anything under Joseph’s charge because the LORD was with him; and whatever he did, the LORD made to prosper.

Joshua 1:7 “Only be strong and very courageous; be careful to do according to all the law which Moses My servant commanded you; do not turn from it to the right or to the left, so that you may have success wherever you go.

2 Chronicles 20:20 They rose early in the morning and went out to the wilderness of Tekoa; and when they went out, Jehoshaphat stood and said, “Listen to me, O Judah and inhabitants of Jerusalem, put your trust in the LORD your God and you will be established. Put your trust in His prophets and succeed.”

2 Chronicles 26:5 He continued to seek God in the days of Zechariah, who had understanding through the vision of God; and as long as he sought the LORD, God prospered him.

Ecclesiastes 11:6 Sow your seed in the morning and do not be idle in the evening, for you do not know whether morning or evening sowing will succeed, or whether both of them alike will be good.

Proverbs 16:3 Commit your works to the LORD And your plans will be established.

Esther 8:15 Then Mordecai went out from the presence of the king in royal robes of blue and white, with a large crown of gold and a garment of fine linen and purple; and the city of Susa shouted and rejoiced.

Deuteronomy 29:9 “So keep the words of this covenant to do them, that you may prosper in all that you do.

Psalm 118:25 O LORD, do save, we beseech You; O LORD, we beseech You, do send prosperity!

Proverbs 15:22 Without consultation, plans are frustrated, But with many counselors they succeed.

Proverbs 21:30 There is no wisdom and no understanding And no counsel against the LORD.

Acts 5:34-39 But a Pharisee named Gamaliel, a teacher of the Law, respected by all the people, stood up in the Council and gave orders to put the men outside for a short time. And he said to them, “Men of Israel, take care what you propose to do with these men. “For some time ago Theudas rose up, claiming to be somebody, and a group of about four hundred men joined up with him. But he was killed, and all who followed him were dispersed and came to nothing.     

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