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House Subcommittee Examines Postpartum Depression

On May 1, the House Energy and Commerce Subcommittee on Health held a hearing on the Melanie Blocker-Stokes Postpartum Depression Research and Care Act (H.R. 20). The legislation, sponsored by Rep. Bobby Rush (D-IL), would direct the secretary of Health and Human Services to expand research on postpartum depression (PPD) and postpartum psychosis. The director of the National Institute for Mental Health (NIMH) would be required to conduct or support research to expand the understanding of the causes of, and to find a cure for, postpartum depression. The measure also would establish a grant program to operate and coordinate care for affected individuals and their families.

Calling postpartum depression a “devastating mood disorder,” Chair Frank Pallone (D-NJ) noted the ubiquitous nature of its symptoms: “An estimated 400,000 women suffer from mood changes following the birth of a child, with the ‘baby blues’ affecting up to 80 percent of new mothers.” He continued, “The causes of PPD are complex and unknown at this time; however, if diagnosed properly and treated with social support, therapy, and medication, relief is highly attainable. All too often PPD goes undiagnosed because providers are not trained to detect the symptoms or the condition goes untreated because of social stigma or embarrassment. Needless to say, we must be more aggressive in our efforts to increase awareness and education for women and their providers so we can ensure that women suffering from PPD receive the care and treatment they need to stay healthy.”

Ranking Member Nathan Deal (R-GA) said, “For many of us who are parents, the issue of ‘baby blues’ is something that people used to joke about but now we know that 50 to 80 percent of women suffer from it in one form or another…Certainly, it is not a joking matter; it is a serious matter. It has consequences not only for the women but also for the child and the family as a whole. Fortunately, we’ve learned we can treat it, but we need to learn more about how we can come to understand it, predict it, and deal with it as early as possible. This legislation is going to be helpful in that regard, directing the NIH to do more detailed research and study the causes and what can be done to deal with depression.”

Catherine Roca, chief of women’s programs at NIMH, presented an overview of current research on preventing and treating postpartum depression. She began with a description of postpartum depression and psychosis: “[It] describes a sustained period (two weeks or more) of depressed mood that interferes with one’s ability to perform day-to-day tasks and can be incapacitating. It is associated with a personal or family history of depression, depression during pregnancy, stress, and lack of social support…Postpartum psychosis, which is rare, is associated with a personal or history of bipolar or schizoaffective disorder. It typically occurs early, usually in the first two weeks after childbirth and is associated with agitation, hallucinations, and bizarre ideas, occasionally leading to violent behavior.” Dr. Roca said that NIMH is researching “the role of stress, hormones, genetics, psychosocial, and cultural factors that may contribute to the development of PPD.”

Carol Blocker testified about her daughter Melanie’s experience with postpartum depression: “Six weeks after Melanie gave birth, at the routine postpartum checkup, she said that she felt ‘hopeless’ and she retreated to her room. We couldn’t get her to go back to the doctor, or back to her job, or back into the world.” Melanie was hospitalized three times and prescribed medication for her depression; unfortunately, the treatment was ineffective and she committed suicide in June 2001. Ms. Blocker told the committee about the seriousness of postpartum depression, saying that “even in the milder forms, this disease manifests itself with a lack of interest in a newborn child, fear of harming the child, fatigue, sadness, hopelessness, guilt, inadequacy, and worthlessness.” In closing, she urged the subcommittee to support the legislation: “I implore you to do the right thing answer my prayers and honor my daughter’s life. Save the hundreds of thousands of other women, children, and families throughout this country by finding the political will to pass H.R. 20.”

“Major depression is a seriously debilitating illness,” said Nada Stotland, a psychiatrist testifying on behalf of the American Psychiatric Association. She continued, “The most serious consequence of untreated depression is suicide. Major depressive disorders account for up to one-third of all deaths by suicide. While men in the U.S. commit suicide four times as often as women, women attempt suicide four times as often as men.” In making recommendations to the subcommittee, Dr. Stotland said, “First, we need to recognize that these illnesses are absolutely real…Second, we need to take postpartum mental health seriously…To achieve this objective, we need to help educate patients, families, and health professionals about the warning signs that a new mother’s ‘baby blues’ may, in fact, be a much more serious condition…Third, the subcommittee should move forward with H.R. 20…Finally, the subcommittee and the full Congress must recognize that the best diagnostic criteria are useless if women can’t get treatment because their health insurance discriminates against treatment of mental illness.”

Mary Jo Codey, former first lady of New Jersey, said, “I was introduced to postpartum depression through my own experience after I delivered my oldest child, Kevin, 22 years ago. Nothing prepared me for what has been the worst experience of my life. Not even having breast cancer could compare.” Ms. Codey described her difficulty in finding a doctor who could help her, eventually locating a psychiatrist who prescribed drug therapy. Unfortunately, following her second and final pregnancy, she had a reoccurrence of PPD and needed shock therapy to treat the “debilitating” symptoms. “When it was all done, I came to be angry that so little was known about this disorder, which strikes an estimated 11,000 to 16,000 women a year in my state alone…PPD isn’t a woman’s illness; it’s a family illness.” Ms. Codey detailed a campaign in New Jersey, “Recognizing Postpartum Depression: Speak Up When You’re Down,” that created a 24-hour hotline and bilingual website for women and their families. New Jersey also has a new law that requires every pregnant woman in the state receive materials about PPD and be screened for it after giving birth. She concluded, “Congress has a moral obligation to women and their families across the whole country to provide more research to determine the full extent of this public health crisis and more education, screening, treatment, and support to avoid needless suffering.”

Michaelene Fredenburg, president of Life Perspectives, testified about her experience with depression following an abortion at age 18. After her abortion, Ms. Fredenburg said she “experienced periods of intense anger followed by periods of profound sadness. For weeks and sometimes months at a time, I was too fatigued to do more than eat a meal and shower during the day.” Ms. Fredenburg said her symptoms went unexplained until she consulted a therapist. Ms. Fredenburg said that many women feel too ashamed to discuss their feelings after an abortion and that “this repressed grief can lead to prolonged feelings of sadness, loss of self-esteem, eating disorders, substance abuse, destructive relationships, an inability to bond with future children or even attempted and completed suicides.” She concluded, “In all the noise surrounding abortion, women are often forgotten. It is time to stop the noise and start listening to women who have experienced pregnancy losses.”

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