The recommendation, which may or may not be adopted, is a welcome recognition that there are unique psychological issues that new and expectant mothers face.
Yet, I have some serious reservations about the recommendations and how they might be implemented.
First, one of the major reasons for the suggestion appears to be that psychological counseling is now covered by the Affordable Care Act. The implication being that we don’t need to worry about mental health unless it’s covered by insurance.
Mental health counseling is indeed covered by the ACA in some cases and the federal government has mandated that mental health, if covered, is entitled to parity with other medical treatment. The result has been that many private insurance firms have dropped mental health coverage and the few that do cover it, reimburse patients at such a low rate that most patients are not able to benefit from it.
Secondly, and perhaps most importantly, I am concerned that the report’s sponsor’s version of mental health treatment, is really just a gateway to encourage medication usage.
According to the New York Times, “The panel said evidence showed that cognitive behavioral therapy. (CBT, as it is commonly known, is a type of talk therapy,) was helpful to mothers.” The study opined that the use of some antidepressants during pregnancy could cause “potential serious fetal harms,” but that “the likelihood of these serious harms is low.”
Let’s just call this what it is, another victory for Big Pharma. Another group of people who may never have considered drugs will get immediate access to a range of medications they may take for the rest of their lives.
I have advocated Cognitive Behavioral Therapy and other non-pharmacological approaches with my patients for many years and will continue to recommend them over pharmaceuticals.
Very few of the studies compare interactive interventions before recommending medication and few have proven medication does not affect an unborn baby. I would caution any prospective mother to be very careful about what she puts in her body while her baby is developing.
The only exception would be a patient who is suicidal and clearly needs medication to stabilize and manage her severe mental status.
While I agree that depression screening and treatment will help many new and expectant mothers, allowing them to receive counseling and hopefully forestall more serious mental illness, drugs are not always the first line of defense. All mental health factors need to be carefully considered prior to prescribing an anti-depressant medication.
In my next post I’ll offer some more natural suggestions that might help.