Depression During and After Pregnancy Can Be Prevented, National Panel Says. Here’s How.

The task force of experts recommended at-risk women seek certain types of counseling, and it cited two specific programs that have been particularly effective.

Comments: 129

  1. Therapy is certainly an essential component of treating and perhaps even preventing pre and post partum depression. But a much more wholistic approach is necessary, particularly in the US where workplace policies & attitudes are not particularly friendly towards new mothers, and the culture of new moms can be very judgmental surrounding putting one's own needs on par with the baby's in terms of taking antidepressants and taking time for oneself. I know this from experience. We could be doing much more. Recognizing the roles of doulas & other non-doctors as additional support providers for mothers during a time of increased vulnerability, coaching of partners on how to be most helpful and supportive (not to mention better paid leave policies), educating more medical professionals and parents-to-be on what post partum depression looks like & how to talk about it openly, and the benefits to baby of treating it in whatever way may be necessary even if that may include antidepressants - all of these approaches are necessary. Therapy, while important, is insufficient to address a problem rooted in more than just flawed thinking.

  2. @Alexa F. While I agree that some of the issues are also important, it is essential to realize that depression is NOT "flawed thinking" It is a biological abnormality that takes place in the brain. It is NOT something that is helped by "grabbing your bootstraps and pulling yourself up." It is a medical problem that can be life threatening.

  3. An interesting article, but like a lot of writing that talks about postpartum depression, they tend to only feature mothers who have catastrophic mental illness and serious life problems. That leaves little room for those of us who had (and continue to have in some cases) symptoms of depression and anxiety and still manage to go on with our regular lives, but with great difficulty. What I had was not "baby blues" (I hate this term), but I also never wanted to harm my kids or myself. Reading articles like this after I gave birth made me feel like those were the only choices, and I suffered alone with my depression and anxiety through two children--but functional--before I finally had the courage to admit there might be something wrong. I strongly believe there needs to be a discussion of 'postpartum spectrum', so women can get help if they don't fall neatly into a diagnosis box. The counseling mentioned in the article would be fantastic for anyone dealing with issues after birth. We should all do it, regardless!

  4. Actually, there is a new term which reflects both the anxiety and depression that can affect mothers during and post pregnancy: Perinatal mood and anxiety disorders (PMAD). There is growing awareness that women can experience both anxiety and/or depression. This is important diagnostically, so that women can get the most beneficial treatment available for their symptoms.

  5. Agreed! There was an NYT article about a year ago titled “the Birth of a Mother” that touches on that spectrum and about giving ourselves the space to feel whatever we need to feel. (It strongly resonated back then, and so I’ll never forget that title!) Unfortunately that spectrum is not spoken about enough and more often than not we just get examples of these extreme scenarios that some of us cannot relate to. It’s not really helpful for those looking for guidance on how to cope with issues that are actually quite prevalent.

  6. As a mental health practitioner I want to underline this message. Prevention of depression has major advantages for the health and well-being of mother and child and will have reverberating effects for years for all family members. Intervention is important and can bring about restorative changes. Imagine a world in which standard pre-natal care included the screening discussed in this article. Kristen Gilibrand, Elizabeth Warren, Amy Klobuchar, and every woman in office- please include this in the articles of health coverage you are promoting for women.

  7. Thank you Ms. Belluck - what a wonderful article on a subject that is very important as if affects so many women. Postpartum depression is something we all have heard about; it's nice to hear it's getting the attention it deserves.

  8. Such an important article! And let's not forget that some men also struggle with their reaction to becoming or being fathers.

  9. N=1, but I believe CBT is a life tool for most everyone, but particularly for those who are under stressful conditions of any kind. That said, I can't imagine why a single mom to SEVEN children wouldn't be depressed.

  10. Depression During and After Pregnancy Can Be Prevented, National Panel Says. Sometimes is probably can. Undoubtedly sometimes it can't. And like all medicinal knowledge, this primarily will benefit middle- and upper-class white families.

  11. Thank you Caportia Porter for recognizing that you needed help to battle this awful disease. To take this first step shows that you are brave. This also shows the love you have for your children. Whether you are a mom with one child or several, whether rich or poor, depression is real and to have options in treating this god awful disease can lead to positive outcomes, not the tragic ones that you hear on the news or read in the papers.

  12. Please include in any prescription for counseling - checkups with both an endocrinologist because of dramatic hormone changes pre and post-delivery, and a sleep specialist because at the end of pregnancy and the beginning of the baby's life-sleep can be in horrifically short supply, with dramatic effects on a parent's well-being.

  13. Parenting is already hard under the most ideal circumstances. I'm glad these mothers were able to get the help they needed.

  14. I really wish the NYT had not used Ms. Porter and her seven children in their story because it just serves to reinforce stereotypes. Don’t get me wrong, I don’t endorse anyone having seven children. They are beautiful children.

  15. It it important to remember that men may also suffer from postpartum depression.

  16. Not brought on by pregnancy hormones!

  17. @Mary A Men have hormonal changes during pregnancy and when bonding with their children. Also, peripartum depression is caused by a constellation of factors. Automatic screening for women makes more sense, but men should know there are resources available as well.

  18. Risk factors for depression when pregnant, according to this article: "recent stresses like divorce or economic strain; traumatic experiences like domestic violence; or depressive symptoms that don’t constitute a full-blown diagnosis. Others include being a single mother, a teenager, low-income, lacking a high school diploma, or having an unplanned or unwanted pregnancy, panel members said" Being single, poor and/or Having unwanted children would and should make anyone depressed. Can we *ALSO* focus on CHEAP/FREE/AVAILABLE BIRTH CONTROL - such as the 5-year implant? Where can poor women go to get this form of birth control? Where can women go and get safe, low-cost abortions? WHY ARE WOMEN HAVING UNWANTED CHILDREN? Because the GOP has demonized abortion and made it very very very difficult to get. OF COURSE we need to help the pregnant women, but let's also help the women who do not want to be pregnant and want to wait until their life circumstances are better. Abortion should not be RARE, it should be easily available at low-cost. Contraception should be free for those of low-incomes so they are not burdened by it and further burdeneed by unwanted children whom they cannot afford.

  19. I’m a mother of two living in the Boston area with access to some of the greatest hospitals. I like to think the doctors in this area would be up to date on the latest research but found them to be lacking in the support and understanding of this issue. It felt as if they were often more concerned about the well being of baby rather than the family as a whole. I wish that doctors talked about depression as soon as mothers go into their OB/GYN and give information about signs/what to do rather than wait until 4-6 weeks postpartum.

  20. I’ve felt symptoms of something close to depression with acute anxiety each time I was pregnant. Each time, my symptoms disappeared within days after giving birth, when my hormones shifted again. I was lucky that I didn’t have post-partum issues - to the contrary, I finally felt like “myself” again within a week of birth. For my first pregnancy in 2007, I had heard of PPD, only, and had no clue that some women experience pre-natal issues. It wasn’t in any of my pregnancy and baby books that filled up an entire shelf. I was too ashamed to mention anything to my doctor, and even to my husband. I was afraid of being misinterpreted. I was afraid they would think I didn’t want the baby or wasn’t ready for motherhood, particularly because I was considered a very young mother among my family and peers (I was 26 when my son was born, married, held a graduate degree and a great-paying job with benefits, but it’s all relative when one’s peers have babies about a decade later), so I was self-conscious and thought people would judge me for having kids so soon, even though the timing was right for us. By the time I had my second and third, I knew what to expect. I guess that made it easier in a way. Those months were still so hard, though. And, I had none of the risk factors mentioned in the article. I’m glad the media is paying more attention to this issue.

  21. I am an osteopathic physician who has been in practice for over 25 years. In that time I have cared for many pregnant women and their children. Post-partum depression is common in many patients but none of those whom I treat during pregnancy. The reason is simple. With the normalization of body physiology the sacrum, at the end of the spine, which has an anatomical attachment at S2 via longitudinal ligaments which run up to the head and are continuous with the dura mater membrane surrounding the brain via the foramen magnum,the sacrum is free to move between the ilia of the pelvis. This in turn effects the function of the central nervous system and normalizes that aspect of it which seems to effect depression. Women who have come to me with post-partum depression, including many who were put on anti-depressants with scant results, find that their depression lifts when the sacrum is returned to its normal physiological motion. This is simple anatomy and physiology in action. Our profession has taught our medical students this work of diagnosis and treatment ( osteopathic manipulation and diagnosis) for many years. Once in practice, many of them have helped women with these symptoms provided the osteopathic diagnosis is found. I write this because many women unduly suffer with these symptoms and do not find the help they seek with purely pharmacologic treatment. Anti-depressants do not treat altered physiology due to structural causes. This is just good medicine.

  22. Most allopathic physicians do not agree and talk more about hormonal changes in the post partum period, not structural changes. This is a case where traditional allopathic medicine has more evidence.

  23. @JJ And the battle is joined! Is the playing field level, or does the pharmaceutical industry tilt it?

  24. Every. Single. Pregnant. Woman. Should. Have. A. Routine. Bio-Psychosocial Assessment (preferably by a social worker we are interested in practical arrangements not just symptoms) Every. Trimester. And Postpartum. The Postpartum Resource Center of New York Provides: Toll-free State-wide Helpline 855-631-0001 or 631-422-2255 (Hablamos Español) M- F, 9-5 is there to help.There are trained volunteers on call 9-9 seven days a week. CBT can work fine but it easy to design studies about it. Other kinds of therapy work can help too. Yes some people need medication. That should be arranged BEFORE the birth. You don't want to do it as an emergency. Yes these services are billable. If you don't provide them you may end up with both psychiatric and medical issues that are quite time consuming not to say horrific I personally don't believe in the 'Baby Blues". That tends to happen in cultures(like ours) that don't provide the normal month or so of intensive help. Exhaustion is a huge factor -try waking up happy healthy men every hour and a half for several months. Physical help, home visiting and doulas are all wonderful. If you are providing perinatal services and not dealing with these things you are not providing good care. Janet O'Hare, LCSW

  25. Very important topic! Peri- and postnatal depression is far more common than most of us realize, and it's not just a case of the blahs or the blues. The hormonal changes plus the stress of the pregnancy and birth can do a number on a woman's mood and mind, and this is very real. A number of OB/GYN and some pediatric programs have integrated mental health check ups in their expecting mother and mother and infant care, with trained mental health professionals on staff and on the maternity wards. I hope this will soon be the standard of care for all pregnant women and recent mothers. The key here is early recognition and treatment. Peri-and postnatal depression doesn't just hurt the mother, but also impairs her ability to fully be there for the child. So, bringing up the rear-guard here: partners (usually men) - you're up, too. If the mother of your child or children seems to show symptoms of depression or mentions it, talk to the healthcare professionals who take care of her and your baby and alert them. All of that is in addition to take as much of the load off her as possible, but you knew that already (:

  26. This analysis seems very wrong to me, as the implication is that only those with stereotypical risk factors for depression should be on the alert. The fact is that a woman can be perfectly well-adjusted, with a great support system, job, self-esteem, no family history of depression, etc., but once those pregnancy-related hormones kick-in (and then see-saw again after childbirth), anything is possible with regards to mood and depression. The prism should not just be stereotypical 'risk factors' but the pregnancy itself, and the severe hormonal fluctuations taking place. Ditto for when women go thru menopause. All women who go thru pregnancy and then childbirth need to understand the effect these hormonal changes may have on them mentally. And then they and their loved ones need to be aware and on the lookout, whether they have any 'risk factors' outside of that or not.

  27. Sorry - no one needs to bear 7 children, let alone take care of them without becoming at least exhausted, if not depressed. A Mom with 2 children would have been more than enough.

  28. Finally, a small step toward recognizing that early motherhood, for all the joy and privilege, can also be a psychological and physical trauma that demands attention and treatment. "Mothercare" is an integral part of childcare. Dayna M. Kurtz, LMSW, CPT

  29. This mother was selected to show that even after multiple pregnancies with no signs of depression, depression can surface. Outside of that, no need to be concerned with her family planning choices. Her children appear to be clothed, housed, well-fed and off to school.

  30. Here's an issue for the pro-life folks. How to help ensure that women who have children can take excellent care of those children after they are born. Go to it, folks!

  31. @sylvia it’s called birth control.

  32. @Syliva...Sylvia I agree with you....some people do not have the parenting skills or the financial wherewithal to raise 6 or 7 children. Counseling or planning of some sort may have helped her circumstance. And some of the people who are making negative comments, regarding this article and this woman's circumstance, are the same people that are pro-life. I wish there was some way you didn't have to rub their noses in it....I don't think that will make them better listeners.

  33. @William - A lot of the pro-life folks are against birth control, too.

  34. I am a mental health professional who has worked with depressio/anxiety during and after pregnancy. The number ONE thing that woman/families need is support. We need paid maternity/paternity leave as well as supportive programs for pregnant woman.

  35. @maria Carella... how the heck can someone with 7 kids even find the time to have employment? "supportive programs for pregnant woman"- cry me a river.

  36. @rufus, don’t cry for me Argentina !

  37. With all three of my kids I suffered through nausea, retching (even in the middle of the night) and exhaustion throughout most of each pregnancy. Depression came naturally with these symptoms. I do hope counseling does not mean drug prescriptions. I would recommend massages and nurturing support to be a more effective treatment.

  38. You should do a follow up article w services offered. The Seleni Institute in NY is a perfect example

  39. Where are the fathers? They can play a role as well.

  40. @Geraldine Conrad even one father could do so.

  41. Congrats! This is a legit issue re women that you did not bash men for. Hint to democrats running in 2020 whether male or female. Do not run an identity obsessed campaign bashing men like Hillary did ie all the problems in the world are caused by men, elect me president because I am a woman and will solve everything. Pick out legit issues that a majority of Americans can agree on, like this one, violence in the military against women, possible renewal of pregnancy discrimination at work.

  42. @Paul Sad. Just sad.

  43. Treating depression in pregnant women and mothers is, of course, extremely important. However, this article sidesteps a very real problem that many mothers who are treated for depression face: Family courts that don't understand where depression begins and ends, and subsequently, continue to consider a mother a risk to her child even after treatment. Single mothers without invested partners and happily-married women can safely seek treatment because the chance that they will lose their children as a result is slim. All other women risk losing their families.

  44. The comments about how bad it is to have a large family are misguided. Our country needs population growth. Our population growth is less than 1%. No big skill in math is required to see the downward trend. Which is bad for the economy, therefore bad for Social Security, Medicare, etc, and the general standard of living. China’s economy will struggle mightily w/the results of their only one child policy. Even the best immigration policies - which we know we don’t have - can’t solve this problem. What we need are policies that support families w/kids, like affordable, safe and reliable child care, preK for all, etc, which of course we also don’t have. But those policies should be our goals. Shaming someone for having a lot of kids? Well shame on you.

  45. @jkk "Our country needs population growth." No, on the cusp of catastrophic climate change there must be a new course for financial, societal and planetary stability. This pyramid scheme mentality is myopic and unsustainable. (And c'mon, if social security is underfunded now, how is perpetuating the dynamic a solution?)

  46. @jkk. If we don't reduce our numbers gradually Nature will do it for us, and that could be most unpleasant. I disagree that we should encourage birthing lots of children in order to fund the US safety net. For one thing, children require an 18 + year investment before they earn any money and (hopefully) begin to pay taxes. Meanwhile they are expensive to the parent and, potentially the taxpayer (minimum $ 250 K per child to age 18). If there are special needs, disabilities, learning/developmental issues - they cost even more and may never be able to support themselves. It would make more sense financially to admit skilled/educated, healthy immigrants who can work at remunerative occupations, support themselves and begin paying taxes right away. I would like to see a reversal of the concept that every adult needs to be a parent - that to live otherwise is selfish, against G_d, etc.

  47. Women do not have the right to keep having children they cannot properly nurture and support. They’re not depressed, they’re selfish and cruel, bringing frail beings into the world without consideration for the children’s well-being and futures. These women don’t deserve to be part of a depression study, they’re depressing these kids, the economy, everyone else.

  48. Nick of Brooklyn and other commenters, Who are you to judge a woman whose religious or other beliefs may be the basis of her decision about what type of family she wants? There is an international human right to choose to have children, the number of children and the spacing between the children. Now, any government can institute policies that incentivize various personal decisions that impact that country’s quality of life, including encouraging large families when there is concern about low birth rates (e.g. France) or encouraging no or or one child (like China did in the past) when there is concern about overpopulation. Please let’s stop criticizing individuals when we should be focusing our ire on an unresponsive government for the masses that is bought and owned by the wealthy to protect the interests of the wealthy few.

  49. @B PC "There is an international human right to choose to have children, the number of children and the spacing between the children. " There is also a huge responsibility that goes with having children. It's not *just* a right.

  50. @B PC. While bearing children is a personal choice, your criticism of “an unresponsive government for the masses...” clearly advocates for limiting large families for which there are limited resources.

  51. Copper is a metal that seems to be irrelevant to postnatal depression. In fact high copper causes anxiety and depression and is the usual cause of panic attacks. During pregnancy the copper level doubles. It reaches a peak near delivery and sometimes the depression arises before the birth. How can we treat it? Antidepressant are used as is psychotherapy. Bring the copper down seems more obvious. Copper and zinc enter the body through the same doorway in the gut wall so if you add zinc of 25-50mg it will gradually bring the copper down to normal. Job done. I learned about this from an American scientist Dr William Walsh PhD. Read his Nutrient Power if you want further information about brain chemistry.

  52. I invite everyone to see the disproportionate reproductive burden women are assigned by Nature as a disadvantageous harm rather than some general good that women should be encouraged to endure. As a man, the only way I know what women really feel about menstruation, gestation, and childbirth is by what they tell me, and they note that those features of womanhood are seriously painful, dangerous, and often unwelcome. Children can be a blessing, but gestation and childbirth are potentially fatal, and always injurious. You can see why a woman would be depressed after going through that. Further, every woman before having any child should consider that the human species is in severe population overshoot, and that every child born is yet another polluter and consumer who'll hasten the ecocidal death of the biosphere. Our culture has many myths and memes to encourage creating more and more humans, but these are dangerously outdated in the Holocene Epoch, which is an anthropogenic mass extinction event.

  53. @Steve Davies And every man before having sex with any woman should have a thoughtful and deep consideration of the problem of overpopulation and his role in it and responsibility for pregnancy should it occur.

  54. @Steve Davies - "every woman before having any child should consider..." You might want to revise that. It takes two to tango. Each child is created by the participation of TWO parents. Both parents should consider.

  55. @Steve Davies Population overshoot? Almost all of the West/industrialised countries, including the US and Japan has fertility rates below replacement levels. More otherwise able bodied but psychologically suffering adults are choosing assisted suicide/euthanasia because their country allows it. The population control measures in China and India have resulted in a gender imbalance that is making it harder for men to find wives, and some sociologists are linking this difficulty to increased demand for the sex slavery industry. African and South American countries are picking up the slack and their contributions as immigrants to Western countries, along with the large families you criticize, are probably who will be the future workers that will allow you to live with privileges you enjoy.

  56. As one of nine children (I am #5), my first instinct is to scream when I read about anyone of any race or any income bracket having large families. No one can give each child the time a child deserves. Any child in a large family will be overlooked, ignored, and not have important interactions with parents who are busy coping with everyday tasks that come with family life. I will state that I am a huge birth control advocate. If your religious beliefs stop you from using birth control, then remember no one else should have to support you or the children.

  57. @Pat I understand exactly what you mean. I was the oldest of ten. Childhood was a nightmare of drudgery. I wouldn’t wish it on anyone.

  58. @Pat Do not project your family's failures onto other families. There are parents negligent with just one kid. There are thriving kids in bigger families, because their parents are organized and manage to make it work (you really don't need equal time, but the time you do give has to meet each individual kid's needs and some older siblings actually love to help out. Then there are many families in between like my own, in which my parents had many emotional and psychological issues that made it so my sisters and I have to work to develop healthier ways to cope with stress. Even so, our parents' love and devotion made it so that we would adamantly refuse to trade our childhood for anything else in the world.

  59. The true obstacle was finding a GOOD therapist and psychiatrist that could fit me into their schedules. The waitlist to speak to a psychiatrist (which was essential if I wanted any medications) was over a month. I needed help immediately, not six weeks later. Also, the cost. I’m privileged enough to have been able to afford over $1,000 in therapy for just those few months, but most people aren’t. There were a few in-network therapists, but none was taking new patients. Those are the real problems. Everyone says to get help nowadays, but no one says HOW or WHERE.

  60. @Nettie Insurance pays a fraction of the going rate for counseling and works to find loopholes to refuse to pay. Also, many HMO providers now employ a handful of counselors and force them to spread services among hundreds of patients. This is one more aspect of the healthcare crisis that needs to be addressed. And not by allowing anyone who can read a manual to provide counseling, as the article suggests.

  61. Women and mothers must become a priority. Also, comments here on family size are not necessary.

  62. This headline is completely irresponsible. It is one thing so say that "certain types of counseling" can help some women avoid depression. But to say, flat out, even in a quote, that pre- and post-partum depression is PREVENTABLE is to say that this always works, in every woman, in every situation...and that it has been proven to do so. (If that were really true, why would you include a line like this: "Even in some cases in which it doesn’t prevent depression, counseling may be beneficial.") Worst of all, your irresponsible and harmful headline implies the conclusion most people will instantly leap to, namely that if G-d forbid a woman still suffers from depression, IT'S NOW ALL HER OWN FAULT. Shame on you, New York Times.

  63. I'm depressed after reading so many hateful comments about a caring mother brave enough to share her story with the NYT. Too many people hide their mental health struggles out of a sense of shame. How sad so many readers here felt the need to prove that these fears are well-founded.

  64. 7 are too many to be cared by one Person does not matter how caring you are. Unfortunately these cute kids will not have enough supervision and likely financial resources to be protected and reared properly in this cruel abusing Brutal world.

  65. Maybe it's normal to be depressed when you're pregnant or within a short period after giving birth.

  66. It's normal to feel pain after a root canal. Does that mean painkillers are unnecessary, or if someone takes them, they are somehow weak?

  67. It's a good thing that researchers are evaluating interventions, because if there is an effective treatment approach for mothers at risk of descending into long term depression, everyone benefits - and it will help their children all the way into adulthood. Working with women before they give birth makes much more sense that trying to identify mothers afterwards, when they are struggling with the demands of the new baby. If they can learn strategies that will help them, that keep them functioning better, they re going to be able to be fully there for their child(ren). Prevention of post-partum depression for a mother promotes health for her children. A woman suffering from depression, whatever the trigger, cannot be emotionally nurturing, and may be neglectful or worse. That is true even when there is enough income or support from others. I especially locked onto the idea of finding the women instead of waiting for them to show up -- or be referred when they are at their worst. Many woman are very isolated, and need someone else to reach out. Too many children? I have personal beliefs about that, but this article is focused on a serious public health issue, which devastates women - and families individually. If we have approaches that work, they should be implemented everywhere. And best not to judge anyone else without walking in their shoes.

  68. Stop having kids. Mental health issues more often than not are hereditary. IMO....one diagnosed with any mental health issue that requires medication routinely should not be allowed to foster kid/s. Most mental health disorders are not curable.

  69. Do you also say this to people with lung, breast, colon, prostate etc. cancer ? Because all of these are also hereditary and by your logic they shouldn’t procreate either!!!

  70. @Jim This is a very uninformed opinion. Most who suffer from mental health disorders are able to, with treatment, reduce symptoms. Your opinions seek to further stigmatize and shame those who suffer in silence and are reluctant to seek treatment.

  71. What prompts this response, I wonder? I don't believe your opinion is consistent with any accepted school of thought.

  72. To those suggesting to not have (as many) kids, please know that I suffered from serious depression after having ONE child. It was part of the reason why we only have one child. Pre-pregnancy, I was a happy, determined, energetic and highly educated person. After birth, I felt like an anxious, despondent, near-suicidal mess. At the eight week mark post-birth, I contacted my OB to ask for support. I told a nurse and OB about my symptoms and tried my best to convey just how far from “normal” for me they were. My OB basically told me that they only provide support up to 6 weeks after birth so... sorry, can’t help you. I felt despair. With a newborn, return to work looming, and a head that kept returning to the WORST thoughts, I nearly did several things that I would have regretted. Chief among them after self-harm thoughts was to quit my career and basically give up on life. The thought of returning to a job in this state was embarrassing and terrifying. I never once thought to harm my baby. These feelings eventually did pass, but they did not begin to wane until nearly two years later when I finally tried an anti-anxiety medication. I was sad to resort to meds, but grateful for any break in this cycle. I know many other women who were not so lucky. My suggestion for those who criticize is that you please be kind to mothers and try to empathize - it was SO much harder than I ever thought it would be and the depression played a starring role in my uphill battle.

  73. This is a very good article based on a very good report as far as it goes. Two things are missing. 1. New fathers have postpartum depression too. 2. A strong correlate of postpartum depression in women is difficulty in the relationship with the child's father. There is evidence that couples interventions work better than individual interventions for women's depressions.

  74. Where might I find the research papers you are referring to? I’m particularly interested in the relationship research. Thanks

  75. Marital problems, with seven children to raise you might want to put those marital problems aside, especially when you live in public housing work a low wage job and have to move in with relative's who more than likely have there own headaches to deal with. No amount of counseling or antidepressants can replace a stable nuclear family with both parents sharing the responsibility and burden of raising the children.

  76. Promoting counseling for women with depression before or after delivery is a good thing. The "default" response from the health care system is to offer medication. This may be because our health care system is far more engineered for delivering a pharmaceutical intervention than a psychotherapeutic intervention. However, evidence shows that most women prefer counseling. Now, this review shows that the efficacy fits this preference. We should be wary of opting for pharmaceutical interventions for women of reproductive age, when psychotherapeutic interventions are available, and have efficacy evidence. A recent meta-analysis shows that serotonin-acting antidepressants seem to raise risk of a few specific congenital heart defects, for first trimester exposure (Gao, et al. 2018. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Medicine 16:205.) Along with this epidemiological finding, there is biological plausibility. A lit search will show this. So, it may be good in more than one way to promote counseling for depression during pregnancy. It is efficacious, women generally prefer counseling to medication, and we might avoid some cardiac birth defects. If only the health care system would get behind this valid form of treatment.

  77. Odd, no mention of Postpartum Support International, a highly respected non-profit that has offered similar programs for over over 35 years. postpartum.net

  78. @anthro Right you are . Here are the phonenumbers.1.800.944.4773 1.800.944.4773. Janet O'Hare, LCSW

  79. Kids make me depressed too and I don’t even have any. Stop reproducing and start enjoying life !

  80. Ah, but we need other people’s kids to help us enjoy life!

  81. I suppose the conservative solution would just be for woman to never have sex.

  82. @Joel C Not on my dime.

  83. A very value article and critical recognition of this under diagnosed and under treated mental health issue. As a clinical psychologist of forty years, I have treated all forms of depression. However, my daughter is a birth and post partum doula and I think her work adds an incredible dimension to this field of both in prevention and treatment and wish the article had recognized the contributions of doulas. Dr. Ann Moye

  84. It is unfortunate that there has been inadequate scientific study of women's physical, spiritual and psychological responses to pregnancy and post partum conditions. These articles tend to downplay the profound lifetime effects of childbearing, family and societal issues and use only the most obvious examples of women at risk. It is a real disservice to women that we don't tell the truth about the complexity of our bodily experiences or work on policy changes for the health and support of women over the lifespan.

  85. 1) THE ARTICLE'S SUBSTANCE. Those who suggest that mental health assessment and assistance should be part of standard pre- and post- natal care are on the right track I think. 2) THE PRESENTATION. Why did author Belluck - or someone else - choose to highlight a low-income woman with 7 children? They had to know that Ms. Porter’s prominent position would derail readers’ focus. At first I thought she was there to highlight that a woman could be fine with many pregnancies, but then have trouble. But then I became curious. What were her circumstances? Could she support so many children? Was she married? What had occurred? So I ended up skimming the article looking for information on Ms. Porter. I found out she is 28, she “has worked as a telemarketer,” she has marital troubles, and has recently moved in with her sister. So how can we think that her depression had to do, in particular, with her pregnancy? She herself seems to be suggesting that she needs help simply dealing with so many children. I don’t get it; I don’t understand why her photograph is at the head of this article. I hope she and the children are ok, and I am glad she got some help. But neither I nor many other readers can ignore the obvious question: what is she doing having so many children?

  86. @CJN Because believe it or not, most articles that feature PDD feature the stories of white middle class women with a husband. Medicine has historically underrepresented women of color of various races, further contributing to women of color systematically experiencing more biases than other populations, that such women overreact to their health problems and medical errors based on racist assumptions about the strength of black women in particular. Even wealthy athlete, Serena Williams almost died from preclampsia. The woman you are criticize is another voice in the PDD discussion and has every right to be heard as any other woman. So if you think you have any right to criticize a woman's choice to have many children and question the use of a picture of only one of the women discussed in the article, who happens to be black and may not live to your standards, thank you for revealing something ugly about yourself for the world to see.

  87. I don't understand when there's an article talking about advances in helping women with their mental health, everyone just focuses on how many kids the woman has. A womans' choice to have more kids is the same as a woman's choice not to have more kids.

  88. Given that women may develop peripartum depression under the very best of circumstances, and additional children TEND to produce enhanced stress, etc., I most certainly hope that the woman profiled with the 7 children has been offered & agreed to some long-acting method of birth control such as an IUD. Sterilization after 7 would also certainly be a reasonable option as well if she were to agree to it. It’s particularly concerning (to me at least) that she has a 1 yo and a 2month old in addition to 5 other young children. I admittedly may not have my math correct, but if one assumes the 2month old was born at full term & the 1yo is nearly 2yo (eg 23 months old), then the mother likely became pregnant with her 7th child when her 6th child was around 3 months old. Another pregnancy so soon wouldn’t likely have helped the psychological status of a woman with 6 children 10 years of age & younger (I assume the 11yo was 10 at that time). Let alone one that has minimal financial resources, insecure housing conditions, unstable marital/relationship issues, etc. Fortunately she had her sister for assistance at the time. I hope that for the sake of her & her children that she takes a very long break, if not a permanent one, from childbearing. Unfortunately, there are many that would rather have women like her continue down a path of ceaseless childbearing rather than employ long acting reversible contraception or sterilization.

  89. This could explain how my marriage fell apart after my ex-wife gave birth to premature twins.

  90. There also has been a long tradition of peripartum care in the psychoanalytic tradition, especially in England. While this article makes some good points, suggesting manualized group treatments by non-clinicians seems dangerous, or at least not the best care available. Considering the long term costs and harmful effects of maternal depression to both mothers and their children, support of programs such as Minding the Baby, as they have in England, and The SPRING Project, as is being developed in DC and Baltimore, is the wiser, kinder, and cheaper alternative.

  91. Ones best chance for not being depressed after childbirth is having a stable relationship with the child's father (preferably marriage), the means to pay for housing and to support a child, and a good family support system as well. All appear to be more rare every single day. One would have to be very, very wealthy to be able to support 7 children and carrying for them alone would require one to be Mother Teresa. I'd be depressed, too! Yes, it's a woman's right to have as many children as she wants. I would not want to see laws such as those in China (perhaps they no longer have them?) in our country, but it's not their right to then insist we help support them and give the mother the emotional support she also needs. I'm 75 with some limits to my mobility. I'd love to still be able to travel, particularly abroad. Of course I have the right to do this - I do have a valid passport and can afford the trip, but I certainly cannot expect the government to provide me with a companion who will push me in a wheelchair when there is much walking and to take care of all the other things I once could do but no longer can. There really is no difference.

  92. @India Do you claim social security? Thank her children for being future workers that pay into that.

  93. The author failed to mention a subset of new mothers who often face post-partum depression: those who have gone through fertility treatments. Some studies suggest that women who have undergone fertility treatments are nearly twice as likely to suffer from post-partum depression than other new mothers. Also, I can understand the concerns raised by some readers about having seven kids. However, I find it odd that these commentors, especially those whose main concern is population growth, do not mention the other mothers in the article: a mother of three and a (single) mother of four. If every woman had three children, the world's population would increase by 50% within one generation; if every woman had four kids, it would double. Who gets to draw the line on how many kids is too many? That said, I also find it unfortunate that the discussion on post-partum depression was predictably derailed by showcasing a single mom with seven kids.

  94. My best friend's wife - who was also one of my best friends - had developed PPD when she had her 2nd kid. She used to be a social worker before getting married but she simply didn't have the mental toughness to handle the job. That was almost three decades ago. After some medical care, she had found God, joined a church and raised two beautiful girls while my best friend globe trotting for his startup businesses. She ended up working for a prestigious west coast institution as the student admin. Unbeknownst to their friends not living in the area, she developed debilitating depression. She ended up getting hospitalized but killed herself there. That was 7 years ago. So you see, you may want to pin a cause or causes on the human psyche turning dark but it could turn on you again. The cause being physical or circumstantial, or both, is not as relevant as you taboo it. On a person suffers depression, the illness can ripple out; but the more it spreads out, the better support the sufferer can get. My best friends and his girls seem to be okay but they just don't bring it up, so I keep my mouth shut. But sometimes I wonder...

  95. The article failed to mention the hormonal havoc that occurs in births that are close together as well as nursing and sleep loss to add to the depression. Anti-depressants have no effect on hormonal decreases and pharmaceutical interventions are not a good idea when pregnant or nursing anyway. One assist that can be effective is the use of progesterone cream in low amounts to increase the hormones that have been depleted curing both pregnancy and nursing - even with one child.

  96. Captoria experienced depression after the sixth child? I'm getting depressed just thinking about it.

  97. One factor in perinatal depression and dysphoria might be that some women may have levels of progesterone that are too low. It might be worthwhile to check their levels of serum progesterone and if low, give oral progesterone. The main concern would be to use natural progesterone and not synthetic progesterone (progestin) which can have very different receptor binding characteristics and not be as effective.

  98. Liberals think let’s find a good program that works and fund it while conservatives think why should I pay for any program if the beneficiaries may be those whose behavior I consider to be reckless.

  99. Gestation and child birth are bloody (literally), painful, and often cause permanent physical and psychological damage to women. What woman wouldn't be depressed when her pelvic floor has been torn apart, she's gained 20 pounds, and breasts are permanently deflated? When she gets no sleep, minuscule leave, and her marriage maybe crumbles under the strain? Does any of this really sound non-depressing to anyone???

  100. Postpartum depression is a real and serious problem for many women regardless of whether they have one or seven children. I'm not sure what many of the comments here have to do with the actual issue of postpartum depression and how to combat it. The photo is simply a photo of one woman who has experienced it and is not representative of all women. Maybe people who just want to sound off their opinions about the environment or birth control should look elsewhere and allow others who genuinely care about this issue or suffer from this malady discuss it in a meaningful way.

  101. Post-partum depression is a real hormonal problem and deserves better treatment than this. Featuring such an outlier (I hope!) with seven children, on public assistance, and questionable spousal support completely distracts from what the headline promises. It is dismissive to the many women who make responsible life choices, yet still find themselves reeling from the effects of birth/motherhood. Also, ANY article about the trials of a single mother should have some explanation of the father’s support. Fathers matter to the children, the mother, and society.

  102. @KLM Thank you for your sensible comments. I agree 100%.

  103. Perhaps we could begin with a year of paid maternity/paternity leave, doulas provided through insurance, and affordable day care when and if parents choose to return to work. Addressing these basic needs might not prevent depression, but could go a long way in providing a space in which to effectively deal with mental health.

  104. Many comments & concerns have been focused on the seven children Ms. Porter has and the subsequent conclusion that she is irresponsible. As a practicing OBGYN indulge me with the opportunity to possibly blame the health care system that MAYBE allowed this to happen. There are two parties that agree upon a contraceptive measure; the patient and her health care provider (i.e. doctor, midwife, or nurse practitioner). It is extremely likely that one or both of those parties failed in their responsibility to start some sort of birth control for Ms. Porter. The options for extremely reliable long term contraception have never been better and the fact that Ms. Porter has probably not recently used any one of them is an embarrassing failure for the health care system or a very poor choice made by Ms. Porter. If it’s the health care system then shame on my profession.

  105. @Sandy As a woman of color also in the health field, you should know better than to raise assumptions of patients in public forums, especially without access to her case history. There could be many health related reasons for having 7 children, with or without contraceptives, and the public doesn't have a right to know the specifics. If I were to be your patient, I would be skeptical of your respect for my autonomy.

  106. @Angela In general, what are “health-related reasons” to have seven children?

  107. Having a strong support network was critical for my wife and I during the first few months/years with our son. Having 7 children seems financially and socially irresponsible to me in an age where abundant overpopulation, inordinate wealth inequality and collapsing natural resources are immediate and real concerns. Healthy support networks and adequate funding and consideration for new mother is important - but so is being socially conscious when deciding to have a child, much less 7.

  108. Nick of Brooklyn and other commenters, Who are you to judge a woman whose religious or other beliefs may be the basis of her decision about what type of family she wants? There is an international human right to choose to have children, the number of children and the spacing between the children. Now, any government can institute policies that incentivize various personal decisions that impact that country’s quality of life, including encouraging large families when there is concern about low birth rates (e.g. France) or encouraging no or or one child (like China did in the past) when there is concern about overpopulation. Please let’s stop criticizing individuals when we should be focusing our ire on an unresponsive government for the masses that is bought and owned by the wealthy to protect the interests of the wealthy few.

  109. @Nick When you discuss wealth inequality and collapsing natural resources, it is important to consider the main causes of those problems. People with more wealth tend to consume more resources. Similarly, corporations with lax environmental regulations will cause a great deal of environmental damage. Overpopulation seems like a likely culprit for environmental degradation but that assumes that everyone uses resources more or less equally. I would argue that a large family is less environmentally damaging than lax environmental laws. I would also argue that a very rich person will have a far greater carbon foot print than Ms. Porter's entire family. I hope you are this judgmental when you see that any celebrity is having a child, knowing the amount of resources the child is likely to consume. Laying the blame for the state of the world at the feet of a regular woman with a large family is reductive and short sighted.

  110. @Nick Instead of shaking a finger, continue contribute to and educate others on ecologically sound practices. Her children are potential workers who just might help keep social security, Medicare, and Medicaid alive in a time when the US finally feels the repercussions of decline in fertility below replacement levels. It's a big risky bet at this point that your son will be sure to have the means to take care of you decades into your retirement. And if you pay into his college education, surely your retirement funds will take a hit.

  111. Here's an idea: maybe instead of trying to identify women most at risk for the condition, just build mental health into pre- and post-natal care. Educate everyone and make mental health a part of the follow-up care. By making it routine, everyone will become aware of the symptoms, and it will be easier to talk about with healthcare providers and other new moms, which will in turn lead to more people getting treatment earlier.

  112. I suffered from depression in my 6th month of pregnancy. It felt like I fell in a deep black hole, too deep to even try and climb out of. I lost all desire to eat. I couldn't sleep. Fortunately, with my husband's help, I sought treatment. My sleep improved and the depression went away.

  113. The headline gave me false hope - hope that the anatomy and chemistry of perinatal depression had been discovered. But instead, it is screening guidelines. I fit none of the guidelines listed; a professional outside of my close circle would have had a hard time pegging me as a likely prospect. The tricky part about perinatal depression is that you don't always know you have it until it is gone. By the time I understood - was capable, given my state of mind, of understanding - I was suffering from depression, it was lifting. It was the very feeling of being myself again that made me realize how much I wasn't for almost 15 months. Looking back, I was acutely in a very bad state, held together by family who frequently visited, took over responsibilities, called daily. Our doctors can talk to us, and if we have a relationship with them, or with their staff, they might be better at seeing depression. But for me, it was family that noticed and family that stepped in. I am forever grateful that they did; and worry about mothers who don't have support systems.

  114. @Cathy After giving birth 25 years ago, I suffered for months before learning about postpartum depression. A few years ago, upon reading about the huge hormone shift that happens upon delivery, it seems a miracle that new mother could weather it without symptoms.

  115. Such an important topic. I wish these interventions had been available when I delivered my only child 30 years ago. On my six-week visit to my obstetrician I was close to suicidal and she laughed and said "if it gets any worse, we'll have to send you to a psychiatrist ." This from a noted and well-respected Park Avenue doctor!

  116. A friend committed suitcase on her baby’s first birthday. Devastating. She was a successful professional whose post-partum psychosis destroyed her.

  117. I’m sorry for you and your friend. I’m sure you meant “suicide.” NYT didn’t catch your autocorrect error. I felt the same way 49 years ago and have a major depressive disorder.

  118. Thank you so much for this article and research. Having suffered during and after my pregnancy from depression, I am scared of trying for a 2nd. Going to a therapist helped, but having the ability to take FMLA for a year was the life saver. Paid leave for parents is essential!

  119. America offers band-aids for broken limbs. Every social problem in America rolls back to the same set of inadequacies: healthcare, education, salary, pension, and paid leave. Mothers have challenges not solved by positive thinking and a few home visits. As the saying goes, "it takes a village" to create positive, stable families and communities. As a mother, who had post-partum depression, and as a mental health professional, I can attest that CBT and support groups produce very short term results unless part of long term therapy. And those services are next to impossible for Medicaid mothers to access and afford.

  120. @Patty There are some long-term programs available, and I think some are waking up to the need. In DC and Baltimore, there is something called The SPRING Project which provides long term therapy for a greatly reduced cost. And there are some clinicians doing long-term work and accepting Medicaid because of this need, myself included.

  121. @Patty CBT and other therapies can have long term results. Much depends on the skill of the therapist and on the patient's willingness to follow outside homework. I too am a therapist.

  122. "Here's how." Sounds great, except that the risk factors most associated with perinatal depression are all things that would make the most effective treatment out of reach, number one being socioeconomic insecurity. Maybe we should take a common sense approach and try to lift up ALL people, including mothers, I don't know, maybe by not making it difficult to obtain contraception, prenatal care, counseling on abortion and/or reproductive choice, personal and family healthcare including post-natal assistance, family leave, housing, food assistance....Naah. Let's cut taxes on corporations instead.

  123. I suggest educating the father about how to identify and help with depression would help a lot, too. Maybe there is a book out there for fathers, now? In my day, fathers were very willing but not well-informed about a lot of these things. Somehow it was the woman's problem, not the couple's. Silly and sad. But probably an attitude depressed women gravitated to.

  124. I'm disappointed to not see more mention of the role in estrogen in severe cases of post-partum depression and psychosis. There is evolving literature on this. Full disclosure, I stopped reading at "Omega 3 fatty acids." As someone who eats healthfully with plenty of fatty acids in my diet, they do two things in serious cases of hormonally-triggered depression: jack and ... well you know the other one.

  125. @LE Richardson My pregnancy was planned. My situation secure. My husband was helpful and my family very supportive. My child was healthy. I didn't have a history, but I endured five months of postpartum depression. Finally one day I felt "myself" and my menses returned 3 days later. Tough situations may exacerbate depression but the physical component needs much more attention.

  126. I'm a professional woman who gave birth to my only child in my early 40s. I stayed home with my son for over 10 months, breast-feeding for 6 of these. Although I didn't want to accept it at the time, I definitely had depression following the birth of my child. I resisted treatment (pills), and eventually recovered while fortunately not impacting the bonding with my baby (I think!) I had no prior depression. When I looked back at it through the lens of someone who finally separated from my child's father and began to understand the extraordinary covert narcissism I'd been subjected to for nearly 18 years, it occurred to me that maybe I was *justifiably* depressed. No longer earning my significant income, located in a rural area with few neighbors or support mechanisms nearby, lacking the positive feedback of professional peers, and having limited savings, I was dependent upon someone who considered those months a "vacation", who paid the mortgage and utility bills but offered no support for me to take a break or even gas up my car to go to town. He headed out with friends to go skiing and boating, and assumed vocally that I was completely fulfilled being a mom and cleaning up after both baby and husband (since I didn't have "real" work to do). You know what? That's DEPRESSING. And it's depressing that I let it happen. I'm back in my career and in public service, have a great son, and got rid of depression through *divorce*, not *pills*.

  127. Thank you for this article shedding more light on this important WOMEN'S HEALTH ISSUE. Along with so many women's health issues, depression related to pregnancy has long been a disregarded, maligned and generally ignored topic world wide. It is unfortunate that so many of the comments do not address the issue at all, but instead choose to focus on the very regrettable choice of featuring a mother with an extraordinary and perhaps inappropriate number of children. In making such that the focus of commentary, we not only support and facilitate the dismissal of the problem by the largely male dominated medical community, but also the continued needless suffering of so many women in the US and around the world.

  128. What a great idea, providing intervention BEFORE women lapse into dire depression. So often in this country, people see depression as a sign of weakness instead of the biological illness that it is. I hope these programs become very widely available and used. Perhaps they should be paired with a babysitter onsite, so that women without a lot of social supports can attend.

  129. Seven young children? I detect other serious issues in this family.