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Release: May 31, 2000

UI offers increased services for women with depression during, after pregnancy

IOWA CITY, Iowa -- Women with depression during pregnancy can manage the condition through increased services offered by University of Iowa Health Care.

The UI Psychiatric Outpatient Clinic is stepping up counseling and referrals for women dealing with mental health issues, particularly depression, during pregnancy as well as postpartum, said Scott Stuart, M.D., UI associate professor of psychiatry.

"Many women do not want to take medication during pregnancy, so counseling or psychotherapy is often the first and preferred course of treatment," Stuart said. For many women, 12 to 15 weeks of counseling can help them successfully overcome their depression.

"Typically, a woman with depression will feel a lack of enjoyment, have trouble with sleep or appetite and experience anxiety," Stuart said.

Stuart said that UI research on postpartum depression has even better equipped the clinic to treat women who have psychiatric problems associated with childbirth. In addition to increasing patient services, Stuart is researching the problem of depression during pregnancy with assistance from a National Institute of Mental Health grant that will go into effect in June. Michael O'Hara, Ph.D., UI professor of psychology and associate dean of research and development in the College of Liberal Arts, also is involved in the research and treatment services.

Stuart added that Katherine Wisner, M.D., Helen C. Levitt Endowed Visiting Professor at the UI College of Medicine, has allowed the outpatient clinic to increase both its clinical services and research activities. Wisner, who is a professor of psychiatry and reproductive biology at Case Western Reserve University School of Medicine and University Hospitals of Cleveland, has shared her expertise on treating depression during pregnancy and the postpartum period.

The UI Psychiatric Outpatient Clinic can see women who self-refer or are referred by other physicians or mental health professionals from across the state. The clinic also can refer women in eastern Iowa to local resources for depression and pregnancy.

"We have trained a number of therapists who can provide the kind of counseling we find effective," Stuart said. "We also can help women find other local resources."

Stuart explained that when medication is needed to treat depression, a physician carefully assesses the patient, particularly if the depression is postpartum and breastfeeding is involved.

The need to carefully manage depression in women who are breastfeeding is also a focus of concern for Alicia Weissman, M.D., UI assistant professor of family medicine.

Weissman said counseling can often be as effective as antidepressants for women who experience depression for the first time. However, for women with a history of recurrent depression that previously required long-term maintenance medication, she does not recommend counseling alone as the primary therapy.

"As long as there is no immediate concern about self-harm or the mother's ability to care for her baby, someone with depression for the first time may want to try counseling before medication," Weissman said. "However, women with more serious depression, or who previously needed long-term maintenance medication, may need to face the decision of whether to continue to breastfeed while taking medication or to stop breastfeeding in order to take the medication."

Weissman added that when treating depression, physicians also must consider what else is going on in the patient's life, including sleep deprivation, how much support the woman receives from her partner and family, and the use of certain contraceptives that may predispose a woman to depression.

As with all medical conditions, people should first talk with their doctors before making any changes in their health care routine.

Women who would like more information about treatment for depression during or after pregnancy may contact Stuart at the UI Psychiatric Outpatient Clinic at (319) 353-6314.

Women who, after talking to their physicians, have questions about breastfeeding and antidepressive or anti-anxiety medication, may call (319) 384-7222 to make an appointment for a one-time consultation with Weissman. However, women taking medications other than anti-depressants or anti-anxiety drugs are best advised to talk with a psychiatrist about pregnancy and medication issues.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.