I can give you depression. Depression is caused by hormonal changes of pregnancy and childbirth – even in the absence of other triggers – in some women. I can provoke clinical depression simply by giving women the pregnancy hormones estrogen and progesterone when they’re not pregnant. Pregnancy hormones trigger depression by blunting the brain’s response to things that usually make us feel good, like when a mom feels numb instead of joy when she hears her baby laugh for the first time. This helps explain why depression during and after pregnancy is so common, affecting one in every eight women.
My work as a psychologist and researcher – along with decades of investigation by others – shows that mental health is rooted in our biology at every level. Mental health dramatically influences physical health not only for new moms but also for their babies. Yet the Senate’s health care bill would allow states to opt out of mandating coverage for maternity care and mental health treatment.
It is nonsensical to treat these conditions differently from other health conditions, because depression during pregnancy and the postpartum period is biologically based, in much the same way that other chronic health conditions, such as diabetes and cancer, are biologically based. Even if this sounds surprising, you’ve probably heard someone you know say, “I’m feeling hormonal.” Almost all of my patients use this phrase when they come to my clinic for treatment, which shows their intuitive understanding that our hormones powerfully influence our minds.
The reverse is also true: Our minds powerfully influence our bodies. Women who are depressed during pregnancy are less likely to attend their regular checkups. They don’t pay as much attention to their diet, exercise and medical problems, which can lead to delivery complications. Babies of mothers who are depressed are more likely to be born early and underweight, and often have slower cognitive development. Mothers with depression also tend to take their babies to fewer well-child visits and are more likely to engage in unsafe practices like putting babies to sleep on their tummies or to bed with a bottle. They also have difficulty connecting with their babies, which can lead to emotional and behavioral problems in their children down the road, including anxiety, depression, and ADHD.
The good news is that we have treatments that work. Some psychiatric medications are safe during pregnancy and breastfeeding, and quite often, the benefits of treatment outweigh the risks to the baby. Many mothers are nevertheless reluctant to take medication because of the potential risks, and for them, psychotherapy is a better alternative. Two specific kinds of therapy – interpersonal therapy and cognitive-behavioral therapy – treat depression quickly.
However, good therapy can be hard to find and afford. Mothers drive from across North Carolina for therapy in my clinic, and those with severe symptoms come from all over the country for treatment in our psychiatric inpatient unit, which is one of only three in the U.S. dedicated to treating mental health conditions during pregnancy and after childbirth.
Some might say tackling mental health care will be complicated and expensive. But making mental health treatment accessible and affordable will reduce costs to the health care system in the long term by improving the likelihood that mothers will attend regular medical checkups and follow their doctors’ recommendations, thereby reducing complications for both mothers and infants.
Carve-outs for maternity and mental health reflect a failure to understand not only science but also economics. Let’s dispense with the outdated idea that the body and mind are separate, which is at the foundation of decisions to pay for physical but not mental health care. Mental health is physical health, and our bodies and our babies are only as healthy as our minds.
Crystal Edler Schiller, PhD, is an assistant professor in the Center for Women’s Mood Disorders and Department of Psychiatry at the University of North Carolina at Chapel Hill.