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The massive health care reform bill the U.S. Senate passed on Christmas Eve also would study the causes and treatment of postpartum depression.

U.S. Sen. Robert Menendez, D-N.J., included five pages on depression as part of his efforts to get the nation to mirror the way New Jersey addresses the mental-health disorder. The entire bill comprises 2,409 pages.

Postpartum depression, also called perinatal mood disorder, affects as many as one in eight mothers, according to the Centers for Disease Control and Prevention.

In 2006, New Jersey became the first state in the country to require hospitals and clinics to offer depression screening to new mothers. The patients are not obligated to take the simple 10-item questionnaire called the Edinburgh Postnatal Depression Scale. It is designed to detect possible signs of depression by asking questions such as, "In the past seven days, I have felt sad or miserable: most of the time, quite often, not very often or not at all."

"It is a screening tool. Just because one tests at high risk does not mean they have postpartum depression," said Celeste Wood, assistant commissioner with the state Department of Health and Human Services.

"It can trigger further referrals to mental-health professionals or peer counseling to provide support," she said.

The state estimates that each year 11,000 to 16,000 mothers suffer from some form of the disorder. Women can develop symptoms during their pregnancy or months afterward, Wood said.

"Seventy to 80 percent of women experience some level of baby blues," Wood said.

But this fleeting feeling of sadness, which develops weeks after the birth, usually goes away on its own without treatment, according to the CDC.

Depression lasts longer and has a bigger effect on daily activity, with frequent bouts of crying and intense feelings of hopelessness or of being overwhelmed. In extreme cases, women can suffer postpartum psychosis and harm themselves or their families.

New Jersey's lawmakers addressed postpartum depression in 2006 during the interim term of Gov. Richard J. Codey, whose wife, Mary Jo, spoke candidly and publicly about suffering through the disorder.

New Jersey also launched a public-service campaign called "Speak up when you're down" to try to remove the embarrassment or stigma associated with depression. New Jersey now has 22 active support groups for postpartum depression, Wood said.

"One of our goals is to try to reduce that stigma. We want women to speak up and talk about their signs and symptoms," Wood said.

A congressional proposal to adopt screening nationwide - called the Mother's Act - prompted some criticism about privacy issues and overreaching by government, and fears that depression diagnoses could lead to the unnecessary prescription of psychotropic drugs.

Bruce E. Levine, a clinical psychologist from Cincinnati, said the questionnaires used by New Jersey are notoriously unreliable because of the subjectivity of the responses.

Levine said doctors too often prescribe strong anti-depressants instead of getting to the root of the everyday stresses that can contribute to depression.

"The overwhelming majority of people on antidepressants are not in therapy or counseling. Nobody has bothered to ask, ‘Why are you down today? What's really happening here?'" he said.

Studies have found higher rates of postpartum depression in American moms compared to mothers in places such as Fiji, where extended families generally provide greater social support, he said.

"Unemployment, poverty, people who have gone through trauma or major losses - that's what depression really is, a reaction to overwhelming emotional or physical pain and people's attempts to cope by shutting down that pain," he said.

He said the harm in the Senate's health care bill is that it does not acknowledge America's cultural predisposition to postpartum depression.

"It would be nice but unlikely if the U.S. Senate would take seriously what's going on socially and culturally for moms in our society," he said. "Offering paid paternity leave at the very least - that would be a start."

The toned-down health care reform bill the Senate passed last month does not ask health care providers to offer screenings. Instead, it merely calls for studies to improve the diagnosis and treatment of postpartum depression.

"The controversy seems misunderstood," Wood said. "It just talks about treatment, which could include medication. The law clearly does not promote the use of medications."

Contact Michael Miller:

609-272-7247

MMiller@pressofac.com

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