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After the Rain

A UIC doctor offers insights into a persistent problem for new moms.

A UIC doctor offers insights into a persistent problem for new moms.

Photograph: Alec G. Huff

Dr. Laura Miller

THE DOCTOR: Laura J. Miller, 49, founder and director of the University of Illinois at Chicago Women’s Mental Health Program

WHAT EVERYONE USED TO THINK ABOUT POSTPARTUM DEPRESSION: Immediately following childbirth, many moms experience sudden mood swings, crying spells, restlessness, and problems with sleeping. If these feelings last only a few days, they are called “baby blues” and considered normal. Postpartum depression, which can affect a woman’s functioning up to a year after giving birth, was often either ignored or treated as a character flaw. Depression during a pregnancy (termed “antenatal” depression) also was often ignored. In society, such depression was considered a politically incorrect reaction to the impending birth. More recently, a series of books on the subject, including Down Came the Rain by actress-model Brooke Shields, have encouraged public discussion and acceptance.

HOW SHE GOT INTERESTED: Miller was working on treatment for women with schizophrenia and found that little was known about how to treat mentally ill pregnant women. She also discovered there were almost no services available for these women after they gave birth and began parenting. She began working to create an inpatient service at UIC for the most severely ill women, but funding was lacking. Then in 1988, a tragedy struck: a woman gave birth in a toilet at a local psychiatric facility that did not have an obstetrics unit. The baby died. “That was the wake-up call for the risks that can happen when there are not services geared towards the needs of pregnant women with depression,” Miller says. Since then, she has been extensively involved in shaping public policy around pregnancy-related depression in Illinois.

WHAT’S CHANGING: Under Miller’s guidance, UIC established an agreement with the State of Illinois to become a special provider of statewide services for pregnant women with depression or more advanced mental health issues. Now Miller and her team are turning their attention to the first line of defense-health care providers. Since 2004, Miller and her UIC team have been holding an expanding series of workshops for Illinois doctors, nurses, and social workers that teach how to screen for depression and how to prescribe the safest treatments. They also aim to guide participants through what Miller calls “those difficult decisions of weighing the risks of medications against the risks of untreated symptoms, what other kinds of treatments there are besides medication, and how medications affect breastfeeding.” Besides the workshops, Miller’s team now operates a consultation telephone line and has launched a Web site (www.psych.uic.edu/clinical/hrsa) so any health care provider can call or e-mail with questions. “This is particularly important since there are new medications all the time,” she says.

WHY THIS MATTERS: Widespread studies show that there is a tremendous underdetection and undertreatment of depression during pregnancy and postpartum, not only for women with mental health issues but for otherwise healthy moms, too. With untreated depression, the potential risk for several problems rises: low birth weight; premature births; or a condition called preeclampsia, which can contribute to the risk of seizures in the mother.

HER TAKE ON THE TOM CRUISE-BROOKE SHIELDS SQUABBLE: It never hurts if someone in the public eye comes forward and discusses that she suffered from postpartum depression and got through it, Miller says. As for Cruise’s insistence that a vitamin cure is all that is needed? “Some interventions are soundly based in research and others are not. Taking vitamins has been studied, but there is no clinical evidence that this is an effective treatment for clinical depression.”

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