Industry action overdue on postnatal depression

Only one in four cases of postnatal depression are diagnosed and treated. Sufferers often believe they will recover given time, while physicians can be hesitant to prescribe drugs fearing breast milk contamination. However, it is vital that something is done to curb the crisis: the WHO estimates that depression will become the second biggest cause of death and disability by 2020.

Numerous epidemiological studies from all over the world have concluded that between 10-15% of all new mothers meet the criteria for postnatal depression in the three-month period after giving birth, however, research has suggested that only 25% of all patients who suffer from postnatal depression are ever diagnosed.

As such, 75% of all patients suffer in silence, meaning that the depression has the potential to become a chronic and recurring illness. Aside from the health of the mother, studies have also illustrated the negative effect that postnatal depression has on the development of infants.

Up the ante

Datamonitor recently conducted a series of in-depth interviews with opinion leaders. The results of this research suggest that of the diagnosed population only 30% are prescribed antidepressant medication.

Although guidelines suggest that antidepressant medication should be prescribed for around six months, opinions leaders say that in practise it is likely to only be six weeks, which outlines the view that postnatal depression is only treated as being a transitory illness.

This lack of effective diagnosis and treatment presents a huge danger to the potential mental health of women suffering from postnatal depression. As childbirth is one of the major physical, social and psychological stresses of a woman's life, research has focused on determining whether it is a predictor for an increased risk of other psychiatric illnesses.

Such analysis has drawn alarming conclusions. The risk of developing psychosis in the postnatal period is estimated to increase by 14.5 times, whilst a study of 35,000 births in the US discovered that patients had a sevenfold increased risk of a psychiatric hospitalisation (87% were for affective disorders) within the three-month period following childbirth.

Milk contamination?

One of the main problems faced by physicians over the treatment of postnatal depression is that very little clinical research has been published in this area. Although drugs such as Eli Lilly's Prozac (fluoxetine) and Wyeth's Effexor (venlafaxine) have proven effective in treating postnatal depression, the majority of first-line antidepressants have instead focused on only presenting safety data.

This is because physicians and patients are concerned about the levels of active antidepressant medication, which can be passed to the infant through breast feeding.

Although a number of trials have indicated that this is not a serious problem, and is only likely at high doses, a widescale trial involving a broad number of compounds needs to be conducted to determine what, if any, problems there are and whether differences exist between different drugs on the market.

Another major impact on the poor diagnosis rate of postnatal depression is the fact that potential patients are far more likely to be diagnosed and treated, at least in the initial stages of the disease, by a non-psychiatric secondary care specialist.

Mothers with newborn babies are likely to have high interaction with specialists such as obstetricians, gynaecologists, paediatricians and even health visitors, as well as an increased use of general healthcare provision, in the immediate period after giving birth.

Therefore, these specialists are in the prime position to diagnose and treat any bouts of postnatal depression. This represents a significant challenge not just to pharmaceutical manufacturers, who will have to devise highly specific marketing strategies, but also healthcare systems.

What's the prognosis?

By 2020 the World Health Organisation has estimated that major depression, of which postnatal depression is a subgroup, will be the second highest cause of death and disability in the world. As such, depression will become an increasing drain on resources, and healthcare systems will focus attempts on ensuring that less people suffer from chronic forms of the illness.

By pushing for increased screening of postnatal depression, then antidepressant manufacturers can expect to see an increased utilisation of their products as the diagnosis rate increases.

"Postnatal depression is a serious medical condition which has not been taken seriously by all sections of the healthcare community," said Nick Alcock, depression analyst at Datamonitor. "It can lead onto a life of chronic depression if patients remain untreated, which can impact not just that patient, but the development of the infant and the family unit as a whole."

"Antidepressant manufacturers need to outline not just the safety, but the efficacy of their drugs for this section of the depression patient population, as well as developing marketing strategies which reach non-psychiatric secondary care specialists."

"Furthermore, healthcare systems need to put into place guidelines which ensure that screening for postnatal depression is more regular and that treatment, when appropriate, is for a minimum of six months as opposed to six weeks," Mr Alcock continued.

"If these recommendations are enacted then postnatal depression will become a more accepted and treated illness, otherwise it will remain an under treated illness which affects thousands of women in the UK alone."

If you found this week's Expert View useful, you may be interested in Datamonitor's reports:

- Postpartum Depression: Overcoming Unique Barriers to Treatment is priced

- Drugs of Tomorrow 2002: Depression - A Pipeline Driven by Side Effect Profile

- Treatment-Resistant Depression: An Untapped Area of the Patient Population

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