Yesterday, I shared the news that the American Psychiatric Association released its initial changes to the manual used to diagnose people with mental illnesses (the DSM). These changes will lead to its 5th edition, known as the DSM-V. This includes information about postpartum depression and postpartum psychosis.
In searching for information about any changes that were going to be made related to perinatal mood and anxiety disorders, I came upon a memo that frustrated me. The language used made it seem that there's an argument about whether postpartum depression even exists. I know, of course, that this isn't what the writer concluded, but I can also see how the average person reading it might be confused.
I am the average person, and I was confused, even though logically I understood what he was trying to say. I'm not a scientist, a researcher, a doctor, a nurse, a therapist, a physician's assistant, or even someone who plays a doctor on TV. I am as lay as a layperson can be. The hairs on the back of my neck stand up, my teeth gnash, my stomach roils and my fists clench when I see anyone questioning or even seeming to question postpartum depression. Those people should read my email.
If I weighed in on that memo, there'd be lots of expletives, inappropriate sneering,and challenges to "take it outside", andcertainly some if not all of my response would be based onscientific ignorance on my part. So I figured I should leave it to the experts to weigh in. They are scientists and doctors and specialists and they understand what goes on behind the scenes. Dr. Lucy Puryear is a psychiatrist in private practice specializing in women's reproductive health and a clinical Assistant Professor of Psychiatry at Baylor College of Medicine in Houston, Texas. She is the author of "Understanding Your Moods When You're Expecting", andthe president-elect of Postpartum Support International. Here's her response to the DSM-V:
If you haven't already heard the news, the Diagnostic and Statistical Manual (DSM) that clinicians use to make psychiatric diagnoses is undergoing a major overhaul. The DSM, now in its fourth version, is being modified in an effort to make psychiatric diagnoses more valid and more reliable. Changes are made usually every 10 to 20 years to reflect progress in research and knowledge that has been gained.
Remember that psychiatrists don't have x-rays or blood tests that we use to diagnose an illness (although research is leading us in that direction); we rely on the DSM, our training and our clinical judgment to make diagnoses. This is obviously an imperfect system that needs updating from time to time.
Now I personally have been anxiously waiting for the language surrounding postpartum disorders to be circulated. In the old manual, postpartum illnesses got very little attention and it's been my hope that the psychiatric community would acknowledge this as a significant entity and highlight the importance of recognizing and treating postpartum disorders.
I think we're moving in the right direction. As I read what is being proposed, the good news is that postpartum mood disorders will have a place in the new DSM-V. Postpartum depression will be listed as Major Depressive Disorder (it is indeedthat) with postpartum onset. To make this qualification the symptoms must begin within the first 6 months postpartum. This is a huge improvement over the 4 to 6 week criteria listed in the DSM-IV.
The memo that is linked to in regards to that diagnosis may be confusing. It could appear that Dr. Ian Jones (the physician given the responsibility to come up with an opinion for others to debate) is questioning whether or not postpartum depression exists. He cites studies both pro and con for including the disorder. This is how scientists come to conclusions. We look at all of the available data, both negative and positive, to decide the outcome that carries the most scientific weight. Then we often argue amongst ourselves and hopefully come up with the right answer and shake hands.
The positive here is that after looking at the research, Dr. Jones supports postpartum depression being included in the DSM-V. He has concluded that there is enough evidence supporting the fact that there is a link between childbirth and depression to include postpartum depression as a real disease. (I am resisting saying "no duh".) This is a victory for women who suffer from postpartum disorders and those of us who treat them. We're not done fighting for recognition and support, but it is a victory to have a legitimate place in the new diagnostic manual.
Thanks Dr. Puryear. Maybe I won't have to get in a fistfight after all! 😉
Know, by the way, that you have the power to speak out about the DSM-V. If you register here (top right corner of your screen), you can add your own comments about the changes that are being made.