Intended for healthcare professionals

Letters Postpartum depression

NICE may be discouraging detection of postpartum depression

BMJ 2007; 334 doi: (Published 15 March 2007) Cite this as: BMJ 2007;334:550
  1. James C Coyne, professor of psychology in psychiatry (jcoyne{at},
  2. Alex J Mitchell, consultant in liaison psychiatry2
  1. 1University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
  2. 2Leicester General Hospital, Leicester LE5 4PW

    The National Institute for Health and Clinical Excellence (NICE) recommends these questions for routinely screening pregnant and postpartum women for depression: has she been sad or blue for at least two weeks; has she had anhedonia for that period; has she sought help for these problems?1 The NICE website offers no empirical support for these criteria.2 The requirement that women endorse sadness and anhedonia is more stringent than that for a formal diagnosis of depression. A recent meta-analysis3 found that requiring both symptoms to be endorsed caused substantial numbers of depressed patients to be missed. Adding the help question to the list can only make matters worse. Uptake of treatment in depressed pregnant and postpartum women is already low.4

    Women may be reluctant to seek help because they have not had the opportunity to discuss treatment options, including the relative risks and benefits of drugs, particularly in the context of any individual risk associated with a personal or family history of prolonged, severe, or otherwise impairing depression. The NICE guidelines may deny these women the chance to make an informed choice between psychotherapy and drugs.5


    • Competing interests: None declared.


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