Funding For Postpartum Depression and Education: It's Not What You Think

Health Professional

There's an interesting news article making the rounds.

Amy Philo is a new mom who, like many others with postpartum depression, had feelings to harm her child and others around her. She even thought to throw the baby down the stairs. While thoughts to harm the child are not common in postpartum depression, when they are, this is, surprisingly, one of the more common ones. Since her experience, she has become something of an activist on the issue.

The MOTHERS Act, which has already passed the House, was written after a pharmaceutical rep jumped from the 12th floor of a hotel, after previously being diagnosed with postpartum psychosis. The act provides for more funding for education and treatment.

The twist in the story is this: Philo is trying to block the MOTHERS Act.

Philo says that her homicidal feelings were caused by the antidepressant she was taking; and when she stopped the medication, the feelings disappeared. She now worries that such an Act would only encourage doctors to prescribe more antidepressants more liberally and earlier to such mothers.

This theme of this story is not a new one. The backlash against antidepressants is growing, not least because the opposing side-- pharmaceutical companies-- have almost all abandoned SSRIs as they have gone off patent. Doctors as well have little fight in them to promote these drugs' benefits, partly because they lack the resources to do so (research is funded either by the drug companies, or by NIH) and partly because they have moved on to other treatments for depressive conditions: antipsychotics, antiepileptics, etc.

On the one hand, it's hard to argue against "education and treatment." But even if one doesn't agree with Philo's belief that antidepressants caused her symptoms, any mental health bill, including the "Mental Health Parity Act" will indirectly lead to greater prescribing of drugs.

The Mental Health Parity Act increases the requirements for what mental health services insurers must cover. However, it is important to understand that the cost for these services will be offset by asking pharmaceutical companies to give money ("rebates") to Medicaid programs. In other words, the cost of your outpatient treatment will be brought to you by a grant from Pfizer.

So Philo is absolutely right, but for the wrong reasons. Increased education and treatment will inevitably lead to more drugs being prescribed (not just SSRIs) because it institutionalizes medication as the primary treatment modality.

The interplay between drug companies and doctors is not as simple as most news reports will imply. Drugs are marketed to doctors, and reps influence their prescribing. But there is a larger and more subtle manipulation going on, the strange bargain the government-- and psychiatry in general-- has struck with drug makers: "We don't like your manipulation of data and undue influence on doctors, and we want less contact with you but more access to your data. Can we have $3 billion now?"