The New Postpartum Depression Drug: What Do We Know?

To date, there hasn’t been a drug made specifically to treat postpartum depression (PPD). Like many issues in maternal and reproductive health, there is a lack of research, funding, and answers. The small portion of people who are currently seeking out help for PPD are prescribed the same regimen available to people with generalized depression: antidepressants and counseling. Although PPD is one of the most common complications in the perinatal period, impacting ~15% of birthing people within the first year of birth, it is still very misunderstood. The FDA just approved Brexanolone, sold under the name Zulresso by Sage Therapeutics, which performed well in trials. Its wide release is slated for June. It will be administered intravenously and, unlike other antidepressants, the effects will be fast-acting with patients experiencing results in less than three days and lasting up to a month.

The drug costs $34,000 without insurance. Insurance companies are still deciding how they are going to cover a drug like this. However, even for people who can afford to pay the price, the time requirement is huge for a new mother: 60 hours in a hospital or clinic with a continuously monitored infusion. Right now it is unclear what type of access a mother might have to her newborn when under this type of care. PPD can be a life-threatening condition, and it is important to have life-saving options for those who are incapacitated and unable to take care of themselves or their babies. In severe cases, some people are hospitalized for much longer than the 60 hours it takes to administer the dose, and proponents of the drug argue that these are the situations where Zulresso will make a huge impact.

Postpartum depression vs. baby blues

Impact

  • Baby blues: ~50-80%  

  • PPD: 15-20%

Onset

  • Baby blues: 3 days to 1 month postpartum

  • PPD: a few days after birth but at risk from 6 weeks to 1 year

Cause

  • Baby blues: hormonal shift

  • PPD: history of depression, anxiety or other mood disorders, severe PMS, thyroid problems, hormonal changes

Symptoms

  • Baby blues: tearfulness, moodiness, frustration, irritability BUT interspersed with positive emotions  

  • PPD: anxiety, sadness, guilt, lack of interest in the baby, thoughts of hopelessness and/or harming the baby or yourself, feeling worthless, extreme fatigue and/or excessive worry about the baby’s health

Management

  • Baby blues: support from family, friends, or a postpartum doula and self care

  • PPD: support from family, friends, or a postpartum doula, self care, counseling, and medication


References and resources:

www.themotherhoodcenter.com

www.seleni.org

https://www.vox.com/science-and-health/2019/3/20/18274133/postpartum-depression-sage-therapeutics-brexanolone

https://www.nytimes.com/2019/03/19/health/postpartum-depression-drug.html

https://www.npr.org/sections/health-shots/2019/03/21/705545014/new-postpartum-depression-drug-could-be-hard-to-access-for-moms-most-in-need