August 10, 2023 – It might be one in all the happiest times in a girl's life – giving birth and meeting a recent baby (or babies) in person for the primary time. But for about one in seven moms, postnatal depression takes over, and the enjoyment is short-lived.
For the primary time The FDA has approved a pillTaken once every day for 14 days to assist women manage these often severe, sometimes overwhelming symptoms.
WebMD asked several mental health and girls's health experts to share their thoughts on this recent treatment option and what it would mean for relieving symptoms like hopelessness, irritability, lack of interest in bonding with the newborn – and in some cases, thoughts of death or suicide.
A quick-acting option
“We don't have many oral medications that work quickly, so this is incredibly exciting,” said Dr. Sarah Oreck, a psychiatrist in private practice in Los Angeles who focuses on reproductive psychiatry. The rapid effect is probably going since the drug targets the hormonal mechanism behind postpartum depression, she said.
Zuranolone (brand name Zurzuvae) is different from most other antidepressants—it’s designed to be taken for two weeks. Also, because zuranolone is available in tablet form, it’s more convenient to take than brexanolone (brand name Zulresso), the opposite FDA-approved drug that’s given intravenously.
“Having something in pill form is obviously a game-changer,” says Dr. Kimberly Yonkers, a psychiatrist specializing in women's health and chair of psychiatry on the University of Massachusetts Chan Medical School/UMass Memorial Medical Center in Worcester.
An necessary reason for that is that the drug should be given intravenously to the patient in a hospital, clinic or doctor's office in order that she or he might be monitored for complications, she said.
Women may notice an improvement in postpartum depression as early as 3 days after beginning to take the medication. In contrast, with typical antidepressants, it could possibly take as much as 2 weeks for patients to note a difference and 4 to eight weeks for a full effect to occur.
“A fast-acting pill that can be taken orally may be an ideal option for the 15 to 20 percent of women who experience postpartum depression,” said Dr. Priya Gopalan, a psychiatrist on the University of Pittsburgh Medical Center Western Psychiatric and Magee-Womens Hospital.
The cost of zuranolone is just not yet known. Yonkers said the price of the infusion could function a cautionary tale for the drugmaker. Some reports put the value of the infusion at $34,000. “Cost is going to be a major factor in this,” Yonkers said. “The previous intervention was so expensive that it was not affordable for many people.”
Beyond the “Baby Blues”
The American Psychiatric Association modified the name from “postpartum depression” to “peripartum depression” because there’s evidence that feelings and symptoms may appear late in pregnancy but before birth. Regardless of when it starts, the condition might be “very serious,” especially if the person already has depression, including bipolar disorder, Yonkers said.
Postpartum depression “is more than just 'baby blues.' It is a potentially debilitating illness that causes feelings of intense sadness and worthlessness and makes it difficult to care for and bond with your newborn,” Gopalan said.
Exhaustion and frustration are normal with a newborn. However, if you happen to find on a regular basis life difficult, you end up withdrawing from life and your family members, or you might be eager about harming yourself or your baby, these are symptoms of postnatal depression.
May be a medical emergency
Severe postpartum depression requires immediate attention and treatment.
“Any thoughts of harming yourself or others is a psychiatric emergency and should be treated in an emergency room as soon as possible,” Gopalan said.
Additionally, if you happen to are eager about harming yourself or your baby, call 988 to be connected to your local suicide prevention and crisis hotline.
“For a person with recurrent depression or major depressive episodes, this may not be enough because they only get those 14 days of therapy,” Yonkers said. “They may need ongoing antidepressants.”
“It may not be the right pill for everyone,” she said. She beneficial that each one patients be closely monitored during and after treatment “to make sure they are responding and to avoid relapses.”
The science that led to approval
Researchers conducted two studies in women who developed a serious depressive episode throughout the third trimester of pregnancy or inside 4 weeks of giving birth. They found that ladies who took zuranolone once within the evening for 14 days “showed significantly greater improvement in their symptoms than women in the placebo group.”
The antidepressant effect lasted for not less than 4 weeks after discontinuation of the drug.
Drowsiness, dizziness, diarrhea, fatigue, nasopharyngitis (cold), and urinary tract infections were probably the most common unwanted effects. There is a warning on the label that the drug may impair the flexibility to drive and have interaction in other potentially dangerous activities. According to 1 study, zuranolone might also cause suicidal thoughts and behavior. FDA press release to announce the approval.
The starting of more help for moms?
Zuranolone is just not a cure-all. Like most psychiatric medications, the drug probably works best when combined with behavioral treatments reminiscent of psychotherapy, taking other medications, behavior therapy, support groups and self-help activities reminiscent of meditation, exercise and yoga, Gopalan said.
Initial reactions on social media to the approval of zuranolone were positive, mixed with calls for more support for brand spanking new moms beyond drug treatment.
“We cannot allow this new drug development – which is very exciting and a wonderful addition to our toolbox – to distract us from the work that needs to be done in terms of advocacy, programming and support to truly improve the lives of mothers and birthing women in the United States,” Oreck said.
Maternal mental health issues reminiscent of postpartum depression are exacerbated by social and policy issues which have yet to be addressed – reminiscent of paid leave, disparities in maternal mortality, reproductive rights and access to mental health care, she said. Health equity is one other issue, she added: “Black and brown women continue to be at increased risk for maternal mental health issues and yet are less likely to receive appropriate care.”
Oreck hopes that the approval of this primary pill will result in further discoveries. “I hope this is the start of further innovation and the development of novel treatments that specifically target women's mental health issues – female reproductive hormones have a unique impact on mental health and it's exciting to see research and development funding finally flowing into these areas.”