What new parents need to know about groundbreaking postpartum treatment
The Food and Drug Administration on Friday approved a first-of-its-kind pill to treat postpartum depression. The news represents a potential breakthrough in the treatment of a condition that in recent years has become one of the leading causes of maternal mortality in the United States.
Research shows that as many as 1 in 7 women will experience depression after childbirth but that only half of those receive treatment. Among the barriers to access are a lack of awareness about the symptoms, difficulty securing the treatment and stigma around mental health issues.
Given those challenges, experts have heralded the FDA's approval of zuranolone, which will be available under the brand name Zurzuvae, for once-daily use over 14 days. While the drug is also being marketed for adults experiencing other types of clinical depression, its ability to address mental health issues much more quickly than other available pills will make it particularly effective for treating postpartum depression during the crucial first days after childbirth, when women are bonding with their babies, experts say.
In addition to being fast-acting, clinical trials showed that the effects of Zurzuvae held for four weeks after the last dose, the FDA said, with the caveat that the trials did not follow up with patients past 45 days.
Given this advancement, The Washington Post asked clinicians what pregnant people and their families should know both about Zurzuvae, its symptoms and its treatment of postpartum depression.
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What are the symptoms of postpartum depression?
The early days of parenthood will make most feel overwhelmed and not themselves. Some of the symptoms of depression common in new mothers include changes in appetite and sleep. But clinicians said there are some more severe symptoms that could signal postpartum depression, including feelings of hopelessness, sadness, worthlessness or guilt, as well as trouble bonding with the baby. In the most severe cases, symptoms include suicidal thoughts. Symptoms can also appear late during pregnancy.
Some women are particularly vulnerable to postpartum depression, said Judite Blanc, an assistant professor of psychiatry and behavioral sciences at the University of Miami's Miller School of Medicine. They include lower-income women, younger women, those who have experienced trauma like intimate partner violence or those who have lost a child.
"In a nutshell, it's about stress and traumatic exposure," Blanc said.
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What treatments are available?
Before the approval of Zurzuvae, the only FDA-approved treatment for postpartum depression was Zulresso, an IV injection that could only be given in health-care facilities and would take as much as 60 hours to administer. The new pill, which acts similarly to the IV injection, greatly expands access because it can be easily taken at home.
There are some other key differences between the two drugs. While Zulresso was shown to affect patients' moods within 24 hours, the pill takes a few days to kick in, which is still a much shorter timeline than other anti-depression drugs.
An important caveat is that the clinical trials have primarily included women with severe postpartum depression, not those experiencing the more common range of symptoms that are more mild or moderate, said Catherine Monk, a professor of medical psychology at Columbia University. For that latter group, Monk said nonmedical interventions like therapy and lifestyle changes aimed at lowering anxiety levels may be more suitable.
For "someone with serious depression … this new medication is an absolute great step," Monk said. But for other cases, "there's still a terrible problem with accessing mental health care in this country, particularly when trying to use insurance to cover it."
Postpartum therapy can give new parents lifelong tools like addressing thought distortions and practicing mindfulness, Monk added.
Blanc said this drug alone won't solve the problem of maternal mental health, which has to be addressed more comprehensively by patients and their health-care providers.
"Just like if you have diabetics or hypertension, you need to exercise, you need to limit the number of hours that you're sitting, you need to take care of what you're putting on your plate," she said. "We have overwhelming evidence showing that those things affect mental health."
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How do you get access to treatment?
Experts say all women should be screened for postpartum depression during the early days of a pregnancy. For those who are not screened or are feeling like they are struggling, they suggest contacting your obstetrician or midwife for help. Other resources include the national maternal mental health hotline, 1-833-852-6262, and Postpartum Support International, which connects women with mental health care providers. Women in rural area can consult telehealth resources, which have expanded in recent years, in part due to the coronavirus pandemic.
"Telepsychiatry and telemedicine [are] much more readily available and covered by payers, both public and private," said Samantha Meltzer-Brody, director of the Center for Women's Mood Disorders at the University of North Carolina at Chapel Hill. "That has gone a long way to improving access to care and … specialized mental health care. That said, mental health care remains far too difficult for many people to access in this country, and that's particularly the case for maternal mental health."
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Sabrina Malhi and David Ovalle contributed to this report.
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