New Mother Finds Hope in New Postpartum Depression Treatment

It was supposed to be an exciting time. A new mother had just given birth at age 42, after a much-desired pregnancy. But within a week, she developed postpartum depression, a medical condition characterized by extreme sadness, anxiety, or despair following childbirth, affecting up to 1 in 5 women.

At five months postpartum, the woman was stuck in a haze, according to Dr. Misty Richards, medical director of perinatal psychiatry at the Maternal Outpatient Mental Health Services Clinic at UCLA Health, who treated the patient. “She wasn’t taking showers. She wasn’t eating,” Richards said, noting that the woman’s husband had taken a leave of absence from work to care for his wife and new baby.

The Role of Zuranolone

Richards’ clinic has treated hundreds of patients with similar conditions. Initially, the woman was connected to an intensive outpatient program, but her condition remained severe, and she was actively suicidal. That’s when Richards prescribed zuranolone, the first-ever pill to treat postpartum depression.

The Food and Drug Administration approved zuranolone in August, but it took months for the drug to become available. Several psychiatrists have recently begun prescribing it, finding suitable candidates willing to try it. They hope it will be a game changer because it’s fast-acting and can be taken at home.

Richards said the woman saw her depression symptoms start to resolve around three days after beginning the medication. By day eight, she experienced dramatic improvements with no side effects. “She tells me she feels like she just woke up,” Richards said. “Her husband was in tears, super grateful. Just a major, grand slam success story — which, by the way, we don’t tend to see in psychiatry.”

Impact and Risks of Postpartum Depression

Postpartum depression can have severe consequences for mothers and their children. For mothers, it may increase the risk of suicide, high blood pressure, diabetes, or stroke. Mental illness, suicide, and drug overdoses are leading causes of death in the first year after childbirth. Children born to mothers with postpartum depression are more likely to have developmental delays and emotional or behavioral problems, and have a greater risk of dying before one year.

Before zuranolone, the only available treatment was an intravenous injection approved in 2019, which came with a risk of excessive sedation and sudden loss of consciousness, limiting its availability. Other women were given standard antidepressants, which usually take weeks to start working. Zuranolone, however, can be taken alongside widely used antidepressants and acts much faster.

Challenges in Prescribing Zuranolone

Despite the potential benefits of zuranolone, psychiatrists said some patients are hesitant to take a new drug due to concerns about side effects or practical barriers. Zuranolone can cause drowsiness, dizziness, diarrhea, fatigue, and urinary tract infections. Patients are advised not to drive or operate heavy machinery for at least 12 hours after taking it.

Dr. Uruj Haider, medical director of consultation services at the Massachusetts Child Psychiatry Access Program for Moms, mentioned some patients' concerns about being too tired to feed their babies at night. She recommends having another caretaker present overnight. Other patients have declined the medication due to a lack of safety data on breastfeeding, as a small amount of zuranolone can pass through breast milk, though studies haven’t evaluated if it poses harm.

Patient Experiences and Outcomes

Despite these challenges, early reports from patients who have taken zuranolone are promising. Haider shared that one of her patients experienced improvements by day four with manageable side effects. Dr. Julia Frew, a psychiatrist at Dartmouth Hitchcock Medical Center, noted similar positive outcomes in her patients, particularly those with chronic depression exacerbated postpartum.

Insurance and Accessibility Issues

Getting zuranolone approved by insurance companies has been a struggle for some psychiatrists. The medication must be obtained through specialty pharmacies and delivered by mail, adding complexity to the prescription process. Insurance companies have varying requirements for coverage, with some requiring patients to have tried and failed a standard antidepressant first.

Dr. Richards expressed frustration with the cumbersome process, noting that it is difficult for severely depressed patients to engage actively in managing their treatment deliveries. However, she remains optimistic about the drug’s potential.

Looking Ahead

Psychiatrists are eager to recommend zuranolone to more patients, despite the current hurdles. “I’ve started telling all my patients about it,” Dr. Katrina Furey, a clinical instructor at Yale School of Medicine’s psychiatry department, said. “Just so they know it’s available and they know that there is this new option.”

The introduction of zuranolone represents a significant advancement in treating postpartum depression, offering new hope to mothers struggling with this debilitating condition. As awareness and accessibility of the drug improve, it has the potential to transform the lives of many more women and their families.

Future Implications for Treatment

The success of zuranolone in treating postpartum depression could pave the way for its application in other mood disorders, expanding its potential benefits. Researchers are also looking into long-term effects and whether periodic booster doses might be necessary to maintain the medication's benefits. The ongoing collection of real-world data will be crucial in understanding the full scope of zuranolone’s efficacy and safety.

Support Systems and Awareness

In addition to medication, comprehensive support systems for new mothers, including counseling and community resources, remain vital. Increasing awareness about postpartum depression and reducing the stigma associated with mental health treatment are essential steps in encouraging more women to seek help.

Conclusion

Zuranolone offers a promising new avenue for treating postpartum depression, addressing a critical need for fast-acting, effective treatment options. As more patients and healthcare providers become familiar with this medication, it could significantly impact maternal mental health, improving outcomes for both mothers and their children.