A mother holding her baby while a doctor reviews information from a clipboard.
The first ever oral medication to treat postpartum depression could potentially make it easier for patients to get the help they need. The Food and Drug Administration approved Zurzuvae in August after studies showed patients had a significant improvement in their symptoms within a couple of days.
That’s a far cry from the months it can take for patients to see changes when taking a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
“Currently, the conventional wisdom in the field of treating depression and postpartum depression is if you have a benefit from a treatment like an SSRI, you usually recommend somebody stay on that treatment for at least six months,” said Gerard Sanacora, MD, PhD, Director of the Yale Depression Research Program and professor of Psychiatry at Yale University. “This is a two-week course that then can be stopped, so it can help minimize the need for long term treatment.”
SSRIs help treat depression by targeting the neurotransmitters serotonin, norepinephrine and to some extent, dopamine. This treatment instead targets the gamma-aminobutyric acid (GABA) neurotransmitter, making it more akin to drugs that have been used to treat anxiety.
Yale New Haven Hospital Clinical Pharmacy Specialist Heather Goodwin, PharmD, MS, BCPP, explains that Zurzuvae is structurally similar to the endogenous steroid allopregnanolone. During pregnancy, allopregnanolone levels increase but drop off dramatically after birth. It’s not fully understood what causes postpartum depression, but it’s hypothesized that restoring allopregnanolone with the use of a medication like Zurzuvae will help improve symptoms.
This treatment is very similar to a 60-hour IV infusion called Brexzanolone, which is costly and requires patients to come to a hospital setting for treatment. A pill that can be easily prescribed and taken at home may allow more patients to seek care.
Screening for postpartum depression
For many patients that first step to treatment is getting properly screened for postpartum depression at their six-week check-up. It’s common for patients to experience the “baby blues” during the first two weeks after delivery but symptoms that persist for several weeks could be a warning sign of postpartum depression. Common symptoms can include difficulty bonding with the baby, feelings of hopelessness, loss of interest and frequent crying.
Even if patients don’t present with symptoms at their follow up visit, Northeast Medical Group OBGYN Stefanie Parks, MD, says patients can still develop postpartum depression for up to a year after their delivery.
“I do see patients who are six to seven months out who are experiencing symptoms for the first time,” Dr. Parks said.
If at any point patients start to experience symptoms, they should reach out to their healthcare provider. An OBGYN is often the first point of contact for care and they can write prescriptions.
However, Dr. Sanacora stresses that additional tools such as cognitive behavioral therapy may be needed.
“I think it’s always important to realize, especially with depression and postpartum depression that these pills are not the total treatment. They’re part of a treatment plan,” said Dr. Sanacora. “To what extent the extra treatments are needed is obviously very individual, but the most important thing is that there’s close follow up to make sure it’s working and when it does work that you take steps to prevent a relapse.”
Additional resources: Postpartum Support International offers resources such as online support groups and a help line. In a mental health emergency, you can call 911 or 211, a free, confidential line for mental health help in Connecticut. If you or someone you know is in crisis, you can also call the National Suicide Prevention Lifeline at 988.
