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Zulresso and other treatments for postpartum depression




Arriving home with a new baby is one of those special life events that new moms will always remember but it can also be an overwhelming and turbulent time. Consequently, it may be unsurprising that up to eight out of ten new mothers experience the “baby blues," a common phenomenon characterized by mood swings and insomnia and caused by a combination of hormonal changes, exhaustion, and the prospect of facing the challenge of looking after a newborn baby.

In most cases, the baby blues pass after around a week but for some new mothers, the symptoms continue and intensify as time passes. This is known as postpartum depression or postnatal depression, a much more serious mood disorder that can last for weeks or months if left untreated.

Fortunately, the US Food and Drug Administration (FDA) has approved a new drug called Zulresso (brexanolone), the first medication specifically approved for the treatment for postpartum depression, providing another treatment option for the many American mothers struggling with this debilitating mental health condition. However, with a list price of $34,000 for each intravenous infusion of the Sage Therapeutics drug, we thought we would look at other postpartum depression treatment options.

What are the signs and symptoms of postpartum depression?

Postpartum depression can only be diagnosed by a healthcare professional and signs and symptoms of the condition are extremely broad, often varying significantly from patient to patient. Signs that you or a loved one may have this depressive disorder and may need treatment include (but are not limited to):

  • Strong feelings of sadness or hopelessness
  • Feeling overwhelmed and struggling with doing everyday tasks
  • Severe mood swings
  • Loss of interest in caring for yourself or your baby
  • Emotional numbness or feelings of emptiness
  • Problems concentrating, poor memory, or difficulty making decisions
  • Loss of interest in socializing or spending time with friends and family
  • Loss of interest in sex
  • Loss of interest in normally enjoyable activities
  • Crying for no apparent reason
  • Anxiety, irritability, or restlessness
  • Difficulty forming a bond with the baby
  • Contemplating self-harm or harming the baby
  • Loss of appetite or over-eating

In cases of severe postpartum depression, mothers may develop postpartum psychosis. Signs of this may include disorientation, confusion, hallucinations, delusions, disturbed sleep, paranoia, having obsessive thoughts about the baby, or attempting to harm oneself or one's child. Postpartum psychosis is a very serious condition and treatment should be sort immediately, as it may lead to suicidal thoughts and behaviors that could threaten the safety of mother and child.

What are the risk factors for postpartum depression?

Postpartum depression can affect any new mother, whether their new baby is their first child or not. There is no single cause for the condition, but changes in hormone levels and the emotional upheaval that comes with a newborn are contributors. Common risk factors that may increase the likelihood a new mom will develop postpartum depression include a history of depression or mental health conditions, such as bipolar disorder; and environmental factors, such as a lack of a strong support system, financial problems, or relationship issues. New moms who have gone through a particularly stressful or difficult pregnancy or birth, have gone through other stressful life events in the year preceding giving birth, or who have other health problems or anxiety disorders, may also be at a higher risk of developing postpartum depression.

How is postpartum depression treated?

If you think you or a loved one shows any postpartum depression symptoms, it is important to seek advice from a psychologist or licensed mental health provider so they can start treatment for postpartum depression as soon as possible. Options for treatment of postpartum depression include psychotherapy and counseling, and taking antidepressant medication.

Treating postpartum depression with medication

Different treatment options will suit different patients, depending on the severity of the condition and each patient’s individual history. However, postpartum depression is commonly treated with antidepressant medication, particularly selective serotonin-reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) or Zoloft (sertraline). Other options include norepinephrine reuptake inhibitors (SNRI), for example, Effexor (venlafaxine) and certain tricyclic antidepressants.

Tricyclic antidepressants, such as Elavil (amitriptyline) or Tofranil (imipramine), are usually only tried as a treatment option after a course of SSRIs have failed to work, as the side effects of these drugs are more significant. Certain tricyclic antidepressants, such as Silenor (doxepin) should not be used by breastfeeding mothers, as it may be passed on to infants in the breast milk. If you breastfeed your child, be sure to speak to your psychologist or healthcare provider to ensure the medication you are prescribed will not affect your infant.

What is Zulresso (brexanolone)?

The US Food and Drug Administration (FDA) recently approved Zulresso (brexanolone), the first medication specifically indicated for treating postpartum depression. The drug is administered intravenously by a healthcare professional in a hospital setting and is expected to be available in the US in the summer of 2019.

Unlike many other medications used to treat postpartum depression, Zulresso can potentially alleviate symptoms within 48 hours of treatment and, according to the FDA, the effects were still apparent after a 30-day follow-up appointment. However, the medication is expected to cost up to $35,000 per treatment and as yet it remains unclear whether insurers will cover the drug.

Commenting on the approval, Ann Smith, CNM, president of Postpartum Support International said: “It is important to recognize that options to treat postpartum depression include self-help strategies, support groups, and counseling, in addition to medication. We want families to realize that medications currently available are effective for many, but having an innovative treatment that has been specifically studied in for postpartum depression and shown efficacy and improvements is an important milestone.”

Are non-medication treatments for postpartum depression available?

Yes, in nearly all cases of postpartum depression healthcare providers will recommend some form of psychotherapy, talk therapy, or counseling to help new mothers through this difficult time. Cognitive-behavioral therapy (CBT) focuses on teaching techniques for dealing with negative thoughts, improving problem-solving skills and educating new mothers on relaxation methods. CBT is one of the preferred first-line treatments for the condition and research indicates it is one of the most effective forms of treatment.

Other forms of therapy used to treat postpartum depression include interpersonal psychotherapy, which focuses on teaching communication skills, and couples therapy, which can provide a safe space for partners to address any issues that may be contributing to the mental health condition.

Other steps to speed recovery from postpartum depression

If you or a family member is struggling with postpartum depression, it is important to seek help from a medical professional. However, there are steps you can take at home to help alleviate the symptoms and speed up recovery. As with other forms of depression, focusing on maintaining a healthy lifestyle can yield positive results, for example, try to get plenty of exercise and rest, eat healthy foods and avoid drinking alcohol.

As a new mother, it is easy for all your attention to focus on your newborn baby, but if you are struggling with postpartum depression, you should take time to look after yourself. This may mean taking breaks to do something you enjoy and asking for help from friends, family or your partner to ensure you get plenty of rest. Try to identify particular sources of stress or anxiety; for example, if you are worried about your parenting skills, seek support or advice to help you through the difficult times.

Seek support

As has already been touched upon, seeking support is an important step in overcoming postpartum depression, whether this is from medical and mental health professionals, or from within your own support system. The period following the birth of a child is stressful and exhausting and this is normal, but if you are struggling with depressive symptoms, it can be even more overwhelming and difficult.

If you have friends, family or a partner who can provide emotional support during this period, make sure you communicate and reach out for help. Around one in seven women in the United States experience postpartum depression and there are plenty of treatment options out there, so try to be proactive and seek help as soon as possible.

Postpartum depression is a common women’s health issue, but there are social support groups for postpartum women and a variety of possible treatments to help get you through this difficult time. The sooner you seek treatment or support, the sooner you can get on the road to recovery and start to enjoy life with the newest member of your family.



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