Amanda Bisnath, National Center for Health Research
There are many physical and emotional changes that affect mothers before, during, and after childbirth. These changes can cause a wide array of mental illnesses called Perinatal Mood and Anxiety Disorders. Postpartum Depression (PPD) is the most common of these illnesses and causes mothers to suffer from serious depression that can last for weeks or months. If severe, PPD can put both the mother and the child in danger. As an illness, PPD is never the mother’s fault. It is not something that mothers can “snap out of” or “get over.”
Although PPD affects between 10-15% of new mothers, available treatments are not guaranteed to help. Antidepressants such as Zoloft and Prozac are commonly used to treat PPD. However, antidepressants are not always effective and when they are, it can take up to four weeks for antidepressants to help mothers feel relief. Mothers may have to try several different antidepressants before finding one that works.
What is Postpartum Depression?
Postpartum Depression (PPD) is one of the most common complications of childbirth. Mothers with PPD can experience debilitating symptoms such as sadness, hopelessness, excessive crying, suicidal thoughts, and thoughts of hurting their baby.[2,3] PPD is often confused with the “baby blues.” Though the “baby blues” and PPD have similar symptoms, the “baby blues” only last three to five days. PPD can last anywhere between a few weeks to a year and can also cause anxiety and psychosis.
Since all mothers experience changes in hormones after childbirth, it is not surprising that some women become depressed when estrogen and progesterone levels suddenly decrease. However, researchers are not quite sure why some have PPD and others do not. Research has found that mothers with anxiety or depression during pregnancy are more likely to develop PPD after childbirth.
Without treatment, PPD can become a chronic condition that severely affects an entire family. In addition to its effects on the mother, PPD can cause similar depressive symptoms in new fathers. Children whose mothers experience PPD are more at risk of emotional, behavioral, and psychological issues. These children are also at risk of delayed language and cognitive development. To ensure the health of the child, it is important that mothers seek treatment for PPD.
Traditional Treatments for PPD
The most common treatment for PPD is antidepressants. Antidepressants alter brain chemicals, known as neurotransmitters, that regulate mood. The most common kind of antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs work by increasing the neurotransmitter serotonin, known as the “happy chemical,” in the brain.
On average, antidepressants are effective for fewer than half of the patients that take them. Nevertheless, a combination of antidepressants and talk therapy is widely considered the most effective way to treat depression. Due to the severe risks PPD poses on both the mother and child, taking antidepressants can be an important way of ensuring a family’s safety.
As noted earlier in this article, it usually takes several weeks for antidepressants to work. When they do work, some patients find that antidepressants stop working after several months. This can make it very difficult for new mothers to care for their children. Additionally, many mothers are reluctant to take antidepressants if they plan to breastfeed. Research shows that very low levels are found in breastmilk, but little is known about how antidepressants affect infants.
A New Treatment for PPD, Brexanolone
In March of 2019, the Food and Drug Administration (FDA) approved the first treatment for PPD. The treatment is an intravenous (IV) injection of brexanolone. Marketed under the name Zulresso, the drug is manufactured by the pharmaceutical company Sage Therapeutics, Inc.
According to the researchers who developed the drug, brexanolone works by blocking receptors in the brain from experiencing the dramatic hormonal changes that cause PPD. Brexanolone is administered intravenously over a 60 hour (2.5 day) period. During this time, healthcare providers must monitor the mother and child to watch for dangerous side effects.
Unlike other antidepressants, brexanolone provides immediate relief to mothers after the 60 hour administration period. Mothers can also continue taking other antidepressants if needed.
However, loss of consciousness is such a common side-effect that the drug must be administered in a healthcare facility. Due to this and other risks, the FDA only approved brexanolone as a treatment for mothers who do not respond to other antidepressants. Another concern is that trace amounts of brexanolone are found in breastmilk. Since no studies have been conducted on the safety of brexanolone on infants, some new mothers might be hesitant to take the medication.[6,7]
Aside from its dangerous side-effects, brexanolone is extremely expensive, with an average cost of $34,000. This does not include the cost of staying in a medical facility during administration. Since it is a new drug, no generic version of brexanolone is currently available, but insurance companies are likely to cover treatment. Additionally, the 60 hour administration period could make it difficult for working mothers who may not be able to take time off from work.
Alternatives to Medication
Medication is not the only way to help manage PPD and improve child outcomes. Research has shown that cognitive behavioral therapy is the best type of talk therapy to reduce depression in mothers with PPD. Staying physically active, avoiding isolation, and taking time to do an enjoyable activity can also help to reduce feelings of loneliness and stress. Some studies suggest that taking supplements high in omega-3 fatty acids, such as EPA and DHA, during pregnancy can help reduce the risk of PPD.[3,10]
Bottom Line and Future Considerations
PPD is a common complication of pregnancy that is in no way the fault of the mother. Antidepressants can help manage PPD, but it can be difficult to find the right medication for each patient. Brexanolone is a new medication marketed to treat PPD, but it can be dangerous and expensive. Sage Therapeutics is currently conducting clinical trials for a pill version of brexanolone. But if patients are taking this new version at home, who will make sure new mothers don’t suffer from dangerous side effects?
If you suspect that you or someone you love has PPD, contact your physician. The choice of taking medication is up to the patient, but should always be an informed decision.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
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- Dominguez M, Burgos L, Bergink V. Perinatal Mood and Anxiety Disorders. In: Sperling R, editors. Mount Sinai Expert Guides: Obstetrics and Gynecology. Hoboken, NJ: John Wiley & Sons, Ltd.; 2020. 127-132. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119450047.ch16
- Office on Women’s Health. Postpartum Depression. Womenshealth.gov. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression. Updated May 14, 2019.
- Brummelte S, Galea LAM. Postpartum depression: Etiology, treatment and consequences for maternal care. Hormones and Behavior. 2016; 77: 153-166. https://www.sciencedirect.com/science/article/abs/pii/S0018506X15300428?via%3Dihub.
- U.S. Food and Drug Administration. Depression: FDA-Approved Medications May Help. Fda.gov. https://www.fda.gov/consumers/consumer-updates/depression-fda-approved-medications-may-help#:~:text=on%20bipolar%20disorder.)-,Treatment%20with%20Medication,are%20involved%20in%20regulating%20mood. Content Current as of April 28, 2017.
- Don BP, Mickelson KD. Paternal postpartum depression: The role of maternal postpartum depression, spousal support, and relationship satisfaction. Couple and Family Psychology: Research and Practice. 2012; 1(4): 323-334. https://psycnet.apa.org/record/2012-18546-001.
- U.S. Food and Drug Administration. FDA approves first treatment for post-partum depression. Fda.gov. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression. March 19, 2019.
- Sage Therapeutics, Inc. Zulresso [package insert]. U.S Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211371lbl.pdf. March 2019.
- Sage Therapeutics, Inc. Form 10-Q. 2019. https://investor.sagerx.com/node/10196/html.
- Huang L, Zhao Y, Qiang C, et al. Is cognitive behavioral therapy a better choice for women with postnatal depression/ A systematic review and meta-analysis. PLoS One. 2018; 13(10): https://pubmed.ncbi.nlm.nih.gov/30321198/.
- Hsu MC, Tung CY, Chen HE. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation. Journal of Affective Disorders. 2018; 239: 47-61. https://www.sciencedirect.com/science/article/pii/S0165032717320141?via%3Dihub.
- Sage Therapeutics, Inc. Sage Therapeutics Announces SAGE-217 Meets Primary and Secondary Endpoints in Phase 3 Clinical Trial in Postpartum Depression. Investor.sagerx.com. https://investor.sagerx.com/news-releases/news-release-details/sage-therapeutics-announces-sage-217-meets-primary-and-secondary. January 7, 2019.