New Pill Approved to Treat Postpartum Depression

Last week, the Food and Drug Administration approved the first oral medication, called Zurzuvae (zuranolone), to treat postpartum depression, a very common condition that is often under-recognized and under-diagnosed.

The pill is taken nightly for two weeks and works quickly to improve symptoms. Two clinical trials found that the majority of women (72 percent and 57 percent respectively) had at least a 50 percent improvement in their depression symptoms after two weeks. Unlike the antidepressants that are often prescribed, Zurzuvae specifically targets the hormonal changes that can lead to postpartum depression.

Prior to the pill’s approval, the only treatment approved for postpartum depression was a 60-hour infusion given at a hospital or clinic. However, the therapy is not widely available and separating a mother from her newborn can be very disruptive for families.

Psychologist Sheryl Kingsberg, PhD, Division Chief, University Hospitals OB/GYN Behavioral Medicine, says the newly approved treatment will give much-needed recognition to a condition that affects up to 15 percent of new mothers. She hopes that it will encourage more women to seek treatment; because with postpartum depression, early diagnosis and treatment is crucial to the well-being of both mother and baby.

Postpartum Depression vs. Baby Blues

Close to three-quarters of new mothers experience the baby blues – a short-lived emotional response in which they feel irritable, restless and anxious. But postpartum depression, which affects around 13 percent of new moms, is different: It's more serious and needs treatment to go away.

“Postpartum depression differs from the baby blues in that the symptoms are more severe and last longer,” says Dr. Kingsberg.

Many women who experience postpartum depression begin to feel its effects one week to several weeks after giving birth.

Symptoms of Postpartum Depression

Symptoms of postpartum depression can develop within days after delivery and up to three months later. They can range from mild to severe symptoms.

Postpartum depression often follows two patterns. One is a pattern of anxiety and obsessive-compulsive thoughts. Women with this anxious form of postpartum depression experience catastrophic fears. These thoughts usually revolve around feelings that they will lose control and unintentionally harm the baby.

These women frequently have “what if” thoughts such as, “what if I accidentally drop the baby." These awful, unwanted thoughts play over and over and these new mothers feel inadequate to the task of taking care of their baby.

The other pattern is a flat and depressed mood similar to other major depressive episodes that are not specific to pregnancy/postpartum. These symptoms include:

• Persistent sad, anxious, or “empty” mood
• Irritability
• Feelings of guilt, worthlessness, hopelessness or helplessness
• Loss of interest or pleasure in hobbies and activities
• Fatigue or abnormal decrease in energy
• Feeling restless or having trouble sitting still
• Difficulty concentrating or making decisions
• Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or sleeping too much
• Change in appetite
• Aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause or do not ease even with treatment
• Trouble bonding or forming an emotional attachment with the new baby
• Persistent doubts about the ability to care for the new baby
• Thoughts about death, suicide, or harming oneself or the baby

Risk Factors

There is no one single cause of postpartum depression and women are not to blame. Postpartum depression is not caused by lack of fortitude or not wanting to parent. Biological and, sometimes, situational factors may result in depression. Postpartum depression is a medical condition that needs treatment to resolve.

Women with these risk factors are more likely to develop maternal depression:

• Previous depression
• Family history of depression
• Lack of support from family, friends and partner
• Marriage or financial instability
• Premenstrual dysphoric disorder or other hormone-related mood changes

Postpartum Psychosis

Postpartum psychosis is much less common, occurring in one to two per 1,000 women who deliver. But postpartum psychosis is a severe mental illness with symptoms that can include:

• Delusions, or false beliefs
• Hallucinations, or seeing or hearing things that are not there
• Mania, or high, elated mood
• Paranoia and loss of reality

Women with postpartum psychosis are at high risk to harm themselves and/or their baby and need treatment and to be under supervision until their symptoms improve.

Self-Care Steps To Take

“Fortunately, postpartum depression is treatable,” Dr. Kingsberg says. “A mental health professional can help by providing some combination of medication and/or cognitive behavioral talk therapies.”

Speaking with other mothers who have experienced maternal depression also can help.

Other steps you can take:

• Asking family and friends to care for your child for short periods of time, giving you time to sleep, do errands or exercise (solid REM sleep is critical to treating postpartum depression)
• Not expecting to be a perfect parent or to pick your life up where it left off before you became a mom
• Joining a support group for mothers with maternal depression
• Recognizing that depression is a real medical condition, not a sign of weakness and requires treatment.
• Accepting that being a parent is difficult for everyone (not just you), and that it is OK to ask for help

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