A New Treatment for Postpartum Depression

Medical terms are often drawn from Latin and ancient Greek. Consider the subject of today’s article: postpartum depression. “Post” means “after,” and “partum” refers to childbirth. Postpartum depression, then, occurs during the first year after giving birth. But for many, says Dr. Soudabeh Givrad, an Assistant Professor in Clinical Psychiatry, Assistant Attending Psychiatrist and Director of the Maternal-Infant Psychiatry Program at Weill Cornell Medicine, mood disorders can occur during pregnancy, well before a woman gives birth.

Broadly, two additional terms—perinatal depression and perinatal mood and anxiety disorders (PMADs)—are used interchangeably for depression that happens before, shortly after or within a year of childbirth.

The good news is that the Food and Drug Administration (FDA) has approved an oral medication called Zuranolone that’s specifically designed to counteract PMADs.

How does perinatal depression differ from "regular" depression?

Perinatal depression is different from “regular” depression in its timing, as it’s uniquely related to pregnancy and its aftermath. Some of the biological and psychological risk factors for perinatal depression also make it different.

What are its symptoms?

The symptoms of perinatal depression, or PMADs, may include:

• low mood
• increased irritability
• high anxiety
• changes in appetite, sleep or energy level
• a lack of interest in what you used to enjoy
• a lack of interest in the baby
• feelings of guilt or shame
• not feeling like yourself
• feelings of hopelessness
• thoughts of hurting yourself

Is postpartum depression the same as the “baby blues”?

Says Dr. Givrad, “For many women, symptoms start in the first several weeks after birth. But postpartum depression is different from the baby blues. That’s when a woman feels very emotional and overwhelmed during the first few days to two weeks after giving birth. It’s a result of hormonal changes and tends to resolve on its own.

What causes perinatal depression/PMADSs?

There is no single cause for PMADs. A woman goes through many physiological and psychological changes during pregnancy and after having a baby. A combination of genetic, biological and environmental factors likely contribute to PMADs.

The following may make a woman vulnerable to pregnancy- or postpartum-related mood disorders:

• an individual or family history of depression, anxiety or other psychiatric disorders
• sensitivity to changes in hormone levels
• psychosocial factors such as a history of adversity, trauma, poor social support or stressful life circumstances

“Developing depression or anxiety during the perinatal period is never a woman’s fault,” she says. “These are real illnesses.”

How common is perinatal depression?

The American College of Obstetricians and Gynecologists has estimated perinatal depression to be one of the most common complications of pregnancy and the postpartum period. Around 15 to 20 percent of women can develop PMADs. This is double the prevalence of major depressive disorder in the general population.

PMADs are even more widespread in those with medical complications for the mother or baby and those who live in resource-poor areas. Lamentably, suicide is actually the leading cause of maternal mortality.

What is the impact of perinatal depression on new mothers and their babies?

Untreated PMADs have significant negative effects on new mothers, their babies and the entire family system. These include an increase in pregnancy complications, premature births or infants with low birth weight. And as already mentioned, suicide is the leading cause of maternal mortality. Untreated perinatal depression and anxiety can also lead to poorer developmental, cognitive and emotional outcomes for the child, lower quality parent-child relationships and bonding, and sub-optimal parenting.

Discuss the new medication for perinatal depression, zuranolone. How does it compare to SSRIs and other antidepressants?

“The mechanism of action of Zuranolone is different from other antidepressants,” says Dr. Givrad. “It’s the first FDA-approved oral medicine for the treatment of postpartum depression in adults, and it’s designed to target pregnancy-related hormonal changes that may precipitate perinatal depression.”

“Unlike other oral antidepressants, which need to be taken for longer periods of time, Zuranolone is only taken for 14 days,” she continues. “Studies have shown a decrease in depressive symptoms after this 14-day period. That decrease has been maintained for 4 weeks after completing treatment.”

When should a patient start taking it?

Zuranolone can be taken anytime during the postpartum period (the first 12 months after giving birth). It should not be taken during pregnancy.

Are there any reported side effects?

The main side effects of Zuranolone are drowsiness and fatigue, along with possible confusion. Patients can also experience dizziness, diarrhea, cold-like symptoms, urinary tract infections and increased suicidal thoughts or behavior.

In your view, can Zuranolone help to reduce the stigma of postpartum depression?

“I’m hopeful that talking about PMADs and the research and treatment options for them will help to lessen the stigma of mental health issues during the perinatal period. The approval of an oral medication designed to counter pregnancy-related hormonal changes may help to clarify that perinatal depression is a medical complication of pregnancy. As such, it should not be a cause for guilt or shame in new parents.”

When will the drug become available to patients?

Zuranolone is available now that the Drug Enforcement Administration (DEA) has completed its 90-day review.

Who is considered an appropriate patient for Zuranolone? Who shouldn't take it?

Zuranolone is appropriate for those with depression starting in the third trimester of pregnancy or the postpartum period. It might not be the first choice for patients who have a history of depression or anxiety and have previously responded to other treatments. However, it can be added to other antidepressants to help with any residual depressive symptoms.

“We don’t have any data yet on the drug’s safety in women who are breastfeeding,” she says. “Therefore, it is not recommended for women who don’t want to forgo breastfeeding during the treatment window. And because it can cause drowsiness and fatigue, it is probably not a good option for those who need to drive or perform other potentially hazardous activities.”

Where Zuranolone is concerned, what needs to be studied and clarified next?

“We need more data related to Zuranolone’s effects on milk production and on breastfeeding infants. Further, we lack long-term data (beyond 4 weeks) on its efficacy, so we need studies that include longer-term follow-ups and assessments. It would also be very helpful to have studies that look at using Zuranolone with other antidepressants during the postpartum period.

“Finally,” she continues, “I hope pricing and insurance coverage are worked out so that Zuranolone can become available to all postpartum patients. I also look forward to hearing from our patients and colleagues about their experiences with Zuranolone. We can learn a lot from these collective experiences.”

Find a doctor at Weill Cornell Medicine to discuss treatments for symptoms of postpartum depression.