Baby blues are a common occurrence for most new mothers, but for 1 in 6, these blues escalate into the debilitating symptoms of postpartum depression, which, in severe cases, can lead to psychosis and, in their offspring, issues such as insecure attachment, emotional regulation difficulties, and poor attention span.
A ray of hope is on the horizon, as the first pill designed to alleviate the burden of postpartum depression is anticipated to hit the market by the end of 2023. Known as Zurzuvae, this groundbreaking medication is a synthetic version of a mood hormone that surges during pregnancy but plummets after childbirth. By replicating this hormone, Zurzuvae aims to mitigate the more severe symptoms associated with postpartum depression.
California is one of several states that mandates healthcare providers to screen pregnant patients for depression. At UCSF Health, those who test positive may find themselves under the care of Dr. Margo Pumar, a psychiatrist specializing in perinatal psychiatry. Dr. Pumar, who identifies herself as a wife, mother, sister, daughter, friend, large-dog owner, and mental health advocate, sheds light on Zurzuvae’s potential and other treatment options for postpartum depression.
Identifying Risk Factors for Postpartum Depression
Dr. Pumar highlights various risk factors associated with postpartum depression. While very young mothers may be more susceptible due to feeling overwhelmed, older mothers can also struggle with feelings of incompetence after their first baby arrives. Additionally, first-time parents, individuals with complex pregnancies or babies with special medical needs, and those with previous or pre-existing depression or anxiety are at a higher risk. Lack of a strong support system, especially in areas without nearby family, can exacerbate the risk.
Zurzuvae: A Potential Solution
Regarding Zurzuvae, Dr. Pumar explains that it has a sedative effect and should be taken at bedtime. This necessitates refraining from driving for 12 hours, which may pose inconveniences for some patients. Notably, the drug operates on the same receptor as benzodiazepines like Xanax, Ativan, and Valium, potentially leading to tolerance buildup over time, though it is currently approved for only two-week usage. Long-term effects on depression beyond four weeks remain uncertain.
Affordability may also pose a challenge, as Zurzuvae was denied approval for broader use in patients with major depressive disorder, potentially requiring insurers to mandate prior treatment failures before granting coverage. Furthermore, the drug’s transfer into breastmilk and associated risks remain unclear, limiting its recommendation to those who do not intend to breastfeed or are willing to “pump and dump.” In conclusion, Zurzuvae holds promise but may primarily benefit a specific subset of patients until more information emerges.
Safety of Other Postpartum Depression Medications for Breastfeeding
Dr. Pumar points out that certain selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Celexa have been used safely by lactating patients since the 1990s. These drugs leave trace amounts in breastmilk with minimal side effects. Decisions regarding their use must weigh the risks of untreated postpartum depression against the potential benefits of these medications. Dr. Pumar attests that SSRIs have made a substantial difference for many of her postpartum depression patients.
Additional Measures to Reduce Postpartum Depression Risk
Beyond medication, Dr. Pumar emphasizes alternative methods for managing postpartum depression. Building a support network is crucial; she recommends joining parental groups or LGBTQ parents’ groups for those who identify as nonbinary. Partnering with a spouse or considering a night doula can help address sleep challenges. Regular exercise and safe supplements like magnesium, which can be taken during lactation, may alleviate anxiety symptoms. Finally, Dr. Pumar underscores the importance of therapy, as it complements medication in addressing the negative thought patterns that often accompany postpartum depression.
