Postpartum depression affects a significant number of new mothers, with one in six experiencing the more severe symptoms of this condition, which can, in rare instances, escalate to psychosis and have adverse effects on offspring, such as insecure attachment, emotional regulation difficulties, and poor attention.
The arrival of the first-ever medication designed to address postpartum depression is expected by the close of 2023. Known as Zuranolone, marketed under the name Zurzuvae, this synthetic compound emulates the mood-regulating hormone that surges during pregnancy but drastically declines after childbirth. It is believed that by mimicking this hormone, the most severe manifestations of postpartum depression can be mitigated.
California is among the states that mandate healthcare providers to screen pregnant individuals for depression. At UCSF Health, those who screen positively for depression may be connected with Dr. Margo Pumar, a psychiatrist and the medical director of perinatal psychiatry, who is also a wife, mother, sister, daughter, friend, and a devoted advocate for mental health. Dr. Pumar discusses the potential of Zuranolone and other treatment options for postpartum depression.
Risk Factors for Postpartum Depression
Dr. Pumar underscores that several characteristics are associated with a higher risk of postpartum depression. Young patients may find themselves overwhelmed, while older individuals who previously perceived themselves as competent may experience newfound doubts after the birth of their first child. Other risk factors include being a first-time parent, experiencing a complex pregnancy, having a baby with special medical needs, and a history of prior depression or anxiety.
Patients with limited support systems, particularly those lacking nearby family support, face additional challenges in managing postpartum depression.
The Efficacy and Considerations of Zuranolone
Regarding the potential of Zuranolone, Dr. Pumar notes that the medication is sedating and should be taken before bedtime, which necessitates refraining from driving for at least 12 hours, potentially inconveniencing some patients. It’s important to highlight that Zuranolone operates on the same receptor as benzodiazepines, such as Xanax, Ativan, and Valium, raising concerns about potential tolerance development, which might require increased dosages to achieve the same therapeutic effects. Currently, Zuranolone is approved for only two weeks of usage, and its efficacy beyond four weeks remains unknown.
The cost of Zuranolone may also pose a barrier, as it was not approved for expanded usage in patients with major depressive disorder, potentially leading insurers to require patients to demonstrate treatment failure with other options before providing coverage. Moreover, uncertainty surrounds the transfer of the drug into breastmilk and its associated risks, making it suitable primarily for individuals who do not intend to breastfeed or are willing to “pump and dump.” Consequently, Zuranolone is likely to benefit only a specific subset of patients until further research provides more clarity.
Safety of Other Postpartum Depression Medications for Breastfeeding Patients
Dr. Pumar highlights that some selective serotonin reuptake inhibitors (SSRIs), such as Zoloft and Celexa, have been administered to lactating patients since the 1990s. While traces of these drugs have been detected in breastmilk, side effects are generally minimal. The decision to use SSRIs during breastfeeding should weigh the risks of untreated postpartum depression against the potential benefits and risks of the medication. Dr. Pumar has witnessed significant improvements in patients with postpartum depression through the use of SSRIs.
Additional Measures to Reduce Postpartum Depression Risk
Dr. Pumar emphasizes that not all cases of postpartum depression necessitate medication. She advises expectant parents to build a support network, join parents’ groups, consider sharing nighttime responsibilities with a partner, or hiring a night doula if feasible, and engage in regular exercise to reduce anxiety and improve sleep quality. Some supplements, like magnesium, can be safely taken during lactation and may alleviate symptoms of anxiety.
Therapy is also recommended, as medication alone may not address the negative thought patterns that often accompany postpartum depression.
