Postpartum depression, a condition that afflicts many new mothers, can take a devastating toll on maternal well-being, with severe cases even leading to psychosis and leaving a lasting impact on their offspring. While most new mothers experience the “baby blues,” approximately one in six will go on to develop the more crippling symptoms of postpartum depression. However, there is newfound optimism on the horizon as the first medication aimed at addressing this condition is expected to become available by the end of 2023.
Zuranolone, marketed as Zurzuvae, offers a glimmer of hope for patients suffering from postpartum depression. This synthetic compound mimics a mood-regulating hormone that surges during pregnancy but sharply declines after delivery. The idea is that by replicating this hormone, it could mitigate the more severe manifestations of postpartum depression.
In California, health care providers are required to screen pregnant patients for depression. Those testing positive at UCSF Health may find themselves in the capable hands of Dr. Margo Pumar, a self-proclaimed wife, mother, sister, daughter, friend, large-dog owner, and mental health advocate, who serves as the medical director of perinatal psychiatry. She discusses the potential of zuranolone and other treatments for postpartum depression.
When it comes to identifying higher-risk factors for postpartum depression, Dr. Pumar highlights that very young mothers may feel overwhelmed, but older mothers may also experience self-doubt when they have their first child. Additionally, first-time parents, those with complicated pregnancies, babies with special medical needs, and individuals with a history of depression or anxiety are at a heightened risk. Lack of a strong support system, particularly in places like the San Francisco Bay Area, where extended family may not be readily available, adds to the risk.
However, while the advent of zuranolone is promising, it comes with some caveats. The drug is sedating and should be taken before bedtime, which means abstaining from driving for 12 hours afterward, potentially inconveniencing some patients. Furthermore, the drug acts on the same receptors as benzodiazepines, such as Xanax, Ativan, and Valium, which could lead to tolerance over time, necessitating higher doses to achieve the same effect. It is currently approved for a two-week usage, and the duration of its effectiveness beyond four weeks remains uncertain. Additionally, zuranolone may be costly, as its expansion to patients with major depressive disorder was denied, potentially requiring patients to demonstrate that they’ve failed other treatments before obtaining insurance coverage. Moreover, the transfer of the drug into breast milk and its associated risks are not yet fully understood, limiting its recommendation to those who do not intend to breastfeed or are willing to “pump and dump.” As such, zuranolone holds promise but may be suitable for only a specific subset of patients until further research is conducted.
Regarding the safety of other postpartum depression drugs for breastfeeding patients, Dr. Pumar notes that certain selective serotonin reuptake inhibitors (SSRIs), like Zoloft and Celexa, have been used by lactating patients since the 1990s. While traces of these drugs have been detected in breast milk, side effects are generally minimal. The decision to use these drugs should be weighed against the risks of untreated postpartum depression, as they have been shown to make a significant difference for many patients.
Dr. Pumar also emphasizes various measures that can help minimize the risk of postpartum depression. Medication is not always required, as some cases may be mild. She advises expectant parents to establish a support system, urging them to join parents’ groups, including those for LGBTQ parents. Sleep deprivation is a common issue, so she recommends sharing responsibilities with a partner or considering a night doula if it’s affordable. Engaging in regular exercise can alleviate anxiety and improve sleep, while some supplements, such as magnesium, are safe for lactating mothers and may relieve symptoms of anxiety. Dr. Pumar underscores the value of therapy, emphasizing that medication alone may not suffice to address the negative thought patterns that often accompany postpartum depression.
