Postpartum Depression: A Silent Struggle
For many pregnant individuals, the period following childbirth is not always the idyllic experience that is portrayed in common narratives. While most may encounter what's known as the "baby blues," characterized by mood swings, crying spells, and anxiety, some confront a more severe and enduring condition: postpartum depression (PPD).1 It's a silent yet common struggle, as a study by the CDC found that approximately 1 in 8 women experience symptoms of PPD soon after giving birth.2 Unlike baby blues, PPD symptoms are more intense and enduring, potentially interfering with daily functioning and the ability to care for the newborn.1 PPD symptoms, which can manifest from the first few weeks postpartum to a year after childbirth, include mood swings, difficulty bonding with the baby, changes in appetite, insomnia, overwhelming fatigue, severe anxiety, and feelings of hopelessness and guilt.1 In rare cases, a condition called postpartum psychosis may emerge, marked by severe symptoms such as hallucinations, delusions, and thoughts of self-harm or harm to the baby.1 Despite its prevalence, PPD often remains undiagnosed and untreated, leaving individuals who have given birth to grapple with its debilitating effects. It's vital to recognize that PPD is a complication of childbirth that requires prompt treatment to alleviate symptoms and foster bonding with the baby.
Current Treatment Landscape for PPD
Traditionally, the treatment options for PPD have been limited, including medication, psychological treatments, or a combination of both.1 Pharmacological treatments primarily involve antidepressant medications.1 Studies have shown improvements in depression severity with medications like fluoxetine and paroxetine, often coupled with cognitive-behavioral therapy (CBT).3 Additionally, other medications such as antianxiety drugs may be recommended for short-term relief, particularly if severe anxiety or insomnia are present.1 Although these drugs are increasingly recognized as effective interventions for postpartum depression, concerns exist regarding metabolic changes postpartum, infant exposure to medication through breast milk, and the perceived stigma associated with medication use.3 Therefore, many individuals with PPD opt for psychological treatments. Interpersonal therapy (IPT), for instance, addresses the relationship between interpersonal problems and mood, with a focus on interpersonal problem areas relevant to PPD.3 Similarly, CBT targets negative thinking patterns and behavioral changes, showing promise in treating PPD, particularly when combined with pharmacological therapies.3 Nondirective counseling, emphasizing empathic listening and support, has also proven beneficial in reducing PPD symptoms.3
While these approaches can be effective for some, they are not universally successful. Many find that they do not respond adequately to these treatments or experience severe side effects, leaving them searching for alternative solutions.
New FDA-Approved PPD Treatment: Neurosteroid Infusion
In recent years, advocacy efforts and research into PPD has brought forward promising options for those suffering from PPD. A breakthrough in treatment has emerged in the form of a new FDA-approved neurosteroid intravenous (IV) infusion therapy.4 This treatment involves giving the body neurosteroids, which are natural chemical substances that play a role in how the brain functions, through a vein for 60 hours.4,5 Brexanolone, which is also called by its brand-name Zulresso, is a man-made version of a naturally occurring neurosteroid that has been approved by the FDA as a treatment for PPD.5,6 These substances eventually reach the brain and specifically target the chemical pathways believed to be off balance in PPD.4-6 Research has shown that this treatment shows benefits very quickly compared to antidepressant medications, which typically take two to four weeks to have a significant effect.5 Therefore, with a quick-acting delivery of a medication that tackles the underlying biological issues in PPD and modifies how the brain responds to stress, the approval of this groundbreaking therapy signifies a significant advancement in combating PPD. It offers a new treatment option for those who haven't found relief with traditional methods and paves the way for future improvements in maternal mental health care.
However, as with any medical breakthrough, there are still challenges to overcome. Access to this new treatment may be limited, and there is a pressing need for further research to fully understand its long-term efficacy and potential side effects. Clinical trials supporting brexanolone's FDA approval highlight its effectiveness, but challenges in delivering this drug through an IV still present a concern for many.5 Researchers are currently looking into making similar treatments that could be taken as a pill, which would be even more convenient at providing quick relief.5 These treatment options are also being studied for how it might help with other kinds of depression, not just PPD.5
The Long-term Battle with PPD
The development of new innovative treatments brings about significant positive impacts in the field of maternal health. However, the long-term battle remains in addressing the stigma and misunderstandings surrounding maternal mental health that prevents many from seeking support. As advocates for women's health, it is imperative that we continue to raise awareness about PPD and champion initiatives that prioritize maternal mental well-being. By fostering a culture of understanding and support, we can create a world where every woman feels empowered to seek help and receive the treatment she needs to thrive.
Overall, the emergence of new FDA-approved neurosteroid infusion therapy for PPD is a big step forward in helping individuals navigate their life after giving birth. It's a sign of hope for many who have struggled with PPD, and it's exciting to see how it could help more people in the future. As we celebrate this milestone, we must also continue with the ongoing fight for maternal mental health equity, ensuring that no woman is left behind in her journey toward healing and recovery.
References:
Postpartum depression. Mayo Clinic. (2022, November 24). https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2
Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2010). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women's health, 3, 1–14. https://doi.org/10.2147/IJWH.S6938
Cleveland Clinic. (2022, February 16). Breakthrough treatment for postpartum depression. YouTube. https://www.youtube.com/watch?v=AnVo0WGBpW8
Edinoff, A. N., Odisho, A. S., Lewis, K., Kaskas, A., Hunt, G., Cornett, E. M., Kaye, A. D., Kaye, A., Morgan, J., Barrilleaux, P. S., Lewis, D., Viswanath, O., & Urits, I. (2021). Brexanolone, a GABAA modulator, in the treatment of postpartum depression in adults: A comprehensive review. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.699740
FDA approves first treatment for post-partum depression. U.S. Food and Drug Administration. (2019, March 19). https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression