Is one pill enough to treat postpartum depression?

Last August, the US Food and Drug Administration announced the approval of zuranolone to specifically treat postpartum depression. Although another specific drug already existed – brexanolone – it required intravenous administration (and hospitalization), and its cost was considerably higher than an oral drug for home use, explains Lluisa García Esteve, a psychiatrist at the perinatal mental health unit of the Hospital Clinic of Barcelona, Spain. The expert is optimistic about the arrival of zuranolone, which has a shorter therapeutic effect, is administered orally and is much more affordable.

The recommended dose for the new medication is one 50mg pill every day for two weeks. According to e-lactancia.org, an online guide on the compatibility of breastfeeding with medications and other substances, it is also “probably compatible” with breastfeeding, due to its low risk.

For García Esteve, it is good news that a new avenue of research has been opened into postpartum depression, apart from common depression, because, although it is a universal disorder, it had not been explored or researched enough as it was considered “a women’s issue,” she says. “Neither science, nor medicine, nor obstetrics, nor psychiatry have had enough interest, or investment, in this disorder (nor others that have to do with women) for us to have had treatments available much earlier.”

Having drugs that provide immediate results – stopping postpartum depression from becoming prolonged and chronic – is also an advance and a type of prevention regarding the health complications that can occur if this dysfunctional state is maintained. And not only for the mother; also for the baby. “We are preventing complications at a neurodevelopmental level, as well as problems in bonding, which we know is essential for the baby,” explains the expert.

Liset Álvarez, perinatal psychologist and psychotherapist, adds that a mother with depression or anxiety is less able to tune in to the needs of the baby, so the prevention and treatment of postpartum depression is a “pressing need” to avoid harmful effects on the mental and physical health of both. In fact, a study from 2020 titled Trajectories of Maternal Postpartum Depressive Symptoms warned that, if untreated, this disorder can persist for up to three years after giving birth, with the negative effects it entails for both the mother and the baby.

More than a drug

The worldwide prevalence of postpartum depression is unknown. However, some studies, such as those included in the WHO guide for integration of perinatal mental health in maternal and child health services, indicate that anxiety and depression in the perinatal period could affect 1 in 10 women in high-income countries, and 1 in 5 in low- and middle-income countries.

Among the risk factors, García Esteve includes having suffered anxiety and depression during pregnancy, having suffered a depressive episode prior to pregnancy, childhood trauma related to abuse, previous perinatal deaths, sexual abuse, or family history (mothers or sisters with postpartum depression, for example). “All these factors must always be taken into account to be able to make a risk assessment for each mother.”

There are always factors – internal or external to the mother – that trigger postpartum depression; hence the importance of better and greater prevention, as well as the training of health professionals. Estefanía Jurado, a midwife at the Virgen de Valme University Hospital in Seville, Spain, states that maternal mental health is a problem that the health system usually overlooks: “All care for mothers has been focused on the physical aspect, while the psychological aspect has been ignored. This absence is a transversal evil that affects the entire health system, from the lack of training of health professionals to the lack of assistance and specific programs.”

For García Esteve, prevention involves having support mechanisms in the perinatal stage. “If we have a circuit in which already in pregnancy it is detected, assessed and referred to a trained professional, or a unit, to be able to follow up, to be able to intervene where possible, this is prevention.” Álvarez, despite also seeing the emergence of this new drug as a very positive thing, agrees, pointing out that this absence of perinatal mechanisms can translate into excess medication, or put all the weight of the improvement on it.

The expert states that trained professionals and time are necessary. “Without a public system that offers this help, and taking into account that in order to access private treatments, resources that are not always available are needed, this is where medication can take over the scene as the resource that apparently relieves the symptoms for less,” says Álvarez.

For García Esteve, it is not just about administering a drug – something that she considers absolutely necessary in some cases – but also about taking into account everything that can be done. “Women have needed drugs that give us relief, that solve our pathologies and ailments, and this new medication is going to provide many benefits.” Still, she emphasizes that we must not lose focus on the many other aspects that surround the mother and the baby, “such as context, prevention, resources and other measures.”

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