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For some of the many mothers who experience postpartum depression, therapy and standard antidepressants can alleviate symptoms. But for others, those treatments are slow to provide relief. Now the FDA has approved the first drug specifically intended to treat the illness. Amna Nawaz talks to Dr. Samantha Meltzer-Brody, director of the University of North Carolina’s perinatal psychiatry program.
It is estimated that at least one out of nine new mothers in the United States experience postpartum depression each year. For some women, therapy and standard antidepressants can help, can help alleviate some of the worst symptoms. But, for many, it takes too long for the medication to kick in. And others go untreated completely.
Now, as Amna Nawaz tells us, the first drug specifically for postpartum depression has been approved by the FDA and it may be a faster alternative for women in need.
Judy, the drug is known by the trade name Zulresso. And it can kick in quickly, alleviating symptoms within just 48 hours.
But it is also a time-consuming treatment and very expensive. Patients have to go to a certified medical center to take the drug, which is administered as a 60-hour I.V. treatment. It can cost upwards of $35,000. And it is not clear whether insurers will cover it. The new drug is expected to be available in June.
Dr. Samantha Meltzer-Brody is the director of University of North Carolina's Perinatal Psychiatry Program, and she joins me now to discuss this newly approved treatment. She was the principal investigator for the trials.
And, for the record, the university did receive a research grant from the company for those trials. Dr. Meltzer-Brody didn't receive or take any money from the company. We wanted to make that clear.
Dr. Meltzer-Brody, welcome to the "NewsHour."
Let's start with the significance of this. You told my colleague earlier, it's a huge paradigm shift in how we treat postpartum. Why?
Dr. Samantha Meltzer-Brody:
Thanks for the opportunity to talk tonight.
So, this is the first drug ever approved for postpartum depression that has a completely different mechanism of action. So this has the ability to resolve symptoms. Moms feel better within a day. And at the 60-hour mark of the infusion, the majority of women that received the drug felt markedly better.
That's unlike any treatment we currently have available. And given how devastating this illness can be, affecting 10 percent to 15 percent of all women that give birth, it's a huge step forward.
So, who is considered a good candidate for this? Does it mean sort of a silver bullet for postpartum?
No, I wouldn't call it a silver bullet, exactly.
The drug was tested initially with women with severe postpartum depression, and then with moderately postpartum depression. This is for women that are having significant impairment in functioning. They're not able to take care of their baby, interact, do the things they want in their life, especially for women who are having suicidal thoughts.
Women who are really suffering and struggling, this can be a major step forward and would be transformative, in that they could have relief of symptoms within 2.5 days or less.
And, as a perinatal psychiatrist, when I see women in clinic, the postpartum period is such a vulnerable time. And for moms, babies, and families to feel they have to wait weeks to months for a treatment to work, that can seem like eternity.
So for something to work quickly is really very exciting to me, and I think can make a meaningful difference for women for whom this is most appropriate.
But when it costs this much and requires you go stay in the medical center for the treatment, doesn't that automatically exclude a number, if not most women?
Well, I think the cost, which is part of the commercialization piece that I have not been part of, is certainly going to be an issue for women if insurance doesn't cover it.
I am hopeful that insurance will cover it for appropriate women. That would certainly be very important. It will be very important — also, the hope is that it will cover a wide range of insurance, both private and public insurance, given that 50 percent of women who give birth in this country are on public insurance, Medicaid.
So, that is definitely an issue and one that we have to watch carefully. But my experience in using the drug has been that the majority of women that had severe symptoms, they were grateful for the opportunity to receive treatment.
And we started developing this many years ago with initially open label, through the double-blind studies. And I can tell you that, for many women that are suffering, if you tell them, we can treat you in 2.5 days, they don't see that as a huge inconvenience at all.
It wasn't an issue for women to come in and receive this type of treatment. People were grateful for rapid relief of symptoms.
Dr. Meltzer-Brody, we should point out, most women who recognize and then seek help for postpartum now are most commonly treated by antidepressants.
Do you see this as replacing those antidepressants in some way?
Well, I think for women with mild symptoms, often, the first-line treatment is psychotherapy. And that will remain a very important part of treatment, because people have life stressors.
For women that have mild-moderate symptoms, I see that standard antidepressant treatment may continue to be very much a first line, for women that do not want an I.V. infusion for whatever reason.
However, I think, for severe symptoms, this really — I see it as a game-changer to have rapid relief of symptoms, which in the majority of women who were treated, that was maintained through 30 days of follow-up.
And so this is unlike anything we have seen before. And I think it will take time for everyone to become comfortable with a new model of care. Psychiatry has not had a new class of antidepressants for a very long time, and certainly rapidly acting antidepressants is something that has not been available.
So I think it's going to take time for people to understand that this is possible. And our ability to treat depression is now changed in a very positive way.
We have under a minute left, but I want to make sure people understand this.
For anyone out there who sees this, hears about this, thinks it could help them, or knows someone that they think needs help, what should they do? What should be their first step?
Well, one of the things that's great about a drug specifically developed for postpartum depression, I think, is it's increasing awareness.
For anyone that's having symptoms, they need to talk to their provider and discuss the symptoms they're having, low mood, anxiety, feeling overwhelmed, not sleeping even when the baby is sleeping, certainly having suicidal thoughts, not being able to eat or function the way they want to.
And a conversation with their provider is critical to decide, what is the best treatment option, and understand that individual mom's history. Is this someone that's had a long history of depression? Is this something that came out of the blue postpartum?
Treatment needs to be tailored, but I do think that brexanolone, or Zulresso, is going to be an important new tool in the toolbox. And we want all moms that are suffering to reach out and get help. It is not OK to suffer with postpartum depression. It is a medical condition, and treatment is vital for the mom, baby and her family.
Reach out and get help, it's an important message.
Dr. Samantha Meltzer-Brody, thanks so much for your time.
Thanks for having me tonight.
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