Finally, a Drug for Postpartum Depression—But There Is a Catch

The first-ever drug approved specifically for postpartum depression is here. The effects kick in much faster than traditional antidepressants, and that makes a big difference for new moms.

happy family. mother and babySunKids/Shutterstock

You’ve just given birth, you’re holding your beautiful newborn in your arms, and yet you can’t enjoy this moment you’ve been dreaming of for nine long months because your world feels like it’s crashing down around you. This is the feeling of postpartum depression, and until recently, the only option was to take standard antidepressants—which can take weeks to start working—and miss out on critical early bonding time with your newborn. A new prescription antidepressent specifically for postpartum depression may change all that. Zulresso (generic name: brexanolone) is designed to start working within a day.

“This approval is a big deal because brexanolone acts differently than all other antidepressants and it starts to work quickly,” explains Samantha Meltzer-Brody, MD, MPH, director of perinatal psychiatry at the University of North Carolina School of Medicine in Chapel Hill and a lead author on the trials that led to the drug’s approval.

Time is of the essence

Different than the baby blues, postpartum depression is a serious and potentially life-threatening condition that can last for weeks or even months. Symptoms such as extreme sadness, debilitating anxiety, and exhaustion make it difficult for a new mom to care for herself and her newborn. Untreated, postpartum depression can hamper a new mother’s ability to bond with her baby—and this can have lasting consequences. That’s just one of the things about postpartum depression that your OB/GYN wishes you knew.

Doctors deliver the new drug via a 60-hour infusion, and that one dose can last at least 30 days—which is often enough time to get new moms through the critical period. Other antidepressants take weeks or even months to start working and they don’t work for everyone, explains Dr. Meltzer-Brody. During this early infusion, mothers are attended in a medically supervised setting—generally the hospital where they gave birth—and monitored for risks, such as dizziness and fainting. Meanwhile, baby is likely be able to visit mom during treatment.

So, how does brexanolone work differently than other antidepressants? During pregnancy, levels of the female sex hormones estrogen and progesterone climb sky-high, then dramatically plummet after birth. It is this striking hormonal shift that can trigger symptoms of postpartum depression in vulnerable women. Where traditional antidepressants target the mood chemical serotonin, brexanolone is a hormonal fix that boosts levels of a key progesterone byproduct that activates mood receptors in the brain. This helps explain why it so swiftly reverses mood and other symptoms of postpartum depression in postpartum moms. Researchers are studying whether administering brexanolone earlier to women who are susceptible could prevent postpartum depression altogether.

Unfortunately, the drug may be out of reach for many women: Media reports suggest the cost will average $34,000—not including the costs of labor, delivery, and stay in a medical center—making the new drug a prime candidate for our most expensive prescription drugs in America list. Insurers may cover some of the expense.

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Denise Mann, MS
Denise Mann is a freelance health writer whose articles regularly appear in WebMD, HealthDay, and other consumer health portals. She has received numerous awards, including the Arthritis Foundation's Northeast Region Prize for Online Journalism; the Excellence in Women's Health Research Journalism Award; the Journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery; National Newsmaker of the Year by the Community Anti-Drug Coalitions of America; the Gold Award for Best Service Journalism from the Magazine Association of the Southeast; a Bronze Award from The American Society of Healthcare Publication Editors (for a cover story she wrote in Plastic Surgery Practice magazine); and an honorable mention in the International Osteoporosis Foundation Journalism Awards. She was part of the writing team awarded a 2008 Sigma Delta Chi award for her part in a WebMD series on autism. Her first foray into health reporting was with the Medical Tribune News Service, where her articles appeared regularly in such newspapers as the Detroit Free Press, Chicago Sun-Times, Dallas Morning News, and Los Angeles Daily News. Mann received a graduate degree from the Medill School of Journalism at Northwestern University in Evanston, Ill., and her undergraduate degree from Lehigh University in Bethlehem, Pa. She lives in New York with her husband David; sons Teddy and Evan; and their miniature schnauzer, Perri Winkle Blu.