New Postpartum Depression Drug Could Be Hard To Access For Moms Most In Need

For some women, postpartum depression is so bad that they struggle to care for their children and may even consider or attempt suicide.

This week, the Food and Drug Administration approved a new drug that can help, the first drug approved specifically for postpartum depression. While researchers and clinicians are excited about the drug's potential, some foresee obstacles to making it available to women who need it the most.

Postpartum depression is more common among women from lower socio-economic groups, yet the drug, which comes with a $34,000 price tag and requires a stay in a healthcare facility, could be out of reach for many of these women.

"Those who have the highest rates of postpartum depression and who would benefit the most, I fear it will be limited access to them," says Dr. Maria Muzik, an associate professor at the department of psychiatry and obstetrics and gynecology at the University of Michigan.

And there will likely be logistical hurdles in delivering the drug, adds Muzik, because it has to be given via a one-time continuous IV infusion over 60 hours under medical supervision at a hospital or another medical facility.

Depression during pregnancy and soon after childbirth can be debilitating and can even lead to hospitalization for some women. It can prevent a mother from taking care of her baby, which in turn affects the mother-child bonding, the baby's development and emotional well-being. Postpartum depression even increases an infant's risk of having depression later in life.

"Postpartum depression is a devastating illness, with implications not just for the women who're depressed, but for their children and their families," says Dr. Joshua Gordon, director of the National Institute of Mental Health.

The new drug, brexanolone, which is being marketed by the manufacturer Sage Therapeutics as Zulresso, is unlike other antidepressants. It is a synthetic version of a compound called allopregnanolone, which is naturally synthesized by the body from the hormone progesterone. And it works relatively fast — women who were given the drug in clinical trials started to feel better as early as 48 hours after starting treatment, and the effects lasted for a month.

The drug had the most impact on women with moderate to severe symptoms of depression compared to women on placebo, who also showed some improvement.

"I think this is a breakthrough," says Gordon. "To be able to offer a treatment that not only works, but works fast is remarkable."

Most current treatments for postpartum depression involve talk therapy and other antidepressant medications, like Zoloft and Celexa. But these drugs typically take anywhere between two to four weeks to start having an impact, says Dr. Nancy Byatt, the medical director of the Massachusetts Child Psychiatry Access Program for Moms, or MCPAP for Moms, a program that helps pregnant women and new mothers get better access to mental health care.

"For myself, as a provider working with women with severe depression, to have a drug that works within a few days, that is very exciting," says Byatt.

She expects that the drug will be most useful for "someone presenting with severe symptoms" and "women who have tried SSRIs and other treatments that haven't been effective for them."

Women with chronic depression might also benefit, says Muzik. "That's where it has a major impact with bonding with the baby," she says. "She doesn't respond, she isn't able to care for the baby. The mom loses out on the joy of motherhood. Getting in quickly and helping her — that's a big advantage."

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