Opinion | A pill for postpartum depression is a game changer for women’s health

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Up to 1 in 7 new mothers suffer from postpartum depression, a serious mental health condition following childbirth. Yet despite the illness’s prevalence, there has been no oral medication to treat it specifically.

That changed last week with the Food and Drug Administration’s approval of zuranolone, a once-a-day pill taken for just two weeks. The medication offers a convenient and effective treatment method for new mothers. It also reinforces the crucial message that postpartum depression must be treated like any other medical ailment.

This is a message I wish I’d heard six years ago. Several weeks after I gave birth to my first child, I was crying all the time and felt scared and anxious without any rational reason. I initially attributed it to lack of sleep, troubles with breastfeeding, and the struggle of balancing work and caring for a newborn. Surely, this was normal, I thought. What new parent doesn’t feel overwhelmed?

But something was wrong. Activities that used to bring me joy no longer did. I had wonderful friends and was surrounded by supportive and kind colleagues at work, but I felt more and more alone.

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During a routine visit with my OB/GYN, I filled out a depression screening questionnaire. My initial score was very high, but instead of seeing it as reason to bring up concerns with my physician, I asked for another form and changed my answers. No amount of medical training could overcome my guilt and shame. Rationality was no match for my deep fear that having postpartum depression meant I was unfit to be a mother.

It took me months before I finally sought help. Over time, I met other women whose experiences mirrored mine. Many were reluctant to tell their doctors because the treatment options didn’t appeal to them. If they started medications, they would probably have to take them for at least six months. The exception was an intravenous infusion that required a hospital stay and 60 hours of continuous infusion, a major inconvenience for most new moms.

A two-week course of an oral medication is far more reasonable, and the data are promising. In clinical trials, women with severe postpartum depression experienced a significant improvement in symptoms. After they stopped the pill, the improvements lasted for at least 45 days.

Importantly, some women reported improvement within just three days of starting the medication. This is another advantage over other antidepressants that take a month or longer to have an effect.

Like virtually all medications, zuranolone has side effects, such as drowsiness and fatigue. For that reason, patients are advised to take it at night and not drive for at least 12 hours after ingestion. It also passes into breast milk, and it’s unknown if ingestion by the baby could have harmful effects. Mothers who wish to keep breastfeeding can “pump and dump” to maintain milk supply, then resume nursing a week after finishing the medicine.

Having to pause nursing might particularly deter many moms from taking the drug given the proven positive health impacts of breastfeeding and the benefits of bonding with their infant. But untreated postpartum depression has profound consequences on women and their babies, too. Studies have shown that it is correlated with shorter breastfeeding duration, greater difficulty bonding, and even developmental and learning problems later in the child’s life. Plus, suicide and mental health conditions are a leading cause of maternal mortality.

Of course, zuranolone is not the right solution for everyone. Most women with mild to moderate postpartum depression can improve with talk therapy alone, as I did. Some, especially those with depression and anxiety before pregnancy, are best served with longer-term medications. And much more needs to be done to shore up social supports for new mothers, including guaranteed health coverage for at least the first year after birth and paid maternity leave.

Still, I believe zuranolone, which is expected to be available later this year, will be a game changer. Its availability will not only prompt more mothers to be screened for postpartum depression and seek treatment options but also challenge the fundamental misconception that people need only to be “strong” to cope with mental health conditions.

This stigma was at the core of what prevented me from seeking care. If I had been diagnosed with new-onset diabetes or heart disease, I would have immediately sought medical treatment, and I wouldn’t have felt ashamed for doing so. A mental health diagnosis should be no different.

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