What is postpartum depression?

The term postpartum comes from the Latin phrase meaning “after childbirth”. After giving birth to a baby, the first six to eight weeks is considered the postpartum period. During this time, mothers are vulnerable to a medical condition called postpartum depression (also called PPD). Often PPD starts within one to three weeks of having the baby. According to the March of Dimes, about one in eight women report symptoms of depression after giving birth. It is the most common problem for new moms. PPD encompasses the feelings of sadness, anxiety or worry, and tiredness during the postpartum period that lasts for more than two weeks. It may become difficult for moms to take care of themselves and/or their baby. PPD is not something that the mom can control, it is a medical condition. PPD is different from the “baby blues” as it lasts longer and is a more serious condition. If you or someone you know is experiencing signs or symptoms of PPD, they should speak with their healthcare provider. You may also call a free and confidential help line listed in resource two below (March of Dimes).

Also, see our blog about Breastfeed Diet For Baby

What is the usual treatment for post-partum depression?

When left untreated, PPD can have long-term effects on both the mother and the child. PPD can be treated with medications and/or counseling. Generally, if someone has mild to moderate PPD, individual or group therapy can be an effective treatment method. Therapy can also be used in addition to medications for the treatment of PPD. Some other non-medication actions you can take to help manage PPD include exercise, self-care, and getting enough sleep.

So far, the standard medication treatment for PPD has been the use of the usual anti-depressants used in treating major depressive disorder and anxiety disorders. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other types of anti-depressants. The choice of anti-depressant medication may depend on whether the mother is breastfeeding their child and whether you’ve used an anti-depressant in the past. See the examples of these types of medications below.

Selective serotonin reuptake inhibitors (SSRIs)

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
  Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Desvenlafaxine (Pristiq)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
  Other anti-depressant medications
• Bupropion (Wellbutrin)

There is one other medication used for PPD called Zulresso (brexanolone). It was the first medication approved by the food and drug administration (FDA) specifically for PPD in 2019. However, the use is limited because it is only available through a restricted program and must be administered by a health care provider at a certified health care facility as a continuous intravenous (IV) infusion over 60 hours (about two and a half days).

What is Zurzuvae (zuranolone)?

Zurzuvae (zuranolone) is the first oral medication approved by the FDA specifically for PPD. It was approved for use in 2023. Interestingly, Zurzuvae works differently than the other anti-depressant medications we typically use. It is taken once every day in the evening for only fourteen days. It should be taken with fat-containing food. During the clinical trial, 195 women were studied for six weeks. Half of the participants took Zurzuvae for fourteen days and the other half took a placebo pill. They found that there was a significant improvement in PPD symptoms by day fifteen, and as early as day three, compared to the women taking the placebo pill. The improvement seemed to last for a continued four weeks following the fourteen-day treatment course. The data on whether Zurzuvae is safe for infants who are breastfed by a mother taking the medication is limited. It was observed that the medication is present in the breastmilk. Speak with your prescriber about the risks versus the benefits of Zurzuvae if you’re breastfeeding.

As with all anti-depressant medications, there is a warning to monitor for changes in suicidal thoughts and behaviors while taking Zurzuvae. The main side effects women experienced when taking Zurzuvae included somnolence, dizziness, sedation, and confusion. Therefore, it is recommended not to drive or engage in hazardous activities that usually require mental alertness while taking the medication and for twelve hours after taking the medication. Zurzuvae should not be taken by pregnant women. Notify your physician if you become pregnant while taking the medication.

The approval of Zurzuvae for PPD is a leap forward in the treatment of PPD. We now have more options for mothers experiencing PPD. Our traditional anti-depressants are still excellent options for the treatment of PPD. Though, Zurzuvae does seem to have some benefits including a quick onset and only needing to be taken for fourteen days with lasting effects following treatment. If you think Zurzuvae could be a good option for you, speak with your healthcare provider and assure they know all of the medications you already take.

We must support mothers and especially when they are most vulnerable. Mothers experiencing PPD do not have to go through it alone. If you or someone you know is experiencing PPD, see resource two for free and confidential help lines and do not feel afraid to speak with your healthcare provider.

Disclaimer: This blog is written for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen online.

Resources:
1) Zurzuvae FDA prescribing information: https://documents.sage-biogen.com/us/zurzuvae/pi.pdf
2) March of Dimes: https://www.marchofdimes.org/sites/default/files/2023-07/MOD_PostpartumDepression_OnePager_v09_FINAL.pdf
3) Am Fam Physician. 2010;82(8):926-933