Finally, a pill for postpartum depression: What it means for new mothers

US FDA approves pill but no one treatment strategy is a magical game-changer. However, policies which decrease stigma, train doctors and health professionals to recognise depression early and enable access to cheaper existing treatments are more likely to decrease the morbidity and mortality due to PPD, says Dr Achal Bhagat, Senior Consultant Psychiatrist and Psychotherapist at Indraprastha Apollo Hospital, Delhi

The news of the US Food and Drug Administration approving Zurzuvae (zuranolone) as the first oral medication for PPD has made expectant mothers optimistic. (Source: Freepik)

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Most young mothers go through postpartum depression (PPD) as they battle new challenges of nurturing a baby and reconciling their new life with the one, they used to know. For years, psychiatrists have tried to bring women out of this stressful mental trough. That’s why the news of the US Food and Drug Administration approving Zurzuvae (zuranolone) as the first oral medication for PPD has made expectant mothers optimistic. But we still have a long way to go before authorising its use here and till then, experts say, we need to focus on early screening, decreasing the treatment gap and increasing access to counselling services.

The approval for the drug was given after two randomised trials proved the efficacy of Zurzuvae for the treatment of PPD in adults. The participants of the trial were women with PPD who met the Diagnostic and Statistical Manual of Mental Disorders criteria for a major depressive episode and whose symptoms began in the third trimester or within four weeks of delivery. The women who participated in the randomised control trial and were given Zurzuvae showed significant improvement in their symptoms compared to those in the placebo groups. The effect lasted till Day 42 or four weeks after the last dose.

According to Dr Achal Bhagat, Senior Consultant Psychiatrist and Psychotherapist at Apollo Indraprastha Hospital, Delhi, the new drug could be a game-changer.

Until now, treatment for PPD was only available as an IV injection. How can the new oral drug be a game-changer?

Zurzuvae (zuranolone) has been recently approved by the US FDA to treat PPD. It is a neuroactive steroid (NAS) GABA-A receptor modulator, which means it works by “rebalancing brain networks.” The difference between this and the other antidepressants is that it acts quicker and is taken once a day for 14 days. However, we have to wait as it is not available in India yet.

Why is it important to take such medicines under a doctor’s supervision?

That’s because of its side effects. The less common but more serious side effects could be suicidal tendencies among users. So, it must always be taken under close supervision of psychiatrists.

The labelling of the drug warns that Zurzuvae can impact a person’s ability to drive and perform other potentially hazardous activities. Patients may not be able to assess their degree of impairment. There may also be increased sedation, so women should avoid driving or using heavy machinery while using this medicine. They should avoid alcohol altogether.

Some common side effects among users are drowsiness, dizziness, diarrhoea, fatigue, nasopharyngitis (the common cold), and urinary tract infection.

What about lactating mothers?

The medicine is also secreted in the breast milk but its effect on the child is not clearly documented. So it is important for the child to be watched by the paediatrician while the mother is using the medicine. Sometimes alternatives to breast feeding may need to be considered.

How important is the new drug in the Indian context?

Many women suffer because their PPD is not diagnosed and more than 90 per cent may not even have access to existing treatments for postpartum depression. So, while each new treatment has the potential to offer hope, as a country we need to continue to focus on decreasing the treatment gap and increasing access to services. No one treatment strategy is a magical game changer but policies which decrease stigma, train doctors and health professionals to recognise depression early and ensure access to cheaper existing treatments are more likely to decrease the morbidity and mortality due to PPD.

How can PPD impact a mother and child’s mental health?

PPD is a common disorder in which women may feel intense anxiety, sustained sadness, shame, guilt, difficulties in sleeping, stress, panic attacks, and suicidal thoughts or attempts. This may delay the child’s physical and emotional development due to the unavailability of the mother for care and attachment. Up to 10 per cent of women may be affected by the experience of depression in the postpartum period.

Usually, this phase starts after delivery and lasts for the initial couple of weeks after it. The reasons for these are major hormonal changes which happen post-delivery, changes in the body, discomfort and pain, lack of sleep, breastfeeding adjustments, a sudden shift of attention and care from the would-be mother in pregnancy to the baby after delivery, and of course, tending to the newborn every two hours. In urban settings, the prevalence of postpartum blues is higher as an extended support system is often lacking.