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Pill for Postpartum Depression: Lancet says medication not a rapid solution

Postpartum Depression

The condition is characterized by sadness and loss of interest in activities that one used to enjoy and a decreased ability to feel pleasure. 

As the US Food and Drug Administration (FDA) approves the first pill to treat postpartum depression (PPD), offering people a new way to get rapid symptom relief, the Lancet warns against viewing medication as a quick fix

In its latest editorial, the Lancet argues that to establish meaningful change on a global scale, strategies focused on social determinants and early intervention for perinatal depression must be implemented into the agenda for maternal health. 

“And for that to happen, the neglect of mental health in the field of global maternal health must end,” the editorial reads.  

The Lancet said perinatal mental health is a drastically underappreciated determinant of maternal health, and medication is only one aspect to addressing perinatal depression.

On August 4, the FDA approved Zurzuvae (zuranolone), the first oral medication to treat postpartum depression in adults. The PPD is a major depressive episode that typically occurs after childbirth but can also begin during the later stages of pregnancy. Until now, treatment for PPD was only available as an IV injection given by a health care provider in certain healthcare facilities.

As with other forms of depression, PPD is characterized by sadness and  loss of interest in activities that one used to enjoy and a decreased ability to feel pleasure. It can present with symptoms such as cognitive impairment, feelings of sadness or inadequacy, loss of energy or suicidal ideation.

According to the FDA, the efficacy of Zurzuvae for the treatment of PPD in adults was demonstrated in two randomized, double-blind, placebo-controlled, multicenter studies. The trial participants 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 daily recommended dose for Zurzuvae is 50 mg. It should be taken once every day, for 14 days, in the evening with a fatty meal. The most common side effects include drowsiness, dizziness, diarrhea, fatigue, nasopharyngitis (the common cold), and urinary tract infection.  

“Postpartum depression is a serious and potentially life-threatening condition in which women experience sadness, guilt, worthlessness—even, in severe cases, thoughts of harming themselves or their child. And, because postpartum depression can disrupt the maternal-infant bond, it can also have consequences for the child’s physical and emotional development,” said Tiffany R. Farchione, director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research. “Having access to an oral medication will be a beneficial option for many of these women coping with extreme, and sometimes life-threatening, feelings.”

The Lancet edit says that the global prevalence of the PPD range from 13% to 30%. Perinatal depression is generally more common in low-income and middle-income countries than in high-income countries, but with notable variations. 

The terms postnatal, postpartum, and perinatal are often used interchangeably. However, it can be unclear whether depression that begins in pregnancy (which accounts for up to half of cases) is included. The interval used to define the postnatal period also varies, commonly from 4 weeks to 1 year after birth. Given this substantial heterogeneity, improved standardization of measures is needed.

“Although zuranolone is being hailed for its potential as a rapidly acting 2-week oral treatment, it seems unlikely that any medication is the answer to substantially reducing overall burden of peripartum depression,” the Lancet points out. “Medication is not recommended as first-line treatment for most patients, and best practice is to consider strategies that target psychosocial factors associated with the development of perinatal depression.” 

“Poor social support, barriers in access to maternal health services, intimate partner violence, poverty, and conflict are well established risk factors. The COVID-19 pandemic amplified many such factors; one study reported an increase in perinatal depression prevalence from 10% in 2014 to 24% in 2020 in England alone,” the edit reads further.

One devastating outcome of perinatal depression is suicide. Data from the UK and the USA report suicide as a leading cause of direct deaths within the perinatal period. However, data from low-income and middle-income countries are scarce.

“There is still substantial stigma associated with low mood and suicidal thoughts during the perinatal period, with societal pressure to consider pregnancy and motherhood as an exclusively joyful experience, contributing to delayed help-seeking and under-reporting of symptoms,” the Lancet explains.

Also Read : Navigating Postpartum Depression: From triggers to healing with Zuranolone