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For the first time ever, a drug specifically to treat postpartum depression is slated to hit the market. But there's more to "the baby blues" than the biological.
It used to be called "the baby blues," but now the medical community recognizes it as postpartum depression, an illness the Centers for Disease Control (CDC) says affects one out of every nine new mothers in the United States. In addition to the symptoms of general depression, a new mother suffering from postpartum depression (PPD) may also feel numb or disconnected from the child, severe doubts about her ability to care from the child, or concern that she will hurt the child.
As National Public Radio (NPR) notes, the majority of current treatments for PPD involves a combination of talk therapy and antidepressants. But in March the Food & Drug Administration approved the first-ever drug specifically designed to treat PPD. Brexanolone (or allopregnanolone), which beginning in June will be marketed as Zulresso, is unlike other antidepressants, in that it is a synthetic version of progesterone, a pregnancy hormone.
The good news so far is its apparent effectiveness. According to NPR, most women given a one-time continuous IV infusion of brexanolone over 60 hours under medical supervision at a hospital or another medical facility start to feel better as early as 48 hours from beginning the treatment, with the effects lasting for a about 30 days. "My experience [is] of seeing people coming in enormously depressed, not interacting, not eating, sleeping and interacting with their babies ... and within 60 hours have remission of their symptoms," Samantha Meltzer-Brody, the doctor who led the clinical trials, told NPR.
The obvious bad news is that this may be yet one more way in which the haves get more and have-nots get nothing. For starters, there's the price tag: $34,000. Then there's the fact that women on the lower end of the economic scale are those least likely to be able to swing 60 hours straight in a healthcare facility. "Those who have the highest rates of postpartum depression and who would benefit the most, I fear it will be limited access to them," Dr. Maria Muzik, an associate professor at the department of psychiatry and obstetrics and gynecology at the University of Michigan, told NPR.
However, considering that the costs of about half of all U.S. births are picked up by Medicaid, getting insurers to include brexanolone as a covered treatment would go some way toward ameliorating this problem. But the fact that women inhabiting lower socioeconomic strata experience higher rates of PPD points to a major caveat in heralding bexanolone as the automatic go-to treatment for PPD.
We see the first caveat when we look toward biology. Because biology doesn't discriminate by income, the fact that PPD does to some degree clearly demonstrates that PPD is, for at least some percentage of women, at least partly psychological. If this were not the case, PPD rates would be consistent across all socioeconomic levels. But because life is generally harder and contains more stressors below the poverty line than above it, just as we see with generalized depression, PPD rates are higher in low-income areas.
However effective it may be, it must be kept in mind that brexanolone is a purely biological treatment, a medication⎯and according to an article published in Monitor on Psychology, the official journal of the American Psychological Association, it is psychotherapy and not medication that should be the first line of treatment for PPD.
"Studies estimate that 10 percent to 15 percent of women may experience a major depressive episode within three months after giving birth," writes Melissa Lee Phillips, the articles author, adding that "clinicians suspect that it’s still vastly underdiagnosed. [...] If minor depressive episodes are included, as many as one in five new mothers suffer from depression." .
To support her thesis, Phillips points to a meta-analysis by University of Iowa researchers, which concludes that that psychotherapy should be “considered a first-line treatment, rather than as an adjunct to medication treatment.”
“The medications absolutely do help, when needed,” Christina Hibbert, PPD victim and founder of the Arizona Postpartum Wellness Coalition, told Phillips. “The problem has been that too often women are not given options other than medication." And considering that (as Phillips notes) PPD incidence may be more than 30 percent higher among poor new mothers than those who are financially stable, clearly medication is, at most, a piece of the puzzle. But sometimes it's the wrong piece. As Hibbert puts it, “[M]any women end up on medications who wouldn’t need them if they had a safe place to talk and receive coping strategies."
The truth of this is apparent even from just the brexanolone clinical trials. As NPR notes, during the trials women on placebos also showed some improvement⎯which means that just the fact that they were receiving some attention for what they were experiencing was helpful.
Postpartum depression is a genuine problem for a significant percentage of new mothers, and it may consist of either biological or psychological factors⎯or a combination of both. Brexanolone may indeed be a breakthrough in helping those who feel helpless in the face of their hardships during what should be a time of joy. But even if so, we should never presume that medical breakthroughs necessarily are the answer to our problems, especially at the expense of ignoring other possibilities.
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