• Postpartum Depression is a frequent disorder that is commonly misdiagnosed
  • The disorder is treated and managed through therapy and various medications, which take time to be effective
  • Now there is new hope for mothers with this disorder everywhere

Introduction – Postpartum depression is a topic that doesn’t get much attention. It is a mood disorder in which women experience severe clinical depression shortly after giving birth. Some of the symptoms that the patient may experience are anxiety, exhaustion and extreme sadness.The pathophysiology of the disease is not known, however it is thought to occur when the levels of hormones such as estrogen and progesterone, (that increase during pregnancy)-drop very quickly after delivery. These changes on a chemical level in the brain are a factor in the mood disorder (1) .

Statistics – According to the studies made by Center for Disease Control and Prevention (CDC) 1 in 9 women are affected by postpartum depression (2), (3) .

Fig. 1.) depicts a visual representation of the frequency of the disorder. Image adapted from Google.

Treatment – Until now the treatment consisted of:

  • Counseling with a mental health professional (therapist, psychologist) either through Cognitive behavioral therapy (CBT) or Interpersonal therapy (IPT)
  • Medication with antidepressants, which take a few weeks to be effective.

Fig. 2.) Cognitive therapy and antidepressant medication have comparable short-term effects.Chart adapted from (4) (5)

Latest Research – For the first time on March 19, the FDA (US-Food and Drug Administration) approved a new drug for the treatment of postpartum depression. The drug is named Brexanolone but is known on the market as Zulresso.The drug was tested in a clinical trial where 250 women were involved, and after the first 60 hours 50% of them had reduced symptoms of postpartum depression compared to the 25% who got placebo (6) .

Mechanism of drug action – The mechanism of the drug is not clear yet, however it is thought to have an effect on the body’s stress response. It does this by binding to the Gamma- Amino Butyric Acid (GABA) receptors (7). This will enhance the work of gabaergic neurons-which inhibit the function of other nerves.

Fig. 3.) shows how a gabaergic neuron is depolarized by a glutamatergic neuron. In the case of this disorder the receptors are stimulated artificially with the drug. Image adapted from (8) .

Use and side effects – Brexanolone will be administered only in healthcare facilities through intravenous injections over 60 hours.There may be side effects like  sleepinessdry mouth, and loss of consciousness (9) (10).Another downside is that the drug may not be accessible to many women of low socio-economic status, as the price of this medication reaches 30.000$ (11) .

Conclusion – The future of the drug includes oral administration, which would be more convenient for the patients. To add to that, it has found a place as treatment in other disorders as well, such as status epilepticus, essential tremor and catamenial epilepsy(12).Although at the moment Brexanolone may be costly, and may include side effects, this drug has shifted the attention to the mothers in need. If anything, it will also pave the way for new research and improvement of treatment on this disorder.

COPYRIGHT: This article is the property of We Speak Science, a non-profit institution co-founded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by  Arrita Beqa, University of Prishtina, Kosovo.

References:

  1. https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml
  2. https://www.cdc.gov/reproductivehealth/depression/index.htm
  3. https://www.ncbi.nlm.nih.gov/pubmed/22691031
  4. DeRubeis RJ, et al. Cognitive therapy vs. medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005;62:409–416. [PubMed] [Google Scholar]
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/#R35
  6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31551-4/fulltext
  7. https://www.livescience.com/65040-postpartum-depression-drug-how-it-works.html
  8. https://www.rndsystems.com/pathways/synaptic-neurotransmission-pathways-gabaergic-inhibition
  9. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/211371lbl.pdf
  10. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm633919.htm
  11. https://www.npr.org/sections/health-shots/2019/03/21/705545014/new-postpartum-depression-drug-could-be-hard-to-access-for-moms-most-in-need
  12. Orrin Devinsky; Steven Schachter; Steven Pacia (1 January 2005). Complementary and Alternative Therapies for Epilepsy. Demos Medical Publishing. pp. 378–. ISBN978-1-934559-08-6.