MUSC Women's Health to offer new postpartum depression treatment

March 20, 2019
Depressed-looking woman holding a baby
An estimated one in seven women experiences postpartum depression.

MUSC Women’s Health will offer the new postpartum depression drug brexanaolone, marketed as Zulresso, within a couple of months. It’s an IV treatment that can cause symptoms to start to ease in as little as 24 hours.

Psychiatrist Constance Guille, associate professor in the Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, specializes in helping women before, during and after pregnancy with mental health issues, including postpartum depression. In this Q&A, she outlines what the new treatment involves, how it works and why it’s an important development.

Q: How big a deal is it for women to have this new option?

A: It is a very big deal. The reason is, with our current treatments, at best, women’s symptoms of postpartum depression will resolve in 6 to 8 weeks. With the new treatment, symptoms start to resolve within 24 hours. And after 60 hours, 75 percent of women with have a significant reduction in symptoms and 50 percent will have complete remission.

Of the people who have a reduction in symptoms, over 90 percent will still be well at 30 days after the treatment. A fast-acting treatment that lasts a month is a huge step forward in the treatment of postpartum depression.

Q: How does it work?

A: It’s a 60-hour infusion through an IV. Women would need to come into a health care facility to be supervised during the whole 60 hours.

When they start the infusion, the doctor carefully raises the dose to an effective level. When you finish the infusion at 60 hours, you’ve been essentially tapered off the medication and you can go home.

It is believed that the mechanism of action of the drug is tied into what we think is the etiology of postpartum depression. It's thought that a sub-group of women are sensitive to the fluctuation of pregnancy-related hormones, particularly the plummeting of a hormone called allopregnanolone in the postpartum period resulting in an anxious and dysphoric state. The new drug acts directly on the receptor that allopregnanolone works on, GABAa, and this appears to help restore mood and decrease anxiety.

Q: Are there side effects?

A: In the clinical trials, the most common side effects were headache, dizziness and sleepiness. There was a serious adverse event in one patient that included an altered state of consciousness and syncope or fainting. The participant recovered quickly with stopping the infusion.

Q: When can women get the new treatment at MUSC Women’s Health?

A: I’m hoping in June. Right now, the Food and Drug Administration has required that a patient registry be established and the Drug Enforcement Administration will need to designate a class for the drug. Once the registry and scheduling are complete and our providers undergo training, we’re hoping that in June or July we’ll be able to start doing the treatment here.

Q: Will it be covered by insurance?

A: The company that makes Zulresso thinks so and has been working with insurance companies for some time with the hopes that this will be covered by most major insurances.

Q: What effect could this have on society’s view of postpartum depression and the women who suffer from it?

A: Postpartum depression is a really serious condition. What most people don’t recognize is that it’s the most common complication of childbirth and one of the leading causes of maternal mortality. It also has a significant impact on not only the woman but also her relationship with her significant other and their child’s development.

We know women who struggle with postpartum depression tend to have more tension in their relationship with their partner. Their children are much more likely to have behavioral problems, academic problems and depression as an adolescent. So treating this is critically important, not only for mom’s health but the whole family unit.

What women have been told in our culture and our media all along is that this is the most wonderful time of your life. You should be so happy to have a baby. So why are you feeling this way? You need to suck it up and be grateful. People need to understand it’s not about that. Of course, women are grateful and love their child. But they have an illness that is getting in the way of their ability to experience the joy that can come with motherhood, and now we have a really exciting and effective treatment that allows women to get back to their lives.

The estimates vary, but usually we say 1 in 7 women will experience postpartum depression. One in 3 women who are low income will experience this. This is a common disease.

MUSC Women’s Health at 135 Cannon Street has a Women’s Reproductive Behavioral Health Program for women dealing with mental health issues related to pregnancy or the postpartum period. Women can access the program by coming to the walk-in clinic at Women’s Health any Monday or Wednesday of each week from 8:00 a.m. to 10:30 a.m. Women will be seen by a psychiatrist and receive ongoing mental health treatment within the program as needed.

About the Author

Helen Adams

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