MUSC psychiatrist involved in testing new postpartum depression pill calls its approval a big deal

MUSC Women’s Health psychiatrist Connie Guille, M.D., is thrilled to see that a postpartum depression pill she was involved in testing in a clinical trial is about to come on the market. Zurzuvae recently earned approval from the Food and Drug Administration.

“It's so exciting to see something that is specific and responsive to this population's needs and can improve women’s health within a very short period of time.”

Guille, director of the Women’s Reproductive Behavioral Health Division and a professor in the departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at the Medical University of South Carolina, called that quick action a big deal.

“Typically we are prescribing an SSRI that can take six to eight weeks to work and needs to be taken daily for at least nine to 12 months,” she said, referring to the most common type of antidepressant. “But this medication is taken for only 14 days and patients’ symptoms significantly improve during this time. It's a completely different class of medication,” she said. 

“It's designed around the mechanism that we think is one of the underlying causes of postpartum depression. Typically in pregnancy, your progesterone and metabolite, allopregnanolone, increase by about 50-fold and then drop precipitously within the first couple days following delivery.”

In some women, that drop triggers a problematic response. “It affects your brain’s main inhibitory neurotransmitter system, and for a subgroup of people, they can start to experience significant dysphoria and anxiety and develop postpartum depression. The medication is a compound of allopregnanolone that is designed to target that neurotransmitter system,” Guille said.

Guille was also involved in testing the pill’s precursor, a three-day continuous IV infusion called Zulresso, which required that the patient remain in a health care facility to be monitored throughout the entire 60-hour treatment. She said the pill is much easier to use. “It’s taken once a day at home for women with postpartum depression.”

This type of depression affects a significant number of women. “Postpartum depression is the most common complication of pregnancy and childbirth. Estimates vary, but we typically say somewhere between 15 and 20% of women will experience this over pregnancy or the postpartum year,” Guille said.

That complication is a serious concern. “Mental health conditions are the leading cause of maternal mortality by suicide and drug overdose. Untreated postpartum depression is costly and associated with an increased risk for behavioral, academic and mental health problems in children. This is not just women experiencing a bad day or a bad mood. This is a significant public health problem that has long-term implications for women’s health and children’s development.”

Guille elaborated on the symptoms. “Most commonly, what women will start to experience is a change in their mood. They’ll feel sad, irritable, not interested in anything. They don't feel pleasure from anything. And then also can feel really anxious and on edge where lots of worries can occur that are disproportional to the situation,” she said.

“A lot of times people experience feelings of worthlessness like they're not a good enough person or a good enough mom. They can also see changes in their sleep and appetite. And often, women can experience suicidal thoughts of wanting to die or wishing that they were not here.”

Guille said women who think they may have postpartum depression should take that concern seriously. “You should call your doctor, but I would also direct them to Postpartum Support International. PSI has a 24 hour a day, seven day a week maternal mental health support hotline. So you could call or text this number and you're going to talk to somebody who is well-versed in maternal mental health and can help you also navigate resources in your state for where you could find treatment.”

The number for Postpartum Support International is 1-800-944-4773. You can call or text the word “help” to that number.

While she’s pleased to see Zurzuvae headed to the market, Guille said more research is needed. “The one downside is that we don't have any data on breastfeeding in this medication yet. So we have to be cautious around that. And we also have to be really cautious around any other medications that they might be taking that are sedating. But otherwise, we're really optimistic in terms of improving treatment for postpartum depression.”