Postpartum - First FDA Treatment

Major Advancements in Postpartum Care

The first drug approved by the U.S. Food and Drug Administration exclusively for postpartum depression is expected to be available soon at MUSC Health.

Constance Guille, M.D., director of of the Women’s Reproductive Behavioral Health (WRBH) program at MUSC and associate professor in the departments of Psychiatry and Behavioral Health and Sciences and Obstetrics & Gynecology, says the new drug, Zulresso, has shown promising results in clinical trials.

“It is amazing how quickly symptoms improve,” she says. “With current treatment it takes six weeks to see improvement, but with the 60-hour IV infusion of Zulresso, women start feeling better within days.” Postpartum depression is the most common complication of childbirth, affecting one in seven women and one in three low-income women. Results can be devastating.

“Suicide is one of the leading causes of death in the year following childbirth.” she says. “Postpartum depression has an enormous impact on women and their families. Children of mothers with postpartum depression are four times more likely to have behavior problems at age 3 or 4, two times more likely to have academic problems in middle school, and seven times more likely to have depression in adolescence.”

Zulresso is administered in the postpartum period, Guille says. Women receiving the medication must stay overnight in a certified health care facility and are monitored continuously. Data on breastfeeding is limited. “Providers need to discuss the risks and benefits of the treatment and breastfeeding during the infusion and assist women in making in-formed decisions that align with their preferences and values,” she says. Zulresso contains brexanolone, a form of allopregnanolone produced by progesterone, which may help ease depression and anxiety.

Although the cause of postpartum depression is not known, it’s hypothesized that for a subgroup of women the rapid drop in hormones negatively impacts mood.

The WRBH program is one of 30 programs in the United States that affords mental health treatment specifically for pregnant and postpartum women and one of 12 programs integrating this care into obstetrics practices and providing specialty training in reproductive psychiatry. Guille and her colleagues see a range of patients, including women having difficulty coping with the many stressful life events that can occur during pregnancy or postpartum as well as mood, anxiety, psychotic or substance use issues that commonly occur during this time.

To increase access to services, MUSC uses telemedicine consultations and operates a twice weekly walk-in clinic where women can get evaluated and treatment started.

“There’s a stigma against mental illness, and it’s compounded during pregnancy,” Guille says. “No woman should feel guilty or shameful for having a common disease – one we’ve known about since the mid 1800s. It’s taken us over 150 years to reach this point, but the outlook for treatment is encouraging.”