For many new mothers, taking on the role of caring for a new baby is a joyful time, but it can also be very stressful and emotional. While many mothers learn to adjust to their new schedules and responsibilities, up to 15% of women develop postpartum depression.

“Women who have had pre-existing depression or depression during pregnancy are more likely to develop postpartum depression,” says Alexandra Burt, MD, Nebraska Medicine psychiatrist and medical director of the Reproductive Psychiatry Clinic.

“In many cases, we can mitigate the risk of development of postpartum depression with medications and/or therapy if depression during pregnancy is diagnosed and treated early on,” says Dr. Burt. 

“Studies show that 60% to 70% of women who experience postpartum depression also experienced depression during pregnancy but only 10% receive treatment on average. We are working closely with our obstetricians to change that by actively screening and diagnosing our pregnant patients for depression so we can be more proactive in treating them.” 

New postpartum anti-depressant drug

In late 2023, the Food and Drug Administration (FDA) approved zuranolone, the first antidepressant developed specifically for postpartum depression.

“An important advantage of zuranolone is that in clinical trials, patients treated with zuranolone showed statistically significant improvement in symptoms compared to placebo just three days after starting treatment.” 

“This is a significant difference from traditional antidepressant medications, which often take four to six weeks to become fully effective.”

How it works

• Zuranolone is a high-potency synthetic hormone derived from progesterone.
• It targets the  GABA-A receptor, a neurotransmitter that blocks the nerve cell’s ability to send and receive chemical messages that help regulate mood and anxiety.
• Traditional antidepressants target serotonin, which also regulates mood, but may not be specific to postpartum depression.

Treatment schedule

The drug is taken once a day for 14 days. Women in the clinical trials showed significant improvement during that time, and most continued to stay well 30 days later, Dr. Burt says.

However, there are some barriers associated with the new drug. Because this is a new medication, we do not have enough data to know how many women will have relapse of depressive symptoms after treatment with zuranolone. 

In addition, the drug does pass into the mother’s breast milk and potential side effects to the baby are still unknown.  Therefore, if a patient is breastfeeding, we do not recommend that they do so during the course of zuranolone treatment, but they can continue pumping with a goal of resuming post-treatment. 

Another barrier involves potential side effects, which may include drowsiness, sedation, dizziness, memory impairment and confusion. As a result, mothers must have assistance with childcare during this 14-day period, notes Dr. Burt. Zuranolone has a black box warning due to risk of impaired ability to drive or engage in other potentially hazardous activities due to central nervous system depressant effects.  Because of this black box warning, patients are instructed not to drive at least 12 hours after administration of the medication.

“While this new drug does have some limitations, it is an exciting tool for new mothers experiencing postpartum depression,” says Dr. Burt.

Conventional postpartum anti-depressants

Women with postpartum depression are typically treated with conventional anti-depressant drugs that are evidence-based but take longer to work. “The advantage to these, however, is that traditional anti-depressant drugs have been studied for decades and we know much more about the risks and benefits of taking these medications when breastfeeding,” Dr. Burt says. “Because there are still some unknowns with this new drug, we are still learning about who the right candidates are for this medication.”

Postpartum depression usually begins within the first three months after giving birth, but can occur anytime within the first year. It differs from the “baby blues” associated with feelings of sadness, fatigue and anxiety that occur in up to 80% of new mothers.

Postpartum depression is a serious mental illness that can cause:

• High levels of anxiety.
• Obsessive compulsiveness.
• Extreme fatigue.
• Confusion, difficulty with memory.
• Inability to sleep.

Women at highest risk for postpartum depression include:

• Young mothers.
• First-time mothers.
• Mothers with little support.
• Single moms.
• Mothers in lower socioeconomic status.
• Mothers with prior depression.

You can help prevent postpartum depression by:

• Getting sufficient sleep.
• Getting social support.
• Receiving talk therapy.

“This is an important new drug as 20% of all deaths in new mothers are caused by suicide,” says Dr. Burt. “We are hopeful that this will be a pivotal tool to help reduce suicide risk in this important population.”