This is Why I’m Not Excited About The Postpartum Depression Drug

The new postpartum depression drug, Brexanolone (a.k.a Zulresso) is a huge step forward for maternal mental health care, so why am I not more excited?

Recently, Sage Therapeutics announced the release of a new drug designed specifically to treat postpartum depression and the maternal mental health community jumped for joy.  The drug is due to be available in June of this year, making it the first and only one of it’s kind. 

Now, don’t get me wrong, I think this is incredible forward progress for maternal mental health and commend all those who put so much effort into creating it.  But after researching more about this postpartum depression drug, I have to admit that I am not nearly as excited as I was when I first heard about it. 

Here’s some more information about the new postpartum depression drug.
The Postpartum Depression Drug | Brexanolone (Zulresso)
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It takes 60 hours to administer.

That’s two and a half days.  For a mother with children who are a bit older – that might sound like a welcome vacation.  But for a women who has recently given birth?  Not so much.  Since the postpartum depression drug is recommended in the first 6 months postpartum, spending two and half days away from a new baby can be a difficult task to pull off. 

The good news is that Brexanolone (Zulresso) can work within 48 hours, so if you are able to manage the time away, then it could be worth it.

It can only be administered in a hospital setting.

The postpartum depression drug is given via an IV, which means that a woman will need to stay in the hospital for the full 60 hours and possibly longer if she experiences any adverse side effects.  Considering that the US only has one perinatal psychiatry inpatient unit (a.k.a. mother and baby unit) in the entire country, this means that a woman will need to be separated from her newborn baby for an extended period of time.  The hospital stay is necessary because a woman receiving the drug can suffer from such side effects as suicidal ideation or a loss of consciousness and therefore would need to be closely monitored.  

This could be a major setback for a mother who may have had a traumatic hospital delivery that triggered her postpartum depression to begin with.

It’s expensive.

The price range for the new postpartum depression drug is between $25,000 to $35,000.  And that’s not including the cost of the hospital stay for 2 – 3 days (or possible income loss and childcare cost during those days).  For a family with accumulating medical bills after the labor and delivery, this is another burden on top of all of that. Even with a great insurance plan, Brexanolone (Zulresso) is such a new drug that you’d have to make sure it’s covered by your insurance, which is yet another hurdle to overcome.

The high price tag and insurance red tape make the postpartum depression drug seem inaccessible to the vast majority of suffering women.

It can obstruct breastfeeding.

The postpartum depression drug has not been tested in breastfeeding mothers, however it is confirmed that the drug does pass through breastmilk.  It’s likely that, until further testing is done, mothers who choose to take the postpartum depression drug will be discouraged from breastfeeding. 

This is just a temporary situation, as mothers can pump and dump while being administered the drug in order to keep up their supply.  But time away from a newborn baby before breastfeeding has been properly established can have a big impact on the overall success of breastfeeding in the long run.

For a mother who is already overwhelmed by the pressure to breastfeed, this can cause an added amount of guilt and regret.

Breastfeeding with Postpartum Depression

It hasn’t been extensively tested.

The clinical trials for the postpartum depression drug was run on a group of less than 250 women.  Considering what we know about the different symptoms and ways that postpartum depression manifests, it just doesn’t seem like enough.  In addition to the low number of women in the trial, there was only a slight difference in the effects felt by the women who received the dose of Brexanolone (Zulresso) versus the women who received the placebo.  Read more details on the trials here.

It’s great that the drug trials were conducted in such a timely manner, but it leaves me to wonder if there isn’t something they’ve missed.

It can discourage other forms of care.

A drug specifically to treat postpartum depression is not a cure for postpartum depression.  I feel like a lot of people will be confused by that.  Just like all other forms of treatment, certain things work for different people.  In addition to medication, therapy is also important to help avoid relapses and tackle the root cause of the symptoms.  And let’s not forget about the importance of self-care.

As of right now, Brexanolone (Zulresso) has only been tested in single doses and the women who participated in the study haven’t experienced a relapse of symptoms.  So there’s no evidence available yet on the long term effect of the postpartum depression drug.

While the news of this new drug is fantastic, it’s not the one and only solution.

Postpartum Depression Self Care

It first requires diagnosis.

Before a woman can even receive the postpartum depression drug, she needs to get a proper diagnosis.  This is one of the biggest problems surrounding postpartum depression and should be where our focus lies.  The screening process for maternal mental illness is not nearly thorough enough.  And too many women slip through the cracks because their symptoms are not being taken seriously. 

So while a new treatment option for postpartum depression is wonderful news, it also shines a light on all the other places where our medical system is currently failing new mothers. 

The postpartum depression drug is just one step.

Obviously, I am excited that progress is being made in the field of maternal mental health.  Brexanolone (Zulresso) is hopefully the first in a long line of treatment options and better care for women with postpartum depression.  While we may not be able to walk into our local pharmacy and buy a bottle of the magic postpartum depression elixir to cure all that ails us – it’s still a step in the right direction.  And I look forward to a future where maternal mental health care is a top priority.


Additional Resources

  • A Primer on Brexanolone (Zulresso) for Postpartum Depression
  • With First-Ever Postpartum Depression Drug, Progress May Not Equal Access
  • Brexanolone (Zulresso) Press Release from the U.S. Food and Drug Administration
  • Information about the dosage and side effects of Zulresso 

The Postpartum Depression Drug | Brexanolone (Zulresso) The Postpartum Depression Drug | Brexanolone (Zulresso)