While mothers with Postpartum Depression have faced obstacles to getting the care they require, the situation has gotten worse since the COVID-19 epidemic began.
Before COVID-19, it was believed that up to one in five would experience depression during the first year after childbirth. However, the stress and disruptions to services caused by the pandemic increased the number to one in three. The pandemic coincided with significant innovations in treatment, which may have improved access and effectiveness.
PPD medications are available.
The FDA’s approval of brexanolone by the United States Food and Drug Administration in early 2019 was a major development. The FDA approved brexanolone as the first in a new class of medications for postpartum depression (PPD), targeting the sharp drop in hormones following delivery. Brexanolone (allopregnanolone) is a synthetic form of the naturally occurring substance allopregnanolone. This substance helps regulate stress in the brain.
The approval of this medicine in the U.S. is notable for two main reasons: It was the first medication approved for the treatment specifically of PPD, and it has a rapid effect — within 60 hours.
It is a breakthrough drug, but it can be expensive. A course may cost up to USD$34,000.
The U.S. FDA has approved quinolone as another allopregnanolone-derived drug. Zuranolone is a much more convenient antidepressant than brexanolone. It can be taken as a pill over 2-4 weeks.
Early studies suggest that PPD symptoms can improve within three days of starting treatment. This is a rapid response for an antidepressant, which normally takes effect over several weeks.
The hype behind the hype
The fanfare that has accompanied the medications may also increase awareness of PPD by suggesting a biological reason for a disorder associated with such a high level of self-blame. This could encourage more people to seek out treatment and increase screening and detection efforts on behalf of healthcare providers.
It would add to the existing array of treatments in Canada. There are also evidence-based therapies, such as cognitive behavioral therapy and interpersonal psychotherapy, which are first-line treatments for mild-to-moderate PPD.
Most people with PPD are treated using antidepressants like the select serotonin reuptake inhibitors, such as sertraline or escitalopram.
While talking therapies are available in some publicly-funded healthcare systems, they are not always timely. Many also prefer to avoid antidepressants during pregnancy and breastfeeding if possible.
Many questions remain unanswered about the potential impact of quinolone despite its exciting advancement.
To date, only two human clinical trials exist, and the eligibility for these studies is restricted to a small subset with PPD. Participants could only be those with severe depression, which appeared between the third trimester and four weeks after delivery.
The researchers only looked at the effects of quinolone for six weeks. They did not study its safety in pregnancy or lactation (participants were required to agree to discontinue breastfeeding when taking this medication).
The cost of quinolone will likely be high despite the excitement around its approval in the U.S. It is also unknown if Canada will approve the drug. It is also unclear whether private or public insurers will cover this medication. This could make it unaffordable for those with PPD.
PPD is underdiagnosed
It is exciting to see new innovative medications being developed. They can give hope to those who are affected. We mustn’t forget that PPD is an under-diagnosed and under-treated problem that already has safe and effective treatment.
The Edinburgh Postnatal Depression Scale is a free screening tool that can help detect PPD. Psychotherapy, combined with existing antidepressants, can be effective and safe for both pregnancy and breastfeeding.
It can be difficult to find inexpensive self-care interventions that are helpful. These include sleep hygiene, relaxation, exercise, and improving social and practical support.
Although provincially funded psychotherapy can be difficult to access, research and efforts to apply findings are starting to bring together the fragmented network of community organizations and traditional and public health services to try to increase access in Canada.
The federal government’s appointment of a minister for mental health and addictions and its prioritization of perinatal parents and research into PPD treatments are other reasons for optimism.
While quinolone raises awareness about PPD, it is important to emphasize the need for Canadian-specific care models, stepped-care pathways, and national quality standards. This would allow people to receive existing treatments more quickly and help Canada become the most desirable country in which to have a child.