Post Partum Depression

At Lone Star Infusion we are thrilled that postpartum depression is getting more attention. Most recently the FDA has approved a new medication for postpartum depression exclusively- Brexanolone, which will be marketed by the brand name Zulresso by Sage Pharmaceuticals.

About 15% of births, or 1 in 7, lead to postpartum depression for the mothers. It often starts in the first month, and it can last months or years. Fortunately, treatment can help many people.

While I’m excited with any research into postpartum depression, I am concerned that the new medication is administered by IV drip over a 60-hour timeframe while the patient is admitted to the hospital. This not only removes the mom from her regular life for 60 hours but also can interfere with breastfeeding - both of which can increase stress, feelings of failure, and make it more difficult for the mom to bond with the baby (although 3 days away from home may be a welcome break for many).

This new drug is also pretty expensive. The patient will have hospital expenses, doctors’ fees, and may have childcare expenses - Sage Pharmaceuticals estimates the medication cost to the patient alone will be $35,000 per 60-hour treatment. I say per treatment because the patients in the two studies that were submitted to the FDA for approval only looked at 30-day follow-up for depression symptoms. Patients with postpartum depression may have their symptoms return and may need another infusion after 30 days.

It’s also interesting to note that although Sage Pharmaceuticals talks about a robust improvement, the data in their own studies tell a slightly different story. From the first study, they submitted to the FDA the scores on the depression survey decreased by 19.5 Points on the high dose of Zulresso, 17.7 points on the low-dose of Zulresso, and 14 points on the placebo group - the group that received no medications but was in the hospital for 60 hours. The second study that was submitted to the FDA showed the Zulresso group having a 14.6. drop versus a 12.1 point drop for the placebo group - again the group that received nothing. What this means is that after 60 hours of being away from home and being on an IV drip 75% of the patients improved by about 50% for 30 days. But meanwhile, the patients who are away from their homes for 60 hours on an IV water drip had almost the same benefit as the medication. The authors of the studies also noted that with less severe postpartum depression the patients received less benefit from the medication.

It may be that the most important benefit from a brexanolone treatment comes not from the drug itself, but actually from taking a 3-day period of rest.

At Lone Star Infusion we have been offering treatment for new moms with postpartum depression since 2015. IV ketamine has a 70 to 80% success rate (depending on which study you read) in decreasing a patient’s symptoms by at least half within the first one or two infusions.  Even with monthly boosters, a patient’s total cost would be significantly less then brexanolone – likely one fifth the cost, or even less. Patients can continue breastfeeding without interruption. They can stay at home and they only need to step away from their normal lives for 2 to 3 hours surrounding their infusion. 

We are proud to have treated multiple moms with postpartum depression successfully. Brexanolone may prove to be a real benefit for patients – and we hope it is. We also urge women with postpartum depression to look at IV Ketamine for fast and effective relief for many patients – without the requirement of an expensive and lengthy hospital stay.

Author
Dr. Allison Wells, MD

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