Post Partum Depression: A new anti-depressant, Brexanolone

Sita is a 27-year-old woman who has been married for two years. Her husband Ram, an army man, applied for paternity leave, and both were excited to welcome the newborn.

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It has been seven days since Sita gave birth, but she hasn't felt like 😊 when she looks at her baby. She worries that if she does smile, something bad might happen to the baby. Sita has been experiencing trouble 😴 and isn't eating properly. Her husband is struggling to understand what is happening to her.

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Approximately 1 in 8 women experience depressive symptoms postpartum. It is common for women not to receive a diagnosis or seek treatment until several months after giving birth. Postpartum depression, if left untreated, can have negative effects on both mothers and their children. It can impact a mother's mental health, quality of life, and interactions with their partner, infant, and other family members. It's crucial to address severe postpartum depression as it can significantly impact children's development, especially those from lower socioeconomic backgrounds.

#PostpartumDepression #MentalHealthAwareness #ChildDevelopment #Parenting #SocioeconomicFactors

Treatment of depression typically involves psychotherapy and SSRIs if the severity of the condition is significant. In cases where the depression severity is high, and the individual is experiencing suicidal thoughts, electroconvulsive therapy (ECT) may be recommended as it can provide rapid improvement and potentially save the person's life.

What is new? 🤔

In 2019, a new treatment called brexanolone was approved for postpartum depression. This treatment is given through an intravenous injection and is known for its fast-acting results. However, patients must be hospitalised for a 60-hour-long infusion and monitored for excessive sedation and loss of consciousness during the treatment.

In August 2023, an oral version of brexanolone 🌟, the first pill for treating postpartum depression, was approved. Similar to the infusion, it acts quickly 💨, but as it only needs to be taken once a day, it is more convenient 🙌. There are a total of three positive randomized controlled trials 📊.

What is Brexanolone?

Claimed to be faster (as quick as three days) acting than SSRI, but at the end of 8 weeks, similar response rates as SSRI. It is a neurosteroid and analogue of the hormone allopregnanolone. Allopregnanolone is derived from progesterone, which rises during pregnancy but then begins to fall in the third trimester and plummets after delivery. It is a positive allosteric modulator of the neuroactive steroid γ-aminobutyric acid type A (GABA-A) receptor.

Possible negative effects of this medication include 💤, so it is important to avoid 🚗 after taking it. Additionally, there is a risk of increased suicidal thoughts in young adults and adolescents. Due to its effects on GABA, this medication also poses a risk of dependence, similar to benzodiazepines. Furthermore, the long-term effectiveness of this drug is unknown.

Dosage: 50mg at night

👨‍⚕️ Prescribed dosage should be followed carefully to ensure optimal treatment.

Not available in India currently and is quite costly.

References:

1. https://doi.org/10.1176/appi.ajp.20220785

2. http://jamanetwork.com/article.aspx?doi=10.1001/jamapsychiatry.2021.1559

3. https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression

4. https://jamanetwork.com/journals/jama/fullarticle/2808852?guestAccessKey=6632f81e-12b7-48c9-a4ee-939184206a71&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamapsychiatry&utm_content=olf&utm_term=082023&utm_adv=000002041852