Just a few days ago the FDA approved the first ever treatment for postpartum depression called brexanolone. Postpartum depression is a serious, complex problem that can last days, weeks, months, or even years, and it affects 1 out of 9 women (some studies say 1 out of 7). Without medical intervention, recovery is challenging.
Brexanolone is administered as an IV treatment given under medical supervision for a total of 60 hours. That’s right, 60 hours. It is a synthetic version of the steroid allopregnanolone, which is made naturally in the body when progesterone breaks down. During pregnancy allopregnanolone levels are high but plummet after delivery along with estrogen levels. For many women this change is just fine, but for that 1 out of 9, this change can trigger immediate and significant depression (1). The brexanolone treatment is thought to work by binding to GABA receptors in the brain (GABA is a naturally occurring neurotransmitter that helps your body deal with stress) and essentially resetting the area of the brain that is responsible for postpartum depression symptoms (2).
The 60 hour IV treatment comes with a hefty price of $20,000-$35,000, lasts for about thirty days, works in approximately 50% of women, and currently has side effects of extreme sedation and possible loss of consciousness (1). There is no mention whether the drug is safe for women who intend to breastfeed. However, we have known since 1996 that a small amount of safe, natural estrogen lifts symptoms of depression in up to 80% of women with postpartum depression (3). In my practice, we talk to women about their risk of postpartum depression, and we encourage those at risk to apply a small estrogen patch immediately after giving birth— with great success.
(1) Howard, Jacqueline. “FDA approves first postpartum depression drug.” March 20, 2019. https://www.cnn.com/2019/03/19/health/postpartum-depression-drug-fda-bn/index.html?no-st=1553279783
(2) Rettner, Rachael. “How Does the New Postpartum Depression Drug Work?” March 20, 2019. https://www.livescience.com/65040-postpartum-depression-drug-how-it-works.html
(3) Gilbert, Susan. “Estrogen Patch Appears to Lift Severe Depression in New Mothers.” The New York Times. May 1, 1996. http://www.nytimes.com/1996/05/01/us/estrogen-patch-appears-to-lift-severe-depression-in-new-mothers.html