A New Era of Antidepressants: Postpartum survivor speaks on new FDA

Dr. Walker Ladd, a clinical psychologist and faculty member at Saybrook University in Pasadena, speaks on the new FDA-approved drug for postpartum depression.

Suicide is a leading cause of maternal mortality in the United States and globally, accounting for up to 20% of postpartum deaths. Pregnancy is a roller coaster of hormonal and physical changes, but add in depression, and it can turn deadly. Postpartum depression is chronically “underdiagnosed and undertreated,” explained Dr. Walker Ladd, a clinical psychologist, faculty member and chair of the research department at Saybrook University in Pasadena. Change is on the horizon with the advent of a new Food and Drug Administration drug approved to treat postpartum depression.

On Aug. 4, the FDA approved the first oral medication to treat postpartum depression. The drug, called zuranolone and branded as Zurzuvae, is a once-a-day pill by biotechnology companies Sage Therapeutics and Biogen.

Whereas some antidepressants can take up to eight weeks for patients to see results, the medication relieves postpartum symptoms within days. The drug works as a fast-acting steroid, binding to GABA receptors in the brain and resetting imbalanced neurotransmitters affecting patients struggling with depression.

Many new mothers experiencing postpartum depression only receive treatment well after their symptoms begin because they are not screened immediately at discharge, and they may not see their provider until six weeks after the baby is born. Most women experiencing symptoms are prescribed standard antidepressants, which can take weeks to take effect.

“So now we’re looking at two or three months of suffering with life-threatening symptoms,” Ladd said. “Zurzuvae’s efficacy in a quick amount of time is a game-changer.”

Postpartum depression, an episode of major depression that can begin in the later stages of pregnancy or after childbirth, affects 15% of women in the weeks or months after having a baby. During pregnancy, hormones like progesterone are elevated to help develop the fetus. But once the baby is delivered, those hormone levels rapidly decline, returning to baseline in around two weeks. Until the advent of Zurzuvae, the only treatment for postpartum depression was an IV injection dispensed by health care professionals at certain facilities.

Like other forms of depression, postpartum depression is characterized by sadness, a loss of interest in activities that once brought joy and an overall decreased ability to feel pleasure. What follows can present as loss of energy, suicidal ideation, cognitive impairment and feelings of sadness or inadequacy.

“Having access to an oral medication will be a beneficial option for many of these women coping with extreme, and sometimes life-threatening, feelings,” said Dr. Tiffany R. Farchione, director of the division of psychiatry in the FDA’s Center for Drug Evaluation and Research.

Zurzuvae’s efficacy was tested in two randomized, double-blind, placebo-controlled, multicenter studies. The results revealed that patients taking Zurzuvae showed significantly more symptom improvement than their placebo counterparts. Zurzuvae is currently in trial with the FDA for the general population as a treatment for depression.

Most people harbor preconceived notions of motherhood, accompanied by an onslaught of images, beliefs and information. “Anything that resembles the current norm for motherhood is depicted as radiant, attached and connected,” said Ladd, standing in direct opposition to a mother experiencing postpartum depression.

Throughout history and mythology, the concept of the “mad mother” has been ingrained in our collective psyche as a threat, explained Ladd. Many mothers who deviate from the preconceived norms associated with motherhood are met with fear. Yet, mothers with thoughts of harming themselves or their babies amount to less than 1% and are associated with postpartum psychosis rather than depression.

“We’re still really uncomfortable saying ‘mental illness’ because it comes with a stigma,” Ladd explained. “We look at this specific topic of mothers and psychiatric differences through a lens that is very heavy with stigma.” Because of this stigma, many mothers may be hesitant to seek help.

Ladd explained mothers face undue pressure and judgment, even when not experiencing illness. There is an unfair pressure for mothers to bounce back physically and mentally after having a baby and “love every minute of motherhood and not have things like depression or anxiety, and it’s supposed to be natural,” Ladd said. “It just doesn’t happen that way for everyone.”

At the time of her son’s birth in 2000, Ladd worked as a couples and family therapist. Despite working as a trained mental health professional, when postpartum depression struck, Ladd had “no idea” what was happening to her and nearly lost her life. She finally received treatment after around two months of symptoms. After treatment, it was “like night and day,” she explained.

With medication and a specialized team behind her, Ladd remained in remission throughout her second pregnancy. “Realizing that I wasn’t going to feel like that again is one of the happiest memories I have in this life,” Ladd said. “It felt like I got the birth I deserved, that everyone deserves.” Her experience drove her to pursue a Ph.D. in psychology, and she has since dedicated herself to maternal advocacy, which includes working as a certified doula and conducting research on perinatal mood and anxiety disorders.

In her book, “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth,” Ladd collected stories from 20 women about their journeys through postpartum depression and the growth they experienced. She also recently co-published a study on the experience of postpartum anxiety during COVID-19. “I’ve been trying to increase the awareness of these disorders in my work and research,” Ladd explained.

Zurzuvae has the potential “to erase a lot of the suffering that occurs, and we could potentially reform or reshape how we perceive the postpartum period,” explained Ladd. As the scientific and medical communities continue to research and delve into the root causes and treatments for postpartum depression, Ladd hopes to see a greater awareness and understanding surrounding the condition.

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