The Food and Drug Administration last week approved the first-ever drug specifically for postpartum depression. The drug, Zulresso, a synthetic form of a hormone produced in the brain, acts quickly, and its effects can last for a month, but there’s a catch.
Until a pill version is approved, the patient has to be hospitalized for 60 hours and receive the drug by IV. She can’t be home with her new baby because the drug may cause dizziness and unconsciousness. The price is also dizzying: $34,000 per treatment.
Zulresso showed enough promise in clinical trials to warrant speedy review and approval, but there was also a powerful placebo effect: While the depression scores of severely depressed women who received the drug dropped by two-thirds on average in one of the trials, the scores of those who got a sham treatment were cut in half. A big placebo effect is common in antidepressant studies, but it should not be overlooked, because it may be emblematic of one of the root causes of our postpartum despair epidemic. What new mother wouldn’t have an improved outlook after three days of TLC?
Postpartum depression is a serious problem, affecting, by some estimates, one in nine American mothers. It can be incredibly painful and is believed to be a growing cause of maternal deaths in the year following a birth. Insurers are expected to cover the exorbitant cost of Zulresso, which suggests that there’s finally a will to address our country’s dismal record on maternal health. Hurray!
But if we really want to tackle postpartum depression, we need more than a drug.
Research has shown that postpartum depression is more common in countries with high income inequality, high rates of maternal and infant mortality, and a work-life balance skewed toward work. (Hello, America.)
The clinical definition of postpartum depression is a “medical complication of childbirth,” but this doesn’t take into account women’s emotional lives, and the fact that the way our culture treats some new mothers amounts to abuse.
Pregnant women are often pickled in horror stories about birth, then subjected to unnecessarily intrusive care. Many suffer pelvic trauma; one in three wind up with major abdominal surgery. Then they are sent home with a newborn, typically without support. According to 2015 data, a quarter of women return to work in two weeks. Everyone says that “breast is best,” but new mothers get a decent place to pump at work only if they’re lucky. Most won’t see their doctor again for six weeks. No wonder depression is so common.
As one mother we know who plans to quit her job (because she can afford to) said about the lack of parental support in this country: “It’s just so mean.”
A new expensive drug is not enough; we need humane, evidence-based maternity care, respect for the “fourth trimester,” months if not years of paid parental leave, and affordable child care.
It’s worth pointing out that the Zulresso study was small, involving 247 women, and that the drug maker was involved in its design and interpretation. Some of the participants were also on other antidepressants, which take much longer to kick in. And according to the lead physician on the study, Zulresso may work by “dampening neural activity,” which has startling echoes. More research is needed before we can be sure that this is not just the latest in a long line of drugs offered to women as a quick fix of middling efficacy, with the potential for unexpected side effects.
We’d be foolish to believe that any drug is the magic fix that will once and for all end the metaphysical conundrum of experiencing fear, sadness, anger and despair during the most vulnerable time of our lives.
Furthermore, let’s be real about who will have access to Zulresso: women with very good insurance, the ability to advocate for themselves, and the flexibility to leave home for three days for treatment. As Jennie Joseph, a Florida-based midwife and founder of the nonprofit organization Commonsense Childbirth, pointed out, “If you’re actually needy, in deep postpartum depression,” you’re “not going to be able to get yourself to the hospital. Where are you a few days after having a baby? You’re in your house being ignored.”
In an article for the National Women’s Health Network, one of the few watchdog groups that shun industry funding, two researchers wrote that if Zulresso becomes the go-to fix for postpartum depression, “the onus of treatment will remain where it’s always been, on individual mothers — hardly a revolution in postpartum care.”
If insurers are willing to throw down tens of thousands of dollars for a mother’s mental health, we can think of some alternatives that might have a better cost-benefit ratio: Six months paid leave. A live-in doula and a private sleep-training coach. Weekly massages and pelvic-floor rehab sessions. Relocation to a commune in the Bahamas.
In the meantime, we fear that Zulresso is just a stopgap, and yet another instance of pathologizing a very sane reaction to our very insane culture.
We’d love to be wrong. We’d love a quick, effective, accessible treatment for all who suffer the emotional pain that falls under the rubric of postpartum depression. But wouldn’t it be better if fewer women were left to spiral into despair in the first place?
Elisa Albert is a doula and the author of the novel “After Birth.” Jennifer Block is the author of the forthcoming “Everything Below the Waist: Why Health Care Needs a Feminist Revolution.”