A pill for 15 days to eliminate postpartum depression, a condition that affects between 10 and 20% of women who have given birth. Zuranolone, the hopeful drug, will begin to be marketed before the end of the year in the United States in 50 mg pills and seems especially effective for the most severe cases and those of hormonal origin. Even without knowing if it will arrive in Spain, the specialists who treat these patients daily praise the pill for being a therapy that tackles symptoms in a few days.
"It is a specific drug for postpartum depression and this is very positive because we are going for personalized medicine," says Dr. Gemma Parramon, psychiatrist and coordinator of the Perinatal Mental Health unit at the Vall d'Hebron hospital, a center that participated in one of clinical trials. Parramon regrets that there are few therapeutic alternatives for postpartum depression and she is pleased that this medication constitutes a new contribution. Efficacy is proven in the most severe cases with a hormonal component. “They were the ones that responded best to the drug,” says the psychiatrist.
"Zuranolone is a derivative of progesterone that acts on GABA A receptors and acts very differently than the antidepressants we have now," explains Parramon. The result is that "the symptoms disappear after three or four days," says the psychiatrist. It is precisely this speed of improvement that is one of the strengths of the pill for the head of the Perinatal Mental Health unit at the Hospital Clínic de Barcelona, Alba Roca Lecumberri. The psychiatrist explains that with the treatments currently used "responses are not seen for four weeks, hopefully", and she stresses the importance of acting and reversing the situation as soon as possible. "You suffer a lot when the days go by and you don't get better." For the mother and also so that the bond with the newborn is not affected.
A drug called brexanolone already existed to treat postpartum depression, although it was given intravenously and required hospitalization for the woman. "Zuranalona is her older sister," jokes Roca Lecumberri. "It gives a quick response, apparently it has few side effects - it forces the interruption of breastfeeding - and it is a short treatment, although I would like to know what happens after three months", continues the psychiatrist, who also points out that it may be that long term is also indicated for other depressions.
Roca Lecumberri considers that it is a good medication for women with moderate-severe depression, but "we cannot consider that we have a pill for all postpartum depression." In addition, she acknowledges that it is not yet known if its effect is maintained over time because the studies carried out so far have reviewed the condition of the woman one month after stopping the treatment.
Patients who entered the study had to have moderate-severe depression beginning in the third trimester or in the first month postpartum. For this reason, she believes that there will be a lack of studies to see the different subtypes of the population. Because in postpartum depression hormones have to do, but there are also other psychological and environmental factors. The psychiatrist Gemma Parramon warns that, for example, male violence is extremely associated with this pathology.
Postpartum depression is still a taboo subject among many women. “Some do not explain it for fear that the baby will be taken away from them, that they will be considered bad mothers or that they will have to be admitted and separated from the newborn,” explains Parramon. “It is still very difficult for a woman to explain that they are feeling bad at a time when she should be fine,” says Roca Lecumberri. Both demand a non-existent service for now in Spanish health: mother-child hospitalization areas to avoid separation in the most serious cases. The Clínic does have a day hospital.
Roca Lecumberri recalls that perinatal mental health is something that has been worked on for a very short time and in the detection of postpartum depression, professional intervention is still crucial. Some are detected at the end of the pregnancy and others in the quarantine control, in which the midwife subjects the mother to a 10-question test related to well-being and mental health. Depending on the result, she will be referred to a psychologist from the Sexual and Reproductive Care Service (ASSIR) and, in more serious cases, to a perinatal mental health unit.
