In August, news broke that for the first time the FDA approved a pill sold to specifically treat postpartum depression.
Sold under the brand name Zurzuvae (zuranolone), the announcement raised hopes about an effective and targeted treatment for a condition that affects one in eight women. In clinical studies, some mothers who took the pill significantly improved symptoms of depression and anxiety just three days after starting the two-week regimen. The effects lasted one and a half months out.
Typically, postpartum depression is treated with selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, or Lexapro. But those can take up to 12 weeks to start working — and sometimes, not at all. For many with mild cases of postpartum depression, SSRIs combined with support and therapy can be an effective treatment. But for those with severe and debilitating cases, news of the first-ever FDA-approved pill was certainly a welcome advancement in maternal mental health, which stands as an ongoing crisis in the United States.
But last week, the pill’s manufacturers Sage Therapeutics and Biogen confirmed the worst fears of many. The 14-day course will be priced at $15,900. While the manufacturers emphasized in the announcement that they are prioritizing access to treatment with “minimal restrictions” and “little to no co-pay,” details on just how accessible the pill will be and how it will be covered by insurance are currently unclear. As a result, maternal mental health providers are concerned that those who need it the most won’t be able to access it, and that the initial hype around the news was all for nothing.
“The fact that it's priced at almost $16,000, I think, is ridiculous,” Dr. Melissa Simon, an obstetrician gynecologist at Northwestern Medicine, told Salon. “It is highly prohibitive.”
Especially, Simon said, for patients who are underinsured, uninsured or who have insurance that will not cover “the exorbitant cost” of this medication.
It’s already difficult for women with postpartum depression to get access to treatment in America, she added. First, it requires going to a clinic and attending an appointment, which could mean having to take a day off of work or getting childcare secured. For others, there could be transportation costs involved. Simon said many people “grossly underestimate” the out of pocket costs women face to get treatment already.
“All of these out of pocket costs impact people who are from lower socioeconomic conditions in our country, and who face larger social and economic determinants,” she said.
The risk of postpartum depression is much higher for women of color. Black women are not only more likely to have postpartum depression, they are less likely to receive support and treatment. Medicaid finances an estimated 4 in 10 births and only covers a woman 60 days postpartum. While more states are offering coverage to women postpartum up to 12 months, with specific qualifications, it’s unclear how much coverage, if any, it would provide in regards to Zurzuvae.
Treatments for postpartum depression depend on the severity of it. Options range from medication to talk therapy to a support group. In 2019, the FDA approved a medicine to treat PPD called brexanolone, sold under the brand name Zulresso, which is in the same drug family Zuranolone. These medications target the GABA receptors in a person’s brain, which is believed to affect stress.
Studies have shown that Brexanolone is associated with rapid improvement in major depressive symptoms. However, there are also many barriers for those who need it to access it. It has to be given by a doctor or nurse through an IV for two and a half days. It is also not safe for breastfeeding. Since it’s been approved, the treatment has only been offered in a limited number of healthcare settings. And its cost is also high: $34,000 without insurance.
Karen Kleiman, a maternal mental health therapist and founder of the Postpartum Stress Center, told Salon there’s also very strict criteria to offer Brexanolone as a treatment option. Zurzuvae is similar to Brexanolone, but in pill form. Certainly this is part of the appeal. Kleiman said she wasn’t surprised to hear about the hefty price tag for Zurzuvae, as “we've seen this before,” referring to what happened with Brexanolone.
“This is sort of the pattern of what happens,” she said. “It's certainly disheartening, but I'm not shocked by it.”
Postpartum depression is diagnosed when a woman is experiencing more than two weeks of a depressive mood and loss of interest in activities, usually when the common phenomenon known as the “baby blues” has been ruled out. The exact cause of PPD remains unknown, but experts have long speculated that a range of factors contribute to someone developing it. For example, hormonal changes like the significant hormone drop after a woman gives birth can likely trigger symptoms. Other studies have found that women with moderate or low social support are more likely to have postpartum depression, suggesting there are external contributors at play as well.
The fact that there are so many potential variables when it comes to the causes of postpartum depression can make a treatment far from a one-size-fits-all solution. Some women with more moderate depressive symptoms respond well to standard antidepressant treatment coupled with therapy, Kleiman said.
“We're finding success with the treatments that we have,” Kleiman said. “For the women who are severely disabled by their depression, this is obviously a very exciting proposition and we hope that things will change so that it will be more accessible.”
Kleiman said she didn’t want to sound “discouraging” and pointed to positive news that, in light of the FDA approval, people are talking about postpartum depression and solutions. She added that there are certainly systemic issues that factor into what it’s like being a mother in America right now. Notably, she said she is seeing more young mothers burn out faster than she’s ever seen in her career.
“Our system is broken and we don't have systemic responses to help make things like childcare and healthcare affordable and accessible,” she said. “It goes all the way back to women being witches and hysterical, and not being taken seriously, having babies and living in a society that doesn't tolerate mothers talking about how bad they feel.”
Simon said there are many steps forward that healthcare needs to take to better support new mothers and reduce the risks of postpartum depression, and it starts with having more than one to two visits postpartum with their doctors.
“People who give birth should follow up every two to three months postpartum, there should be more routine visits and all of the healthcare needs included in those visits should be covered,” Simon said. “Mental health, contraception, breastfeeding support and physical health.”
