I’m a Reproductive Psychologist: but I’m not on the Zulresso bandwagon
My specialty is reproductive psychology, as several clinicians that I work with also specialize in. So one would think that I should be “over-the-moon” happy about the new FDA approval of brexanolone (brand name, “Zulresso”). Two years ago, I was at a presentation that Sage (the company that tested and created brexanolone) gave, and was also skeptical. Upon the release this week, my skepticism grew.
Here is how I see it: the positives (of the medication) are: that we have something that is relatively quick for the most severe cases and that there is research looking and taking seriously maternal mental health. The limitations are: how/where it is administered, a relatively small sample size, no longitudinal research (the study mentioned that the dosage works for 30 days, but was unclear about what occurred after–was another infusion needed?), the cost (not to mention the facilities and administration costs in addition to the medication cost), and that this medication was “fast-tracked” for FDA approval, which then means people who seek out the treatment are still being “experimented” on without their consent (this goes back to the longitudinal argument).
My concern is that we continue to stratify maternal mental health–where those that have access to resources (good insurance, money, physicians) will be able to use this where as many who don’t will continue to suffer. This medication will be available to those that are in the privileged position to afford it. Yet, postpartum depression doesn’t discriminate based upon social-economic-status. 1 in 8 women suffer from it. That’s not 1 in 8 WHITE women, but in general, all women. (I should add that the statistic needs to include gender non-binary people too, so rather than just stating women, it should read “people”….but this is a post for another day).
Don’t get me wrong: acknowledging that postpartum people deserve treatment for perinatal mental health issues is a huge victory. Declassifying medications and looking at pregnancy as part of research are two overlooked and very important steps. Researching medication to treat postpartum mood issues is another huge step, and I commend Sage for looking at this group of people that truly suffer. However, keeping treatment away from all who need it sends the message that only some people are worthy of healing.
