Tag Archive for: depression

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.

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Understanding Perinatal Mood Issues–When is it a Problem?

By Dr. Julie Bindeman

Recently I came across a blog about postpartum depression and distinguishing it from no depression post-baby and the baby blues. While well intentioned, I was dismayed to see how inaccurate the information was, as it not only combined postpartum depression with postpartum anxiety (two VERY different issues) but also over-inflated the baby blues and short-changed the variety of postpartum depression symptoms that exist. Postpartum mood disorders impact 1 in 8 new parents (for the non-pregnant parent, it tends to occur in 1 in 10 people). Perinatal mood disorder can be serious and even deadly if not treated. Fortunately, treatment is effective. A consultation with a trained mental health provider and/or psychiatrist that has specific training in reproductive health can reverse the symptoms and help you feel more like yourself.

 

To clear up any misconceptions, here is my chart:

 

Not impacted Baby Blues Postpartum Depression Postpartum Anxiety
Tears of joy or frustration on occasion Random tears (even for a toilet paper ad) that come out of nowhere Tearfulness that may or may not have a direct cause. Tears around thoughts that might be scary.
Sleep deprived, but able to take naps during the day. No issues falling or staying asleep. Learning to sleep when the baby sleeps. Getting used to sleep/wake cycle that isn’t what one is used to. Sleep is interrupted in one of two ways: difficulty rousing oneself (consistently) or not able to fall and stay asleep. Difficulties falling and staying asleep. Not able to sleep due to racing thoughts.
Your mind might feel clumsy at times and forgetful, but you are able to carry on a conversation (unless the baby interrupts) Your mind feels a little foggy and it might be hard to focus. Your mind feels full and it can be hard to express yourself. You might feel forgetful or distracted. Carrying on a conversation can be difficult, and not because of the baby. Your mind is racing and it is hard to slow it down.
You seldom worry  about things that are new for you. You worry a little, and sometimes check in with others, and sometimes keep it to yourself. You feel too sad or angry to worry. You worry constantly and some of your worries might scare you. You are afraid to tell others about ALL of your worries, though you might share some.
The changes in your life are exciting and make you look forward to the future. The changes in your life are temporarily overwhelming, but you are able to adjust with a little practice. The changes in your life are completely overwhelming and you are having difficulty adjusting to them. The changes in your life cause you perpetual worry as you struggle to make sense of them.
Bonding with your baby isn’t something that you spend time thinking about, as you do so by caring for your baby. Bonding with your baby is initially awkward, but with practice, you adjust. Bonding with your baby is hard as you feel detached from your baby and attending to its needs. Bonding with your baby is something that you are thinking a lot about: are you doing it right? Is your baby attached enough?
After a few weeks, you relish in your new routine as your “new normal.” After a few weeks, you are getting the hang of things and start to feel more like yourself. After a few weeks, you feel as bad, if not worse. After a few weeks, the worrying persists.

 

 

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