Three decades ago I was struck by the frequency and seriousness of Postpartum Depression. At that time the usual treatment was nothing --' they will get through it, just wait it out'. I found that to be a cruel misogynistic abuse by the mostly male medical establishment.
I found that 2-3 nights of low dose Elavil almost magically brought the new mother out of the grips of the depression. Maybe I was just seeing natural improvement or placebo effect, but the rapid dramatic change was what was needed. RJ, MD
91
Yes, we'd be foolish to believe this drug is magic, even though in some ways it seems promising. An ultimately far larger issue is its astronomical expense, which places it outside the reach of most of the new mothers who might benefit from it. At present, the primary beneficiary appears to be its maker, Sage Therapeutics. And while I don't really blame any any drug maker for trying to earn as much money as possible, I continue to wonder why the US Congress, unlike the governments of almost every other advanced nation, refuses to enact meaningful price controls on medications.
84
I couldnt agree more. I lived in the US when I had my son. SO MUCH pressure, everyone has written a book or a blog on how babies should be.. none has written anything about the fact that each baby is unique and there is NO size fits all. And if your baby doesnt fit in the criteria, oh then something is wrong... not to mention to almost non existent maternity leave, the stress of going back to work when the baby is so young, finding a babysitter, etc.. Fast forward 7 years, now I live in Sweden... 480 parental leave to be shared by both parents, nobody loses their jobs, on the contrary your job is right there waiting for you when you go back to it, FREE day care everywhere, financial support to families, if both parents work the day care and school keep your child until you pick him/her up, so you know its there safe, with his classmates and teachers, you dont have to worry about finding a babysitter who basically spends her time checking her phone.. if the child is sick, either parent can take time off to tend to the sick child.. paid! And we wonder why American parents are stressed...
252
SLEEP AND HELP! Agree agree agree.
26
We need to fund programs to help new mothers. The Dutch model is the gold standard. https://www.findingdutchland.com/postpartum-care-and-what-we-can-learn-from-the-dutch/
9
Isolation is not a problem limited to mothers with a newborn at home. If you don't have a job to go to and the concomitant issues of no money coming in there's not much to be done either. Neighbors are at work, most of your contact with potential employers is online, and you can't afford to spend money going out.
In the last 30 years America has evolved into a very unsupportive country for those without jobs, those with children, and those who are "different". Do you have a mental illness? Are you unemployed? Is a family member seriously ill and in need of care? Are you seriously ill? Do you need help or human contact? Forget about it. Our society is programmed to go on without you and not to notice you.
What would help people in need of human contact and mothers with newborns is precisely that: human contact. A real person to assist with the daily tasks of living when they are overwhelming. Someone, not necessarily a drug, to provide the warmth and nudge we need. It's easy to say you care: prove it. Offer to hold a door for someone whose arms are full. Offer to help that young woman with a newborn if you know her. You never know whose life you may be saving. The same for that woman who is caring for her elderly parents and holding down a job.
47
While reading this article, I thought with amusement, I bet getting out of the house and away from the demands of being a new mother for a few days, was a big part of the "cure." It also brought me back to when I had my first child, who was born during the end of my medical school training. Experiencing what I would call the "blues" rather full on post postpartum depression dealing with a colicky baby on my own, what helped me tremendously was taking a break for several days to fly up to Sacramento with my school mates to take the medical licensing exam. My fellow students were stressing out while I was enjoying the hotel, the restaurants, no cleaning, diaper changing, baby feeding or midnight crying. I came home refreshed, and my husband had a crash course in newborn care.
34
This just screams solution looking for a problem.
My guess is it was easier to get the drug patented by declaring PPD as the purpose due to novelty (first drug for X...). It has nothing especially to do with mothers or PPD. In fact it seems rather unsuited for that population. But this is business in America these days.
7
From start to finish everything we do in the course of a day is unnatural. Fake lighting, screen time, traveling in rocket ships, manufactured foods, drugs, and the list goes on forever.
And now motherhood has become as unnatural as can be imagined. C Section, isolation, bottle feeding, unknown fathers, surrogacy, test tubes, and the unkindest cut of all...moms inexperienced, weakened and alone who return home to care for a child with no support. Then they return to work in a matter of weeks and leave the newborn with strangers. Unnatural and detrimental on all counts.
16
I can't argue with most of the conclusions drawn by the authors. New mothers do need more support, better ability to balance work and a newborn, especially if there are other children as well, and some way to find help in the months in which the new mother finds herself chronically sleep deprived.
But I doubt that will fix postpartum depression; it will help the mother continue to care for her children and herself, while depressed.
For me post-partum depression - a 15 month journey - began as pre-partum anxiety. After my second child was born, I found myself unable to remember basic things; unable to handle normal tasks; superstitiously scared to take both children in the car at the same time for fear, like stepping on a crack, I'd bring disaster to them. I believed my new house was actively out to get me, even as simultaneously believed that that was insane. I found myself fearing I was bordering on agoraphobia.
I can guarantee you I would not be first in line to try a new drug that messes with my neurotransmitters, but a supportive environment wasn't the fix either. Post partum depression needs a lot of focus from the medical community.
12
Absent the magical thinking of doula woo - an actual empirically proven solution that addresses physiology of the brain is an acceptable second choice.
"We’d love to be wrong" - I am confident that the last thing on the PhD researchers working to address the horror of postpartum depression is how are we going to convince the doula's of the world that actual science works.
5
It should be noted that even adoptive mothers, as documented by their doctors, can suffer from "the baby blues and hormonal changes, though not postpartum.
9
I am convinced that while medication can help treat PPD, we also use address many other factors that make new motherhood very very hard in the US. The big factors: Social isolation (we're expected to navigate this role - especially first-time mothers- singlehandedly and in the confines of our own homes), the expectation of perfection (think breastfeeding, child-wearing, co-sleeping), an insane lack of sleep that continues on well after returning to work (4-5 broken, non-contiguous hours for nearly an entire year) and a complete void of community or institutionalized support. It's not small wonder that I got into two car accidents, had severe panic attacks, and thought my breast pump was speaking to me. The word is: Inhumane.
19
The big factors: Social isolation (we're expected to navigate this role - especially first-time mothers- singlehandedly and in the confines of our own homes), the expectation of perfection (think breastfeeding, child-wearing, co-sleeping), an insane lack of sleep that continues on well after returning to work (4-5 broken, non-contiguous hours for nearly an entire year) and a complete void of community or institutionalized support. It's not small wonder that I got into two car accidents, had severe panic attacks, and thought my breast pump was speaking to me. The word is: Inhumane.
5
Australian new mothers can turn to tresillian.org.au for help from birth up to 36 months. Residential programs are WITH the baby and are covered by both public and private insurance.
It’s NOT based a on a 3 day drug infusion hospital stay without your baby! A trip to the Tresillian website really zooms in on how disfunctional the US really is... there it’s more about monetizing post partum depression and here it’s real help at little cost working through a challenging situation.
17
It should be enough to focus on the devastating effects of postpartum depression on the mother, but since she's so often discounted, consider the costs also to her family and society:
A child of a depressed mother suffers life-long handicaps in performance, mental health, earnings, nutrition, physical health, etc. This translates to enormous personal and societal costs. And since she'll likely have several children, and it's not only the newborn who is being neglected, multiply the costs by the number of children.
Rate of suicides or suicide attempts will be higher in her children than in families where the mother avoids postpartum depression--and that effect will be a life-long risk, long after the mother recovers.
The diagnosis postpartum depression gives a connotation that the mother will recover. But that's not always the case. If it is unrecognized and untreated, it can continue for a life time. Lifetime depression is hugely expensive to both the woman and society, and brings with it a host of chronic co-morbidities such as chronic pain, heart disease, diabetes, etc --for which we all end up paying.
So, if you don't feel like supporting the mother in the name of decency, then consider the cost to your tax bill. A night nurse, pelvic rehab as the French offer, and extended work leave for child care--all these are cheap, compared to the catastrophic costs of postpartum depression.
12
Yes! As a recent new mom, I had this exact reaction when I heard the reports of a new post-partum depression drug, i.e. quick fix that can make our decision makers feel better without actually addressing the issues. I was lucky enough not to suffer from severe post-partum depression, but I was shocked to find myself home, by myself, recovering from the most intense medical experience of my life with a human that was completely dependent, and demanding, of me for food, sleep, cleanliness, and comfort.
Physically, I couldn't even lift her from a laying or sitting position due to my recent surgery, and mentally, I certainly didn't feel competent to handle the huge responsibility that had been place on me while I was still fuzzy from surgery, hormones, and meds.
Wake up and support new moms! We need understanding workplaces that give us the mental freedom to take a real break and recover; government supports that take away the anxiety of being home; and social supports that help us recover and take care of our baby so we are not isolated, alone, and over-stretched. This means paid maternity and paternity leave, as well as work culture that understands the need for it; doctor or nurse follow-up visits in the home; and insurance-provided dulas or other paid care givers to help immediately post-partum if we do not have the social supports needed to help.
15
The column omits one major item--the importance of nutrition. We know that the body will favor the developing fetus when insufficient nutrition is present. Even conventional medicine recommends prenatal vitamins. If prenatal vitamins plus maternal diet does not provide sufficient nutrition for the mother, the first thing to go will be the mother's mental health. Nutritional supplements, along with all the supports described in the column and comments, should be the primary means of dealing with the issue of postpartum depression. We should not be pandering to the pharmaceutical companies, with unknown risks to mother and nursing baby.
3
When are we going to stop avoiding treating the causes of every physical, psychological problem and human interaction known to humanity by creating “magic pills” that typically disrupt or imbalance the bodies and minds natural functions and healing. Why do we rarely, if ever, address the influence of harmful cultural forces contributing to or exacerbating breakdowns of natural systems that promote health?
16
We do need to pay more attention to postpartum depression among new mothers. We need to pay more attention to depression, period! Way too many depressed, moms, women and men, boys and girls.
Drugs can help. But not every drug works perfectly. If not, get some counseling help. Don't stay depressed. It can end tragically.
4
I don't think anyone feels more isolated by our society than a woman of a certain age that has not yet had children. Try being in your late 30s - all your friends are mothers of young children - they are not the isolated ones.
9
I was in my 40s when I had my son. I know the isolation of being a single woman in my 30s and the isolation of being at home with a colicky infant in my 40s. While I adore my son and his presence in my life has been richly rewarding, I have to say that the lack of support for women in the postpartum period is far more stressful and isolating than being a single woman in your 30s.
27
I was fortunate enough not to have to return to work after the birth of each of my two children. But, I still would have welcomed the presence of another human who understood I needed to take care of my infant and myself. Instead I had a husband who couldn't understand why I was always so tired and couldn't understand why I didn't want to entertain a constant stream of visitors (his friends), and who felt sorry for himself when asked to help with simple chores (the dirty dishes).
The OB/GYN (male) was not very helpful. Any complaining was treated as whining, so I soon learned to smile and say everything was fine. It wasn't.
I didn't need a pill, I needed someone to take care of the household so I could take care of myself and the baby.... and have an occasional uninterrupted nap.
44
A strong placebo effect is common for anti depressants should tip you off as to lack of rigor in clinical trials. Phase III clinical trials tend to be the most expensive and difficult. In depression, no one is certain, of a cure, because no one has a an objective standard, of what depression is. All anti depressants are evaluated without any gold standard. Prozac had twenty failed phase III clinical trials, until one trial showed a barely statistical improvement over the current treatment for depression at the time. Most diseases have an endpoint, or a survival rate. Depression doesn't kill people, suicide does.
4
I didn’t find my “major abdominal surgery” (c section, the most common surgery and usually uncomplicated) to be “unnecessarily intrusive.” I found it to be lifesaving, for both my baby and me. Neither of us would be alive today without it. It was both necessary and desired. I like my babies born alive. Also the recovery was much better than my vagina birth, for which I was only allotted 48hrs in the hospital. Postpartum depression is not caused by mode of delivery.
13
A quarter are back to work in two weeks..... I love America but the way you treat each other is, quite frankly, disgusting.
73
Please read Michael Pollan’s latest book, “how to change your mind.” Much, much more affordable and effective treatment is explained.
1
Here is the author practically pleading for six weeks paid leave while those awful socialist countries give the mother as much as a year of paid leave and a choice of how to use it. Oh did I mention?--fathers get a year paid leave as well.
No other country rivals us in loving and supporting fetuses. Babies, children, mothers and fathers--well that's a different story. Another example of good old-fashioned American exceptionalism.
31
i often wonder how the overwhelming majority of the females in the world giving birth handle things without drugs, therapy, and leave policy.
2
@pierre Well, they have higher rates of maternal mortality and infant mortality, so the lack of drugs and medically necessary interventions isn't something I would like to see make a comeback.
Plus, in parts of the world, like the "old days," women still don't work, and there is more of that old-fashioned "village" to help raise the child. In the past, children were raised (or expected to be raised) by the mother, grandmothers, aunts, siblings, neighbors, etc. We've lost the "village" for the most part today, which is why we need to stop pretending that all families have a village and make efforts to provide affordable supports (i.e. childcare, therapy, in-home support, etc.).
10
This is a repeat of a sad situation in American medicine. No one knows what depression is, or even what causes it. The theory is that it is a chemical imbalance in the brain. The reality is that a lot of smart researchers have been striving for decades to find that chemical imbalance and it has not been found. Despite that, the pharmaceutical industry and the psychiatry profession, a fully funded subsidiary of the former, have had no hesitation to use that claim as a marketing strategy. It will be left for some generation in the future to stop this madness and look back with amazement at how foolish this generation has been.
2
I remember, so vividly, sitting in my car thirteen years ago crying in Target parking lot. I had needed to escape the confines of the four walls of my house after two long weeks of isolation. Perhaps a latte and a bit of time cruising the aisles of Target I thought, foolishly. Not only one, but two! women publicly chastised me for having my two-week old out in public. I am aware that PPD is a very real and very separate issue, but I whole-heartedly believe ALL new mothers would benefit from other women just stopping. More often than not, your 'advice' which is actually harsh judgement, is neither valued nor valuable. If you cannot lift another parent up, say nothing. Period.
41
The success of the placebo in this drug trial reminded me of my mother, who, in the 1950s, was employed by a diaper service (not disposable! it took back dirty cloth diapers and gave you clean ones every week!). She was a customer service rep, who visited new mothers 1-2 weeks after birth to see how they liked the service. I can't count the times she encountered young mothers in tears, isolated at home, terrified that they didn't know how to care for their infants. Many were afraid to ask because they'd heard "real" women were just supposed to know. She would hold their hands and walk them through elementary baby care, and leave them feeling that at least one person cared. So I wasn't surprised at how effective the placebo treatment was in the drug trial. It certainly suggests what my mother found: that a little TLC goes a long way, and that supporting and valuing and really assisting new mothers will go a lot further with a lot of mothers for a lot less money than the drug companies' latest, stratospherically priced entry.
42
Not a doctor, nor a statistician, but I would imagine that rates of PPD are even higher among single moms. How in the world are THEY going to be able to spend 60 hours in a hospital? Do they get to bring the baby with them?
5
The efficacy and the cost of the drug aside let's not throw the baby out with the bathwater. There is no doubt that pregnant and new mothers need and deserve much more support and care. That said, depression can be caused by changes both external and internal. In cases where the cause of the depression is external caused by events such as the death of a loved one, the loss of a job or lack of support during pregnancy condition. Usually, depression of this type is temporary and will greatly diminish over time. Depression is also caused by chemical abnormalities in the brain which may be genetic in origin or have an external cause such as previously mentioned and does not diminish over time but does respond to the use of anti-depressants. Since this Zulresso is designed to treat the latter condition, the critical questions are, which type of depression is it, what are the causes and how do we treat it. Until these are answered, the use of either the author's remedies or the medication may be of no use to a segment of the patient population
Yet another example of our dysfunctional approach to providing and financing medical care in the U.S. Throw tens of thousands of dollars to the newest (highly questionable) "miracle cure," yet refuse to legislate a commonsense paid parental leave policy that would make a real difference in alleviating postpartum depression.
293
@Cindy Robinson
As to the efficacy of this new "miracle cure", Public Citizen recommends waiting seven years until the real safety profile of a new drug becomes clear - for good reason.
16
@Ellen Perhaps because the recently resigned head of the FDA is also a venture capitalist?
13
@Joanna Stelling
Well, and the head of HHS, Alex Azar, was a top executive at Eli Lilly.
12
I had severe postpartum depression and thought I was never going recover. My life was saved (and I really do think it was saved) by a new form of intensive group psychotherapy. For three weeks I attended 6 hours a day of group therapy with other new mothers and our babies. Instead of leaving our babies at home we brought them with us and learned how to care for them while supporting each other. We were learning how to integrate new motherhood into ourselves surrounded by others doing the same thing. Yes I took medications too which probably helped, but it was the program that was magic.
274
@Elizabeth
You (and your child) are so very fortunate to have found the support needed after the birth. I too had severe postpartum depression, long ago when my husband was in the U.S. Military. PPD wasn't recognized. We were confused and I was ashamed to admit what was going through my mind. Treatment (valium) was useless. Attempts over the years to redeem what was lost between my daughter and I have failed. We exist in a vacuum with a biological relationship only; nothing more.
No drug can fix PPD, it's a temporary "dis" after birthing. A mother must understand what's going on, get answers and believe that her mother, family and husband will be there, not criticize her feelings. The mother must find her happy place with the new baby and feel supported in this fragile situation.
48
That sounds like an amazing program. Does the approach have a name?
11
@Elizabeth As the saying goes, it takes a village, and you found one. Its what's lacking in modern western society today. We are sociable, tactile animals who need to be nurtured, supported and validated by each other. Thank you for sharing that a program like this exists.
34
I was suicidal after my twins were born. After finally realizing I could use some help beyond my anti-depressants, I attended the only PPD support group I could find, where the group leader shamed me in front of the group for not breastfeeding. I try to think back to what would have helped me at this time, and it’s sleep and help. I had some support from family who would bring an occasional meal or rock a baby for an hour, but I could have used a night nurse for a solid couple of weeks while I recovered from my c-section. Paid help was out of the question financially but also in more of a general social way - the prevailing sentiment is that no mom should need to ask for help, you just do it.
Two weeks of a night nurse would cost a lot less than $34k, too.
366
Oh, this and so much more. Ten thousand dollars in maternity leave income support combined with home visits from postpartum nurses and lactation support would reach (and benefit) more women than a drug that requires a multi day hospital stay without the baby.
This physician had five and a half weeks of leave with each baby (two cesareans) and bitterly wept when it came time to leave my baby at an expensive day care and go back to a job (residency) where I was treated like absolute [poop] and roundly demeaned, criticized, and guilted for choosing to have children while being a doctor in training. One guess as to the specialty? Obgyn. The ones who are supposed to be women’s biggest advocates.
We as a society, profession and specialty need to clean our house before any drug will put a dent in the suffering of postpartum moms. Why not celebrate and support mothers? We all have them. Many of us will become them. Let’s start treating them as importantly as they are.
222
I appreciate this response to the recent article and announcement for Zulresso. This timed as it was in close conjunction with ketamine being used for depression, just leaves me wondering what we're doing supporting these drugs with such dangerous side effects. At least in the case of this drug, gives these women some rest - I thought so many of the same things listed in your opinion piece. Support families and there will be less need for dangerous and expensive drugs. Big pharma is indeed the tail wagging the dog these days.
2
Medication is like using a bandaid to treat a gushing artery. It is only effective at keeping you collected till you get some real treatment. I wish I’d known that 12 years ago so I could have taken better care of myself. In this country, working environments are deeply anti-motherhood and we are insisting on treating the wrong problem.
3
In this instance, we could take a lesson from the Amish....yes, they have lots of children, but after the midwife-assisted home birth of each and every one, the community takes on the care of the new mother’s household for six weeks. The mother herself takes care of the baby....that’s all! Someone else is feeding the rest of the kids and the husband, doing all the housework, laundry, shopping, etc. When mom decides she can do it herself, they all go back to their own families, but, the new mom decides when that time has come.
7
Yes, better social skills and a good support system for new mothers is dramatically better than a drug. But, that is socialism and we are a capitalistic system and you cannot make money by having a content society.
1
American health care is all so confusing. Kinda like a pickpocket working a crowd. I'd be depressed, too.
2
It’s the sleep deprivation that nearly killed me. No one - not grandparents, not spouses, not siblings, not friends - readily volunteers for the midnight shift -(let alone 2am, 3:30am and 5am). No expensive drug or paid leave can fix that. $34k can pay for a night nurse though!
136
"Everyone says that “breast is best,” but new mothers get a decent place to pump at work only if they’re lucky."
It's the women who believe that every new mother wants to breastfeed and/or pump, and who badger other women about their personal decisions with their endless "are you sure?", who contribute to a lot of post-partum depression.
3
Not all women can breastfeed. I was fortunate to have an easy time nursing my three children. My mother could not breastfeed and somehow her 5 children survived. I was fed with formula and here I am at 65 years-old.
4
One in three pregnant women get major abdominal surgery? You need a citation if you are going to make such a patently absurd claim
1
@Tom, that reference is probably ro the rate of Caesarian sections performed in the U.S.
1
@Tom a c-section is major surgery here are the CDC stats on that. https://www.cdc.gov/nchs/fastats/delivery.htm
1
@Tom you could start with this article in the Lancet.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/fulltext
Tl;dr: in 2015, 32% of births in the US were Caesarian sections. This is considered a major abdominal surgery.
1
Isn't it ironic, or rather just downright hypocritical, that we seem to be in an age when increasing numbers of conservative people want to limit women's access not only to abortion but to birth control in general
Yet when it comes to the women giving birth, they make women's lives as difficult as possible. The suppression of women's rights and the mistreatment of women in general is a hallmark of fascism. I wish I didn't believe that we are marching all too quickly in that direction, but it sure seems that way.
13
The article says, "the Zulresso study was small, involving 247 women, and that the drug maker was involved in its design and interpretation."
That and the $34,000 price tag don't sound very good.
3
The US is a nakedly predatory and hostile place. The "leaders" serve themselves and their oligarchical donors.
Among the more successful predators are all those who make their profits on the wellbeing and lives of people in distress. It's really not worth pursuing "healthcare" here. There isn't any. There is only profiteering at the direct expense of those in a position least able to fend for themselves.
The US has become a disgusting sewer of profit and predation. The carcass has been picked clean.
4
This article raises a real issue:postpartum depression is devastating to new mothers and their babies. This quick fix seems ridiculous-it almost seems like a punishment-if you complain of depression after the birth of your child the proposed solution is to take you away from your child, hospitalize you for 3 days and then bankrupt you. I fully support a rethink on pregnancy, birth, and the so called 4th trimester. Women need to stand up and demand reasonability in all of these segments of their life with regards to the demands placed on them through work and home duties. Having a baby should be a joyous time to celebrate with family and for mom and dad to have the time to learn all about their new baby. The assembly line C section fits all followed by the reality of having twice as much to do in half the time with half the money, and ending in big pharma fast tracking a drug for the resultant depression, a drug with uncertain side effects, is just nonsense.
1
Looks like big Pharma is hoping for a big payday on this one.
4
This is insane. Both progesterone and its precursor pregnenolone, the active hormone in Zulresso, is available over the counter and by Rx through compounding pharmacies in oral pills and transdermal cream. Why aren't these women being prescribed inexpensive hormonal treatments first. What is wrong with their OB/GYNS? I'm flabbergasted.
2
The "pro-life" people demand that every pregnant woman who wants and needs an abortion must be forced to bear a child--for the benefit of infertile couples.
They love to claim that having an abortion will harm the woman.
But the dangers inherent in childbirth, including major surgery (Caesarians) and post-partum depression, are far, far worse.
8
Your article is spot on. Thank you!
First off, let’s be real, the little word “depression” is covering an ocean of altered emotions that’s can range from the blues to psychosis. It’s not fair to clinically lump all new mothers bungee chord emotions into “depression.”
Second, private practice specializes in pelvic floor rehab and most women prefer to deal with their injuries 20-30 years later when they are incontinent or have sexual dysfunctions.
American patients are too consumers and they prefer to consume pills.
Sweden offers an incentive of increased hours of family leave when the father takes them and a slightly lower number of hours when just the mother uses the hours. Also the hours extend until the child is 18, thus can be used for leave to school plays, sports events or other such preferred leave. The US is in the stone age in supporting families, slowly moving to policies state by state with money/business driving all of the backlash.
Post partum depression is increased by hormonal imbalances which is caused by having children close together and nursing for long periods of time in some women. It is a slow process to sink into the depressions and slow one to emerge to the light again. Progesterone and estrogen are decreased during pregnancy and a cream containing both greatly assists in bringing a hormonal balance back. Somehow Big Pharma always makes out, no
matter what the issue is.
101
@Lazlo Toth
They still have many cases of postpartum depression in Sweden.
3
As a retired ob/gyn I look back at the mediocre response of the US health care system to postpartum mental health issues; ranging from the “baby blues”, depression, severe depression, bipolar disorder, to postpartum psychosis. It is good to see that research is being done to find effective treatment, but Zulpressa appears to be an expensive treatment with minimal benefit compared with placebo.
I would like to see a well controlled study where the Zellressa and placebo group received comprehensive mental health care and social support. Care that all postpartum women should receive. I suspect the outcome would be good for both groups.
Postpartum mental health issues are common and can be serious, leading to suicide and infaticide. I hope more research is done.
10
I'm pretty tired of the entitled and hysterical rhetoric coming from the pro-breeder crowd. People who choose to pump more units into an already overloaded system do so from their own choice - and should suffer every negative consequence that comes their way as a result.
With 8 billion humans on this planet, we could easily do with a lot less "mothers" - and certainly we shouldn't encourage them in any way, shape, or form.
1
When I had my son, I was shocked and dismayed at how awful the nurses were during my long (40 hour) labor and my postpartum hospital stay. I had not slept for about 60 hours before my son was born (at 6am, so then I was up all day), and I was so tired, I was almost hallucinating. I could not handle caring for him, and really needed someone to care for me. I needed sleep and rest, badly. But my family (my parents and husband) was not supportive at all, and seemed to think I should just get over it. I had hospital staff waking me every 1.5 hours at night and constant interruption during the day time. The nurses ignored my pleas for time to nap. By the time I got home, I was severely sleep deprived and depressed. On top of that, breast feeding was not working, and I felt like a failure. Oh what I would have given for some help in that first week so that I could catch up on some sleep and feel loved. Instead, the doctors and my family ignored my needs.
I agree whole heartedly with the authors and other commenters that what we need is a re-boot of postpartum care in this country. Home visits by compassionate caregivers emphasizing maternal care would go far. Paid family leave. Rest, relaxation, and time and space to adjust to motherhood would do wonders for the mental well being of mothers. Coaching dads on how to be helpful would be icing on the cake.
53
I would say that you have this exactly right. Your prescription for care of new mothers should also be considered by hospitals that treat those having severe depression. I had one bad incident some years ago and my physician assigned me to a hospital stay. (She was horrified by my experience.) The treatment was similar to being in jail. The nurses acting just like law enforcement officers. After realizing what I had agreed to, I asked to be released. I was released the next morning but the night there was one of tremendous fear. Imagine someone who is going through post part depression finding themselves in a similar situation? Not very enlightened medical care.
4
Exactly right. I have, to be fair, treated only 4 women with post-partum depression using Acupuncture, Chinese Herbal Medicine, and some what should be common sense life coaching. None of them had worked with a therapist, and all 4 resisted my urging that they do.
Never the less, it was easy to see in each woman's story a simple theme of isolation and also abandonment, in the sense that once baby arrived mother became irrelavent to the husband and his family.
3 of the 4 improved dramatically, enough to return to normal activities and to find joy in living again. Total cost for the entire treatment ranged from 500 to 1000 dollars over 3-4 months.
I would think before referring women who might be breast feeding for super expensive drug therapy that may have Goddess knows what side affects for mom and child, that Western Med Docs would leave no stone unturned first...
There is no drug without side effects. There is no surgery without risk. Stop being so arrogant and narrow minded and look into things other people do....
3
Once I met a young couple and their baby from Germany - they were scuba diving and snorkling down in the Caribbean. They each were able to take a year or more off from their jobs, with partial or full pay, to bond as a family. Moreover, they were guaranteed to get their jobs back.
5
@Ellen That is quite ridiculous.
It will take a Village. A father who is present throughout the pregnancy and birth and night feedings and diaper changes, who encourages the mother to get out of the house for a bike ride or yoga class or lunch with her friends, a culture which does not expect a woman to recover her pre-pregnancy waistline, a workplace which allows both mother and father to use parental leave, assistance with household duties and care of siblings. Bringing new life into the world is the most important job in society, and it is high time new mothers are celebrated for this contribution to society.
20
Amen! When are we going to get the message: "Mothercare" is an essential part of "childcare." Pharmaceutical intervention has an important role for women who are suffering from perinatal mental health disorders, but no drug can solve the real problem. We do nothing to set our new mothers up for success; quite the contrary. Time to stop thinking that popping a pill is the answer, and pass legislation (mandatory paid maternity and paternity leave, subsidized, quality day care for all, quality, affordable healthcare etc) to fix a failing system.
7
This is an outstanding analysis of the problems facing mothers and the pathologizing they face, as well as the problems rife in the pharmaceutical industry. Thank you.
7
Thank you for the uncommon common sense. All we need is for enough Americans to peel the screens from our faces, pay attention to what we are doing and vote, we could be creating a better world for us all. The awful irony of this new medication is the only people who can afford it probably won't need it.
3
At $34K a pop can there be any doubt that this will be a drug for the rich and only the rich? No insurance company is going to voluntarily agree to cover the cost for poor and middle class women.
5
Weknowand opine: Drug makers are always on the prowl for the new quick fix that they can charge big dollars for. As we here on our commune see it, too many of those terribly expensive drugs, whose development costs are deductible (you taxpayers paid the bill), are poorly tested and have no longitudinal data about their efficacy or short/long term benefits and side-effects. It appears that in your country the role of your FDA's oversight and regulatory function has been assumed by the companies themselves and your courts, as evidenced by the massive class action suits against many big pharmacuetical companies. When will you-all learn and accept that you are being taken advantage of by those drug makers and that they really are pursuing your money ... not your health and well being. That is our opinion. And stay away from those so called cures for male problems, as seen on your TVs ... they are potemtially dangerous (in our opinions).
2
Why are we even believing that this drug works? The head of the FDA is also a venture capitalist. Do we know what companies he's investing in? And why did he just resign?
A quote from Dr. Michael Carome, Director of Public Citizen's Health Research Group
"[H]is tenure as commissioner was marked by regulatory decision making regarding medications and medical devices that tilted further in favor of industry's financial interests rather than the interests of public health."
Didn't we just go through this with the FAA?
4
I do agree that our society's treatment of new mothers is insensitive and woefully out of date. The kinds of nurturing that the authors recommend are all to be wished for. However, as a survivor of postpartum depression myself, I have to say that massages, having family close by, etc. would not have helped my depression.
I had a fantastic pregnancy, but right after the birth I suddenly felt completely disoriented, anxious, and just not myself. I am sure that the dramatic fluctuation of hormones after birth immediately plunged me into my depression.
I had a husband at home who helped me with everything, my parents and siblings lived 5 minutes away, and I did not have to go back to work for a while. And yet, my condition was not alleviated by any of these benefits, because it was a chemical imbalance.
It was the worst experience of my life. Fortunately, a combination of Prozac and time helped me to get better.
19
When I was young there was no health insurance, and cancer and diabetes were rare. If we all lived healthy lives as we should in order to protect our bodies, our health costs would drop dramatically! Our society has taught us to eat badly, to do things that are bad for us, and to drink things that are bad for us. Most people have no idea how to take care of themselves! All drugs are poisons and have serious side effects. As George Bernard Shaw famously said, "If all drugs were thrown into the ocean, it would be all the better for us humans but all the worst for the fishes." Taking good care of your health pays huge dividends, y'all! I am 78 and my husband is 82 and we do not even have a doctor! No drugs for us.
7
@jimfayeCancer wasn't rare. It just wasn't talked about, and fewer people survived it. Stop glorifying the past and look at the benefits of modern medicine.
11
@jimfaye
Taking care of your health pays huge dividends but we all know people who did and still were victims of cancer or other devastating disease. You can’t deny genetics. The fact that you are doing well is partly luck/good genes so I wouldn’t be so critical of others if I were you. You may be next.
8
@jimfaye your nostalgic view of the past is flawed. A lot of people were sick back in the bad old days. It was not talked about as much, or they died before you heard about it. If you don't have a doctor well, so be it. That is no indication of something superior.
9
I share the concept that better social circumstances for new mothers would prevent much depression. Surely, this situation is one where prevention is wiser than an obscenely expensive, highly inconvenient treatment.
I think there is a comparison to the opioid situation. Do not many persons turn to opiates for the temporary relief that they obtain from the hopeless and despair in their lives as well as chronic somatic pain? All of the alternatives for the somatic pain amount to "live with your pain, humans are meant to suffer." For some, a moderate dose of an opioid is a practical solution. Current reactions to the "crisis" vilify those who do need a moderate daily dose for relief. But our society needs to face up to the hopelessness and despair wrought upon our citizens by so many of the heartless outcomes of unregulated, unshackled capitalism. Therein is the true "crisis."
9
The cost of the treatment alone puts it out of the reach of the average mother. It’s cruel but I’m not surprised. That how big Pharma works.
7
When my sister in law had her first baby, she was living in London. Five days in hospital, "till ones milk comes in and nursing is established", followed by a month during which visiting nurses, including a lactation consultant if necessary, came by daily. Only in this country do we spend research money to throw a drug into the mix instead of allowing a mother time to recover without fear of a pay cut. New mothers need support, coaching, sleep. New families need time and regular check-ins with experienced healthcare providers.. not more chemicals!
45
@insomnia data I had both my children in the UK. I too stayed in hospital 5 days with the first and 3 with the second. I could have stayed for 5 but chose to go home early. I also had a nurse visit for a month after each birth, which was daily for the first 10 days. I also received 6 months of maternity leave at full pay.
9
Yay, NHS!
We continue to refuse to acknowledge that giving birth to a new creature is a special event. Women continue to be punished for every female feature of their existence. America operates, it feels like still, under the ‘you made your bed’ philosophy of an older time with respect to childbirth and that includes giving meagre emotional, physical and work support to new mothers. It makes the heart weep, just as the breasts of newly returned to work too soon moms do.
10
I work in home care and I wish we provided service to new mothers. Imagine what a difference that would make to a new mom, who is in pain, sleep deprived, overwhelmed, and often alone since the spouse has had to return to work. We could provide HHA to help the mom shower and clean up, OT/PT to help recover those pelvic floor muscles and nursing to help with recovery and nursing. It's possible!
23
All doctors need to be screening for PPD since many women just think they are at fault for how they are feeling and don’t seek help. Of critical importance is the impact on the baby- secure attachment is necessary for healthy brain development (think Romanian adoption children). Depressed mothers are not able to provide the attention babies need. US maternity leave policies are harmful to children- 3 months is not enough time! We need to invest more in our infants to grow a healthy future society.
10
The case can be made for better support of new mothers without opposing the new drug for postpartum depression. The new drug might have saved a close relative of mine from suicide, despite support and care, within a year of the birth of her second child.
9
I had both of my daughters 6000 km away from my mom and sister, but my six weeks of paid maternity leave prior to my due date, coupled with plenty of professional pre-natal care, took away a lot of the nervousness/anxiety about not being up to the challenges. It was an incredible relief knowing that I would also have 10 weeks of paid maternity afterward to bond and organize, without the stress of returning almost immediately to work, and that flexible and affordable childcare was available when my leave ended. My French employer and colleagues treated my leave, not as an inconvenience, but as something to be celebrated and supported.
Although I realize that for some women postpartum depression can be at least partly due to raging hormonal imbalances that necessitate medication, whenever I read about the miserable level of before/during/after maternity support American women receive, I’m only surprised that the estimation of “one in 9” women suffering PPD isn’t much higher.
45
Elisa Albert has it right. Loneliness and exhaustion are the typical state for new mothers, unless they're very lucky. Add that to the hormone mix and the physical trauma, and it's amazing the rate of depression among new mothers isn't far higher. Caring for a newborn can be overwhelming even for someone who isn't recovering from giving birth!
What do women really need? Three days of IV psych meds to "dampen neural activity" (spelled in big dollar signs for the medical industrial complex)? Or maybe some HELP in the home and a good night's sleep once in a while?
64
Postpartum Depression is a well-known clinical condition, as with most psychiatric illnesses it has biological and psicological causes, but hormonal changes after childbirth is clearly one of the main factors.
The question about new treatments and it´s cost is a very interesting one, specially when there are efective and much cheaper alternatives, and most SSRI antidepressant and dual-action NSRI have proven useful.
This should be a matter of clinical discussion between mental health specialists, but , frankly, I wonder wether the authors of this article have any clinical experience in the matter
4
We already have treatment both pharmacological and non pharmicologic therapy for post partum depression which is really a major depressive disorder. The causes of PPD is as complex and incompletely understood as MDD. Most women with infants do not wish to be placed in the hospital for treatment which is understandable. Of course breast feeding is out; and this cost is prohibitive. With this cure worse than the disease I wonder if the approving panel have an understanding of the realities of psychiatric practice.
30
@Markham Kirsten, MD
Unfortunately, the approving panel is often made up of "insiders" from the very profession that will ultimately use the drug. The F.D.A. is riddled with corporate compromises.
6
Post-natal care in the Netherlands has had the answer for decades: real, practical support to all parents of a newborn, in the home.
One of the unique features of giving birth in the Netherlands is every woman’s entitlement to a maternity nurse (Kraamzorg), the cost of which is covered by your mandatory basic insurance package. A trained medical professional attends your home every day during the week following the birth, with their services covered by your health insurance.
As well offering support and advice, and answering any questions you may have, the Kraamzorg can also assist with everything from general household chores to purchasing groceries, preparing a meal or taking older children to preschool. Depending on your needs, the maternity nurse will be available to assist you full time (up to eight hours per day) or for just a few hours each day. They are also trained to identify signs of potential post-natal depression and enable early intervention.
175
@Anne That sounds pretty good--for the first week. By the way, who decides what the new mother's "needs" are for full time help versus just a few hours a day?
2
@Anne Nice, but why is the birthrate so low in the Netherlands with so much help provided?
2
Completely agree with this article. This drug is absurdly expensive and represents a myopic approach to postpartum depression. In Mexico where my two children were born, we were distrustful of doctors and hospitals and mostly opted for home birth with midwife. Our friends brought baskets of food and tidied up and provided company and moral support, but mostly, everyone delighted in the new life we'd created. They like babies in this country and you get smiles of approval. In France, the government recognizes that you have created a French citizen and gives you a stipend. The American way of birth is increasingly unnatural, fearful, and does not encourage joy.
73
Many of the comments indicate that many people believe postpartum depression is simply due to women being overwhelmed by the responsibilities of being a mother and could be solved with paid parental leave and other financial benefits.
If this were true, then no mothers who had the financial where with all to take extended leaves or to hire sufficient supportive help in caring for the baby would suffer this disorder. The reality is very different.
Postpartum depression is a serious mental disorder the origins of which we still don't fully understand. To reduce it simply to a social problem denies just how complex problem it is.
57
@Steve I do agree with you based on my own experiences with chemical imbalance that has been treated successfully with medication, but what these women are saying is they need more than medication, they need an attitude shift in society that says that we are all responsible for the well being of mothers and children at a critical time. This country has a "pull yourself up by your own bootstraps" philosophy at the expense of kindness and caring at vulnerable times. And worse than that our reptilian brains are right in fearing that the other reptile will devour us if we show any weakness. Some societies are much more evolved than ours.
16
@Steve The authors don’t reduce it to a social problem.
9
Yeah but before we live in a leftist paradise (and I mean that somewhat positively), we still need to help moms with PPD. I would love it if we lived in Denmark.
The upside to Zulresso is it works really quickly, while most SSRIs take weeks to work. Also Zulresso has an enduring effect so you don't need to keep taking SSRIs.
Sure it's expensive but this is cheaper than and a better use of money than we spend on extending the life of terminal cancer patients. We spend $100-200K on oncology treatment per patient. Prevent super depressed moms in their 20-40s from hurting themselves at 1/3 to 1/7 the cost of oncology treatments that extend life for a few more months for 70-80 year olds who have a terrible quality of life at the end of their life. Nobody complains about treating terminal cancer patients, why are people complaining about treating young moms with depression who just gave birth!?
18
A much better treatment approach than the ones the authors suggest and that would cost far less than that $34,000 would be to have every pregnant woman screened by a psychiatrist and receive preventive therapy if indicated. Postpartum depression rarely appears out of the blue (no pun intended). This approach won't prevent every case of PPD but I bet it would be a lot more effective than Zulpresso. But of course, drug companies aren't stupid enough to fund studies comparing the two approaches unless they were 100% certain that the drug would be better. Sadly most obstetricians know very little about depression and try to avoid as much as possible inquiring about the expectant mothers' mental health.
I am not sure if the authors are being serious with their suggestions that PPD could be treated with weekly massages or moving to a commune in the Bahamas. PPD is a serious, potentially life threatening disorder and these "treatments" are no more likely to be beneficial for it than they would be for diabetes.
The writers are correct about something. When studies are performed, the participants receive much more support than most patients do in the usual practice of medicine. Unfortunately, this is rarely factored in.
22
@Steve How about making people get training and license before being allowed to breed?
1
More maternal support makes much sense. One wonders if more support would be available if most mothers stayed at home and were thus surrounded by those in the same situation. As Betty Friedan, who's book The Feminine Mystique, sparked the beginning of woman's liberation, questioned 30 years after the book was published, did she hurt more woman than she helped? Arguing that women should be able to work instead of raise children freed many women from being something they despised being; a housewife. Unfortunately for most women, like most men, a job is not a fulfilling career but simply a way to make money. But the feminist charge to have all women work led to the loss of a cadre of women who wanted to raise children. Now we seek a medicine to solve a problem that was created by a change in societal norms. Perhaps we need a new book, the Maternal Mystique, to emphasize that for most mothers life would be better if they lived in a community where women stayed at home with their children.
9
@Dr B
Full time homemakers get postpartum depression too.
4
The child care problem in America is caused by the same thing that causes many of our other problems: greed. Of course there should be paid maternity leave as well as child care. But it will have to be mandated.
Now, many companies allow unpaid leave (they are required to, under the Family and Medical Leave Act of 1993). Then, instead of hiring temporary workers to fill in, the employers pile the work of the employees out on maternity leave onto the other employees, in addition to their regular work, of course.
31
For that amount of money, the health care system could institute a week's hospital stay for births - that gives the new mothers time to get their milk flowing, monitor the baby's behavior and discuss oddities with the nurses, make sure the baby is gaining weight on its diet, and give the new mother human contact in those critical first few days. The security of knowing that you have a few days to get rested and check your body as well as your new baby and not have to go home right after birthing to your daily routine is worth its weight in gold.
I had my children in German hospitals, and far from home and family, those long birth stays gave me the strength and confidence to go home and enjoy caring for each new baby.
66
@Sara. My mother had five children (1946-1960). With all five of us, she spent one week in the hospital. The downside—my dad had to take care of the kids at home. My father couldn’t boil water.
5
YEARS of paid parental leave? I realize this is hypothetical, but still.
I’m a liberal & have a ton of issues with how our society in general views & treats those that are in need, including many new mothers/parents.
However, I really have some serious doubts re: “years” of paid parental leave, especially without further clarification.
Would this require a parent’s position to be held open at an employer for years during their leave?
How would this be funded?
Private companies and/or government(s)? Either way, how?
How much money are we talking about per annum?
The annual equivalent of one’s former salary, whether it’s minimum wage or $500K? Is there a floor or ceiling?
“Sliding scale” based on total family income & assets, total # kids (ie “means testing”)? A standard amount for most like many federal safety-net programs? Based on prior pay-ins like Social Security?
I certainly support greatly enhanced support for parents/mothers, children & families in society, especially for those that are financially challenged.
Societies suffer not just socially but financially as well when it’s too costly for many individuals to afford to have children. Thus it’s generally in the interests of us all to help support families.
But “years” of paid family leave is another issue entirely.
9
It's not uncommon in Europe to have "years" of parental leave. People (mothers or fathers, depending on the country) often take a day of unpaid parental leave until their child is 7 or 8. It gives them time at home away from the cattle crush of a busy work day, but at the same time allows people to stay active in the workplace and in their career. It's valuable. The USA has antiquated views of how to run a modern society.
22
The proper "control" in the clinical trial for this drug would be to give each mother $34,000 (i.e. the cost of the drug).
I have bet that with $34,000 in hand, the "control" new moms would recover from postpartum depression just as fast (if not faster) than the new moms on the drug. $34,000 could pay for a round-the-clock nurse for both baby and mom for the entire first month.
114
For 34 thousand dollars, insurers should offer 6 months paid leave instead!
66
@MSC,
Totally agreed!
How weirdly hide-bound and brainless can our system get? Completely lacking in both human intelligence and human compassion.
Even half that amount would pay the airfare for a parade of family and friends to come by to help out. Just like humans have done for eons. Much better for the baby, too.
Crikey!!
10
There is a simple dietary aid for combatting postpartum depression - pharmaceutical grade fish oil (which has proven helpful in countering depression). High concentrations of EPA and DHA are needed brain and nerve cell development for a growing fetus, as well as for the mother. American diets are poor in EPA and DHA.
Of course, parental leave and cultural support won't hurt, either....
3
Elisa Albert is so spot on here; a society that actually supported new mothers--and new fathers--would do a whole lot more good overall than this expensive new drug.
But that would require us to have such a society--and right now, the interests of big pharma, big insurance, and big reactionary-ism are far more important than the interests of mothers or their offspring. And that's not likely to change anytime soon.
42
Incredibly, these non-physicians have decided to come out against a breakthrough treatment for post-partum depression within days of FDA approval.
Instead of wallowing in their negativity, we should all be thankful that postpartum depression finally has a highly effective treatment.
8
@Troglotia DuBoeuf
except that it is absurdly expensive and there are likely better natural solutions...this article is right on, the society is exacerbating the problem and isolation (and the modern way of birth in the US, which generally cedes power to the medical establishment) is at the heart of it. Drugs are not the answer to everything.
23
@Troglotia DuBoeuf Nonsense. A “highly effective treatment” that separates mother and baby for days, interrupts nursing, costs a year’s salary, and has neural side effects is not an entirely benign treatment modality.
And get over that privileging of people with MD’s. Maternal health requires holistic approaches, and mental/emotional health is best understood as responsive to a combination of medicines and therapy.
6
A 34k treatment? How about support new mothers by providing services to to really help them: someone to help with the newborn. Allow the new mother to recover some physically and emotionally from labor and birth. Help keep the house clean. Help with other children. Allow a mother to stay home and bond with her baby for more than two weeks before going back to work due to there being no financially supported time off. I could go on. And we wonder why there is so much depression. Take something hard like having a baby and make It harder by isolating new mothers and their infants. The a magic solution! Offer a 34k drug (wait, what is the median take home in America?) rather than do any of the above. Awesome. Best country ever. Yeah. Right.
84
I think it's a shame that mothers have no more rights in America, but getting the same rights as Western European women won't be enough to help women maintain good mental health.
For example. maternity leave per se does not solve the problem of loneliness. As some have commented, Sweden encourages fathers to take a leave too. Otherwise, all the responsibility of caring for the baby falls on the baby's mother, potentially increasing her stress levels instead of reducing them.
It's time for women to stop being victimized and a good start would be to stop victimizing ourselves and other women. Let us accept that there are no perfect children or mothers, and that raising children requires, maybe not a village, but at least more than one exhausted woman.
53
Thank you for your article. We need longer maternity and paternity leave . Women are still trying to receive more than four weeks of paid maternity leave and worry about job security.
Mothers need to feel ok about whatever choice they make about feeding their infants,not guity. There are people who care and want to help.
Please ask for help. There is no shame.
13
Strangely, this article says nothing about the effect this miracle drug has on breastfeeding--and on breastmilk itself. Are mothers who take the drug (and their babies) expected to forego the many emotional and physical benefits of nursing? Does the miracle drug go directly to the mother's...
Wait. What's the theory behind this drug, anyway? The serotonin-uptake theory (chemical imbalance, broadly) is now finally getting serious scrutiny. (Fact: Science doesn't know what a normal level of serotonin is, in control groups.) So what's this new idea, eh? And let's not forget generations of infants who were born addicted to substances their mothers continued to be prescribed while they nursed. Let's remember the numerous newer illnesses and conditions babies seem to be developing. And yes, opiods used to be prescribed after Cesarean sections, too. Restraint and more research, please.
19
@Lexicron Mothers who take this drug presumably are taking it because they are severely depressed, perhaps suicidal. Your concern about their breastmilk seriously misses the mark here. Interestingly, your lack of concern for the suicidal mother supports the point the author is making.
8
Other than paid leave, what "support" is the "culture" supposed to provide? Women are left to "spiral into despair"? By who? Postpartum depression comes at all income levels. Hormonal shifts are the cause. Six months paid leave are not going to change that. (I was happy to get back to work after 10 weeks.) If new mothers want more support, better to live close to parents, grandparents and other family. But in this country families are far-flung by choice. Yes, pumping at work is a pain, but a minor one, and no cause for depression. I thought it was great to be able to say I pumped and was a trial lawyer at the same time - fodder for stories when the kids are older. These new drugs sound great and will help some women. The ongoing trend to insist that women are victims (here, because postpartum depression exists) is ridiculous. There is no magic elixir for getting through life on planet earth.
18
I’m glad you did not suffer from postpartum depression but completely disagree with you based on my experience. Some of the severe feelings of depression I had after the birth of my first child were specific to my circumstances: traumatic birth and protracted recovery, inexperience with babies, no friends who had children at the same time, difficulty with transitions and my decision not to return to my rewarding job because of poor benefits and inflexible schedule. BUT major societal policies were significant factors too—or rather lack thereof that would have made the entire experience more civilized: guaranteed paid leave for an extended period, an insurance covered doula to help with my recovery and adjustment to motherhood, more regular doctor visits, the opportunity for a job share or flexible schedule among others. American society does not generally appreciate the difficulty of this life change which is intricately bound with public health and employment policies. Acknowledging it head on could have major positive implications.
38
@Jeannie R Fisher
I did have postpartum depression with my first daughter and an emergency c-section with the second. Fortunately, both were manageable. I represent women in pregnancy discrimination cases (its illegal) and am aware of what is going on. We may - one day- get some required paid leave other than just FMLA from large employers. That is something the government can do (but then what about paid leave for cancer, mental illness, diabetes, etc.) As of now, pregnancy leave by law is treated the same way as any other "disability" and is governed by the employers policy, which is usually 6 weeks.
1
@Jeannie R Fisher Thank you for your compassion and reasonable response.
2
I imagine most affected mothers would need only one dose of Zulresso; it's particular benefit is that it acts immediately and lasts 1 month. A regular oral daily antidepressant - which typically takes 3 weeks to "kick in" - could be concurrently started, and would become effective approx 1 week before the initial dose of Zulresso wears off. So I doubt the overall price of treatment of postpartum depression will be as astronomical as might seem.
1
@GBR if you give the family $34,000 for 3 months off and help it would be even better.
94
We "can't afford" social supports that might benefit new mothers and families here in the U.S. because -
1. We pay so much for Corporate Health/BigPharma.
2. We pay so much for our military/"defense" budgets.
81
34k for treatment for an emotional condition, but Medicare pays nothing for dental care.
14
Sir/madam, your concern is valid but this is the wrong forum to raise it. Treating postpartum depression doesn’t affect Medicare spending because Medicare doesn’t cover maternity services. Treating new mothers doesn’t take away from treating seniors. Everyone deserves good care and those who need it must stand together and support each other, not snipe and gripe between ourselves.
91
@me
What is it that makes you believe that dental care is more
important that Postpartum depression?
Until such time as women over 65 start giving birth,
Medicare won't be paying 34K or any amount of money to
treat postpartum depression.
28
@DJS Why is dental care more important than Post Partum depression??? Everyone has/or had teeth, for one thing. And infected teeth can lead to other health problems, including death if the infection spreads.
3
I think that the 50% improvement with the placebo is truly interesting. Perhaps having a three day break from caring for a newborn and the extra restorative sleep that entails did a world of good. When my kids were little, I used to fantasize about spending a few days at a hotel by myself with no one placing any demands on me. Being a new mother is exhausting and good sleep is essential for good mental health.
200
@SRA Agree. And many don't have the support from family that can stay and help clean, do laundry, cook, and just hold the baby a little longer while you sleep between feedings. Women used to stay in the hospital for 3 days after a normal birth, up to a week with a c-section. Now hospitals kick you out at 24 hours and many no longer keep the baby in the nursery while you try to sleep; they are put in the room with you. Lack of sleep will depress anyone, lack of sleep for a week or six will push some to the brink.
But I have to wonder whether this drug makes any sense at all. Results between the control and study groups are close, and the variable of rest (IV in hospital for 60 hours) is the real fix.
I also think men and women are unprepared when the first child comes. They have heard from friends how exhausting it is, but nothing like living through it teaches you how much the babes turn your life upside down. The good thing, is they look at you with their sweet face and needy cry and you fall in love, forever. Post partum depression is more about setting expectations and getting sleep for most, at least.
7
For a society that says its pro family the walk doesn’t match the talk. Families need support. Support from their families, communities and the government. All the drugs in the world aren’t going to help without that support network. They are one piece of a much bigger puzzle. All drugs alone do are get some pharma Executive rich.
133
@Stephanie - The drugs might even poison
breast milk.
4
@Stephanie Support from families and friends is critical. But the government? Now we want our government responsible for new babies and their mom and dad?!
Maybe 4 months maternity leave, 2 months paternity leave. I think we can skip relocation to a commune in the Bahamas.
18
In addition to longer maternity leave, there is research from Sweden showing that when they implemented paid paternity leave, rates of postpartum depression in mothers went down.
85
Everyone says breast is best...
Not going to argue that it’s nature’s Plan A, but the flip side of society not supporting nursing is the hounding of women who consider going to Plan B when Plan A is just not working.
You can be in so much pain you can barely get dressed, getting depressed, and sleep deprived to the point of borderline hallucination, and still it’s “Oh, honey, you aren’t going to give up?” and being asked if you tried the football hold position and nursing longer, as if forty minutes every three hours wasn’t a good faith effort.
183
@Di I'd like to see more easily accessible lactation consultants come to the home a few times within the first month. Establishing breastfeeding is HARD and something to learn from other women, not fumbling after googling for what a good latch looks like.
I only succeeded after dragging myself and my 5 day old to a breastfeeding group (also crucial is that my husband had a few weeks of paternity leave and could drive me). As helpful as the group was, it should be easier to get a home visit.
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Agreed. Formula is food, not poison, and breast feeding is only easy for some women. It’s hell for the rest of us.
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@Di: My wife, a perinatologist (high-risk obstetrics), was accosted several times by La Leche League evangelicals after the births of both our kids. Their opening line was always the same: "So how's the breast feeding going?"
These were complete strangers who had no business whatsoever even asking! Even though both kids were entirely breast fed for their first year of life (and then some), my wife felt like shaming them back by saying something like, "I'm sorry, I can't breast feed; I had breast cancer."
My observation as a parent is that many people have major boundary issues when it comes to parental advice. And the most forceful unsolicited opinions I've heard came from people who had no kids.
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