Hope for Postpartum Depression

A fast-acting drug has shown results in an early company trial.  

Scientists are looking hard for faster-acting antidepressants. No one should suffer through months of debilitating anxiety or despondency — especially if you need to be focusing on a newborn. 

“Baby blues,” anxiety, and exhaustion in the first couple of weeks after birth, affect the majority of mothers. After childbirth, the estrogen and progesterone in your body quickly drop. Those hormonal changes, plus sleep deprivation, can affect your mood. Don’t be afraid to share your feelings and ask for help caring for your infant, especially if you’ll be able to nap

But baby blues pass quickly. Postpartum depression is more extreme and, without treatment, can last for months or years. It occurs in nearly 15 percent of births, usually beginning between a week and a month after delivery.

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You’ll recognize the signs of a bad mood  — irritability, anger, and restlessness and dissatisfaction. But lingering postpartum depression can make you inconsolable and also lead to panic attacks. Some women ache all over or get headaches and stomach problems. Some withdraw from other people and feel detached from their baby. You may worry that you can’t care for your baby.

If you aren’t sure you wanted the baby or the baby was born with medical issues, you may be at more risk of depression. Other risk factors include a difficult pregnancy; a family or personal history of depression or bipolar disorder; a recent trauma like losing a job, domestic violence, or a death; lack of emotional support; or a drinking or drug problem. 

When you’re feeling this awful, it’s more important than ever to get sleep and emotional support. Otherwise, the standard treatments are the same as you’d get for other causes of depression: a combination of psychotherapy and medication, which typically requires six to eight weeks before you feel better. That’s a long time for a newborn to wait to see her mother smiling.  

In the search for faster treatments specifically for new mothers, a drug in clinical trials called SAGE-547 has shown promise. In one small trial (which has not been reviewed or replicated by other scientists), the drug manufacturer Sage Therapeutics reported that seven of the 10 women who received an injection of SAGE-547 to treat postpartum depression said they felt significantly better within 60 hours. The effect lasted 30 days. None of them complained of the common psychiatric side effects that can crop up with antidepressants, such as insomnia. 

Among 11 women who received a placebo instead, only one felt better within 60 hours.

“The rapid onset of action of this drug observed in the trial is unlike anything else available in the field to date,” said primary investigator Samantha Meltzer-Brody, MD, MPH, and associate professor and director of the UNC Perinatal Psychiatry Program of the UNC Center for Women’s Mood Disorders. 

The proposed new drug works differently than the familiar SSRIs or SNRI antidepressants, focusing instead on receptors for GABA (gamma amino butyric acid), a promising area for the next generation of antidepressants. Put simply, the GABA receptor system sends out stop signals, and in depressed people, may fail to stop unpleasant emotions. (Coffee, by the way, can interfere with the calming action of GABA.)

The early results are “promising and exciting,” said Allison Baker, MD, a psychiatrist at Massachusetts General Hospital’s Center for Women’s Mental Health, noting that further studies involving more women are needed. 

The company isn’t yet seeking approval of the drug for postpartum depression. The next step is to enroll more women and look for a lower dose that might be just as useful, especially for women who breastfed. For this trial, women were asked not to breastfeed for the first 10 days after receiving the injection. 

The same drug is further along in tests as a treatment for a rare form of epilepsy. 

Another promising avenue for a faster antidepressant is the prescription drug ketamine, an anesthetic delivered through an IV infusion often used in veterinary medicine. It’s also the illegal street drug “Special K,” which can cause hallucinations and a dream-like trance. Ketamine isn’t approved by the Food and Drug Administration, but some psychiatrists administer it off-label to patients who haven’t responded to other approaches. 

Scientists are also investigating nitrous oxide (commonly called laughing gas), xenon gas, magnets, infrared waves, and deep-brain stimulation as immediate remedies for mood disorders like depression and anxiety. 

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