The FDA Just Approved the First Drug for Postpartum Depression—but Can Anyone Afford It?
Postpartum depression affects as many as one in nine women in the U.S. annually, and its symptoms are serious, including suicidal thoughts and thoughts of harming your child. The condition, which often goes undiagnosed, strains a new mom’s ability to bond with her infant. In some areas of the country, the postpartum depression rate is as high as 20%.
Before now, antidepressants and counseling were used to treat postpartum depression. But as early as June, a medication designed to treat postpartum depression will be available after the FDA announced the approval of the medication, an injection called Zulresso, yesterday.
A more effective treatment for postpartum depression is long overdue. The treatments currently in use work, but they’re both problematic, Columbia University Medical Center professor of psychiatry Philip Muskin, MD, tells Health. Some women shy away from antidepressants, and the time commitment that counseling sessions require can be hard to fit into your schedule. These issues make the promise of an effective and convenient postpartum depression medication even more exciting.
The FDA has given the drug, created by Sage Therapeutics, the seal of approval, meaning it’s effective. We asked Dr. Muskin to explain postpartum depression—and how Zulresso aims to fight it.
After giving birth, Dr. Muskin says, hormones change drastically in just a few hours. “The hormones that sustain pregnancy are no longer needed because you’ve given birth,” he explains. Your body, therefore, stops making them. “For some women that’s inconsequential. However, for some women, this rapid drop in hormones seems to set off a psychiatric disorder,” Dr. Muskin says. Experts don’t yet know why postpartum depression affects some new moms but not others.
Zulresso mimics the hormones that your body stops making after giving birth. It’s a much more efficient treatment than counseling or antidepressants, as it works in just two-and-a-half days. “I think it’s a miraculous treatment,” Dr. Muskin says. But the accessibility of the drug will likely be an issue. “It may not be practical for many women who will go on to suffer postpartum depression.”
The women who participated in the drug testing trials leading up to Zulresso’s FDA approval had immediate access to the medication when they felt depressed. This won’t be the case for many women in America, both insured and uninsured, because of the high cost of the drug. “This a very different sample than the sample in the real world. In the trial, these women had access,” Dr. Muskin says.
Without insurance, the injection is expected to cost $34,000. As of the 2016 census, 28.1 million people lacked health insurance in the U.S. The accessibility of the drug will come down to whether or not insurers will cover it for many women.
Steve Kanes, MD, PhD, chief medical officer of Sage Therapeutics, tells Health that the company hasn’t been seeing a lot of pushback from insurers, however. “They’re understanding that this is extraordinarily innovative,” he says.
Even if you are insured, your insurance company might ask your doctor to exhaust other options before agreeing to pay for Zulresso. These treatment options could take weeks to work, possibly outlasting your postpartum depression symptoms.
The cost of the injection isn’t the only prohibitive factor here. The administration of Zulresso is a process itself. The injection is given as a continuous IV infusion, which has to be administered over a period of 60 hours. This means a hospital stay, the average cost of which is more than $10,000 a night.
The FDA’s approval announcement also noted some pretty scary side effects. Women receiving Zulresso have to have their blood oxygen levels monitored and are not allowed to be left alone with their children during treatment. A press release from the administration says: “Because of the risk of serious harm due to the sudden loss of consciousness, patients must be monitored for excessive sedation and sudden loss of consciousness.” Experts aren't exactly sure what's to blame for those alarming side effects, Dr. Muskin says, but hormones may play a role. “This is a drug derived from hormones, and hormones are very powerful.”
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