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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by beckett2 on March 20, 2019, at 20:46:17
I've often thought of the drop of progesterone after childbirth had something to do with PPD.
https://www.livescience.com/65040-postpartum-depression-drug-how-it-works.html
Posted by Phillipa on March 21, 2019, at 18:13:34
In reply to brexanolone for PPD, posted by beckett2 on March 20, 2019, at 20:46:17
I got a notification of this in RN newsletter must be administered inpatient. Given IV and cost of one infusion is $3,800. And not know if insurance will pay for this. Also hospital costs are not included. Who could afford this?
Posted by Phillipa on March 21, 2019, at 18:17:32
In reply to Re: brexanolone for PPD » beckett2, posted by Phillipa on March 21, 2019, at 18:13:34
Mistake that is $38,000 for one infusion.
Postpartum depression, which affects as many as one in nine new mothers, can be life-threatening and yet, the main treatments for this illness can take weeks to start working. But a new drug just approved by the U.S. Food and Drug Administration (FDA) can take effect in as little as two days.
The new drug, brexanolone injection for intravenous (IV), or Zulresso, is the first medication approved specifically to treat postpartum depression in adult women. And unlike antidepressants that can take weeks to work, this new drug can start working almost right away.
Postpartum depression (PPD) is a serious mood disorder that develops after childbirth. Its characterized by sadness and/or a loss of interest in activities previously enjoyed, a decreased ability to feel pleasure, and symptoms like cognitive impairment, feelings of guilt or worthlessness, or suicidal ideation.
"Women may experience thoughts about harming themselves or harming their child. Postpartum depression can also interfere with the maternal-infant bond, Tiffany Farchione, M.D., acting director of the Division of Psychiatry Products in the FDAs Center for Drug Evaluation and Research, said in an FDA press release.
This new medication provides an important treatment option. Currently, however, its only available to patients through certain health care facilities where the provider can monitor the patient.
The drug is given as a continuous IV infusion over two and a half days (60 hours). Risks include sedation and the sudden loss of consciousnesshence the need for careful monitoring during treatment. The most common side effects are sleepiness, dry mouth, loss of consciousness, and flushing.
In clinical trials involving women with moderate or severe PPD, Zulresso was significantly more effective than placebo at reducing depression symptoms at the end of treatment and 30 days later.
How does it work so fast?
The current mainstays for PPD treatment are similar to those for depression that occurs outside of the postpartum period: talk therapy and antidepressants, including SSRIs. But Zulresso works differently.[SSRIs] mostly affect the neurotransmitter serotonin, and take two to six weeks to begin working, says perinatal psychiatrist Pooja Lakshmin, M.D., an assistant professor of psychiatry at the George Washington University School of Medicine. Brexanolone [Zulresso] appears to have a novel mechanism of action it is a [synthetic form of a hormone produced by] the human hormone progesterone, acts on the GABA neurotransmitter system [a part of the brain thought to control anxiety], and works much more quickly within a few days. But despite the quick-acting nature of Zulresso, it may not be the right choice for every woman following childbirth, Dr. Lakshmin tells HealthCentral.
Brexalonone [Zulresso] is for women with severe postpartum depression, whose illness is debilitating enough that they require hospitalization, she says. Women with mild to moderate postpartum depression are not going to be ideal candidates for this new treatment.
There are two reasons for this, Dr. Lakshmin says:
Patients with moderate PPD showed a less dramatic therapeutic response to the drug than those with severe postpartum depression.
The drug currently comes in only an IV form, and must be administered over 60 hours, in an inpatient setting, thus, limiting its use.
And theres another unfortunate catch, Dr. Lakshmin says: Zulresso is really, really expensive. Sage Therapeutics, the company that developed the drug, charges $34,000 for one course of the infusion. And that doesnt include the cost of the hospital stay. (Its not yet clear how or whether insurance companies and hospitals will cover the drug costs.)While these factors mean that the majority of patients with PPD may continue to rely on antidepressants and talk therapy for treatment, Dr. Lakshmin says, the new drugs approval is an important step forward. [The approval] indicates that maternal mental health conditions are being taken seriously, she says. For those patients with severe illness, this new drug carries hope.
Posted by beckett2 on March 21, 2019, at 20:57:47
In reply to Re: brexanolone for PPD, posted by Phillipa on March 21, 2019, at 18:17:32
I imagine the price will go down and insurance will cover at least some of it. I also imagine it will be reserved for the most severely depressed.
Posted by beckett2 on March 21, 2019, at 21:04:34
In reply to Re: brexanolone for PPD, posted by Phillipa on March 21, 2019, at 18:17:32
After childbirth, I had a difficult time. From depression to anxiety and BPll. I thought it had something to do with rapid hormonal changes and because of my age, I also became peri menopausal. My therapist said to go to a hormone specialist, etc etc. But that didn't really exist yet, the science to restore (or?) that sort of hormone disturbance. I was given estrogen, which didn't help at all. Should I have been given small doses of progesterone? Idk. I'm glad there is now something for these women.
Posted by Phillipa on March 21, 2019, at 23:22:18
In reply to Re: brexanolone for PPD » Phillipa, posted by beckett2 on March 21, 2019, at 21:04:34
Born ahead of our times. Now you could get bioidentical progesterone cream to rub on. I had severe anxiety after third child and had been allowe to take valium and drink wine during the pregnancy so she was born and projectile vomited and cried the first 18 months of life and was in and out of the hospital as cried 24 hours a day. And when I started having contractions two weeks early can you believe in the hospital L&D they gave me two seconals so I would sleep? How medicine has changed.
Posted by beckett2 on March 23, 2019, at 18:51:13
In reply to Re: brexanolone for PPD » beckett2, posted by Phillipa on March 21, 2019, at 23:22:18
I agree. If I knew then what I know now (cliched but true), I could have had an easier time. I dont think anyone asked me about my mood postpartum. Now (I think) a new mom is checked for depression. Nor did I recognize peri menopause.
Posted by Phillipa on March 23, 2019, at 22:36:11
In reply to Re: brexanolone for PPD » Phillipa, posted by beckett2 on March 23, 2019, at 18:51:13
Was okay after birth of kids but remember had first at age `19 second almost 22 third 27 and was anxious and depressed then. Knew nothing of peri menopause or menopause and when going through them that is when thyroid went. If I had known about what my body was going through. I think I wouldn't have needed meds.
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