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UPMC Magee-Womens Hospital offers new drug for postpartum depression

Pittsburgh Tribune-Review - 11/7/2020

Nov. 7--Having babies brought Emily Washburn joy. The experience of motherhood also crippled her with sadness.

Washburn, 25, of Carlisle, was diagnosed with postpartum depression -- in September 2017 after the birth of her first child, Wyatt, a boy. As she is about to deliver her third baby, she remembers her bout with depression.

"I remember being in the kitchen and leaning over the sink and crying thinking, 'It shouldn't be like this. There has to be something going on with me,' " Washburn said. "I was suicidal and barely able to move and function."

She now knows there's now a treatment -- brexanolone.

What is brexanolone?

Brexanolone was approved by the U.S. Food and Drug Administration in March 2019. It's a one-time infusion.

The brexanolone program is a joint initiative through between UPMC Western Psychiatric Hospital and UPMC Magee-Womens Hospital. The inpatient psychiatry consultation-liaison service. UPMC said it is the first in Pittsburgh to offer the drug.

It is administered intravenously over a 60-hour period, requiring patients to stay at the hospital. Gopalan said for women who have acute symptoms, it's crucial to intervene quickly.

"This medication has a rapid onset with most patients reporting effects within 24 hours after completing the infusion," said Gopalan. "This will not be the first line of treatment for moms with mild to moderate postpartum depression because options like psychotherapy and antidepressants have proven to be effective in those cases, but this medication provides another option for mothers."

Washburn had brexanolone treatment after having her second baby, a girl named Willow, in October 2019 at UPMC Pinnacle Harrisburg. Pinnacle was the first hospital in the state to offer the treatment, according to UPMC.

"The new medicine is great, said Washburn. "I know I sound like a commercial for it, but I was having such a hard time. It made me feel like a new person. Mental health is so important."

Very few drugs are designed specifically for pregnant and postpartum women, said Dr. Hyagriv Simhan, executive vice chair of obstetrical services at Magee. This patient population often is excluded from clinical trials and research because of the possible risks for the developing fetus, Simhan said.

"However, it's important to include moms in research so that their needs -- along with the needs of their baby -- are appropriately addressed," said Simhan. "Moms deserve more and offering this unique drug designed specifically for postpartum women is certainly a step in the right direction."

About postpartum depression

According to the FDA, postpartum depression is a major depressive episode that occurs following childbirth, although symptoms can start during pregnancy. It is characterized by sadness and/or loss of interest in activities and may present with symptoms such as cognitive impairment, feelings of worthlessness or guilt, or suicidal thoughts.

"Postpartum depression is a serious condition that, when severe, can be life-threatening," said Dr. Tiffany Farchione, acting director of the division of psychiatry products in the FDA'sCenter for Drug Evaluation and Research, in a statement on its website. She said women may experience thoughts about harming themselves or harming their child.

Postpartum depression can interfere with the maternal-infant bond, said Dr. Priya Gopalan, medical director of psychiatry services for UPMC Western Psychiatric Hospital and UPMC Magee-Womens Hospital in Oakland.

The Centers for Disease Control and Prevention reports about one in seven women experience symptoms of postpartum depression. While psychotherapy, medication, or a combination of both, have been proven as helpful treatment, it isn't the solution for some women.

But brexanolone may be.

Postpartum depression is a serious and sometimes difficult-to-treat disorder, said Dr. James Schuster, associate chief medical officer and senior vice president of medical and behavioral services at UPMC Health Plan.

If a mother had postpartum depression during a prior pregnancy, the risk increases, said Gopalan. She said 80% of moms go through what's called "baby blues."

Screenings are done if someone is referred for brexanolone. There is an initial phone call then an in-person evaluation.

"There is so much stigma associated with postpartum depression," Gopalan said. "We know that untreated depression can definitely have an effect on the baby. Anxious moms have a hard time being with their babies and we want to help with the quality of the relationship between the mom and her baby."

Support groups

Washburn joined a mom's group on Facebook.

"I've had other women reach out to me and tell me I am brave and if there is anything I need that they are here for me," she said. "I share my thoughts because I want other women to know there is help out there."

Having support is crucial, Washburn said. She said her husband David and their families have always been there.

"If I have rough days they will help me," she said. "They will take care of the children and help with doing the dishes and laundry and let me take some time for myself."

Pandemic isolation

Emily Washburn said the pandemic has created more stress because there aren't many places to take her children since people are staying home more and not physically seeing each other.

"That makes it hard," she said. "I am very open so people know how I am feeling. I might catch some people off guard from what I say because I am not afraid to put it out there. It's important to let people know and they might think that if I am having a bad day it is OK for them to have a bad day too. It helps me to share how I am feeling."

Gopalan said it is still early to talk about any effects of the pandemic on new mothers. But she added that isolation can definitely affect mental health and can lead to anxiety.

"Depression affects the entire family," Gopalan said. "It can put extra stress on the people around mom as well."

JoAnne Klimovich Harrop is a Tribune-Review staff writer. You can contact JoAnne at 724-853-5062, jharrop@triblive.com or via Twitter .

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