Research Shows Postpartum Depression Needs Early Diagnosis And Psychotherapy

Zuranolone is the first pill against postpartum depression. The medicine already existed in its injectable form in the United States, but it was not very accessible due to its high cost. Data from the clinical study of the product already indicate that it acts more quickly to alleviate depression in relation to other antidepressants, but there is still no forecast for its arrival in Brazil.

understanding the disease
Between 10% and 15% of women are affected by postpartum depression and the disease is considered up to one month after the child’s birth. According to Joel Rennó Júnior, professor at the Department of Psychiatry at the Faculty of Medicine at USP and coordinator of the Women’s Mental Health program at the Institute of Psychiatry at Hospital das Clínicas (HCFMUSP), there are some risk factors for this type of depression: “60% of postpartum depression are due to undiagnosed depression or abandonment of treatment already during the pregnancy period”.

The professor also explains that there are different types of postpartum depression. The most common of these, baby blues , occurs in about 70% of women, but tends to be a milder condition. “The blues is a self-limiting condition that lasts for an average of ten to 14 days and disappears spontaneously with just a few support measures for this woman.”

However, some blues frames can progress to postpartum depression, more severe and persistent. “Postpartum depression meets the criteria of what we call major depression, which has two cardinal symptoms: depressed mood and also anhedonia, which would be the loss of pleasure or interest in usual activities accompanied by other symptoms, such as changes in the pattern of sleep, appetite, thoughts of negative content, changes in attention, concentration, memory, energy, mood, a series of symptoms that persist for at least two weeks”, explains Rennó.

Causes and action of the drug
Rennó explains that today the causes of postpartum depression are clearer, a factor that contributed to the development of the remedy. “Today we know that there is a molecule called allopregnanolone, which is a metabolic derivative of progesterone, the female hormone. This allopregnanolone is involved in the issue of postpartum depression. Allopregnanolone acts on the central nervous system on a receptor called GABA, this GABAergic receptor is a receptor that is a central nervous system depressant,” he says.

The drug, although approved by the FDA, does not yet have a defined cost, but what is known is that its effect is very fast. “Current antidepressants generally begin to take effect between 15 days and 30 days. This specific antidepressant for postpartum depression starts to take effect in three days and the duration of treatment is around 15 days.” It is worth noting that the drug is specific for postpartum depression and does not work for depression in other life periods of the female reproductive cycle.

continuous studies
The tests carried out on this medication did not include breastfeeding mothers, so further studies will need to be carried out to prove the pill’s compatibility with breastfeeding. “Since it is a short-term treatment and its effect occurs in the first three days, the idea is that in the most serious cases afterwards you continue with the common antidepressants that we have today and that are also effective in postpartum depression. These common antidepressants, most of them are fully compatible with breastfeeding,” says Rennó.

early diagnosis
The professor points out that vulnerability during pregnancy can occur more than once in a woman’s life. “There is a subgroup of women who may have other episodes in the future, become more vulnerable, even to having depression in other pregnancies or postpartum periods, and also until then, in what we call perimenopause, which precedes five to seven years the onset of menopause. It is these periods of hormonal fluctuation where the woman is most vulnerable”. The ideal, in these cases, is an early diagnosis. “When you diagnose early, the condition is mild and often only with psychotherapy can you resolve the condition.”

In addition, it is necessary to reduce the stigmas regarding postpartum depression, so that more women seek help during this period. “In prenatal care, it is important to also assess mental health. (…) These women are unfortunately often diagnosed late and, when not diagnosed correctly, 20% of them may have an increased risk of suicide, so early diagnosis and treatment is important, as postpartum depression is still a target of many prejudices. The more we talk about the topic, the less stigma these women have in relation to this disease”, concludes Rennó.