The transition from pregnancy to postpartum can be tough on mothers. It may be exciting to welcome a newborn and start life afresh, but it is not an emotional joyride for many women. From joy and excitement to fear and anxiety – it can cause a wide range of powerful emotions. The stigma around postpartum depression kept it brushed under the carpet for many years. But growing conversation about the struggle of motherhood has opened up people’s minds to this reality. In a major step towards acknowledging the seriousness of postpartum depression, the US Food and Drug Administration has approved Zurzuvae (zuranolone), the first oral medication indicated to treat PPD in adults.

What is postpartum depression?

Postpartum depression is typically a depressive episode that typically occurs after childbirth. The postpartum period is generally the first six weeks after the birth of a child. Women may experience a mish-mash of emotions – anxiety, sleep difficulties, mood fluctuations and crying fits – also called ‘baby blues’.

According to Dr Pooja C Thukral, Consultant – Obstetrician and Gynaecologist, Cloudnine Group of Hospitals, Faridabad, baby blues resolve in two weeks. But in a section of women, these baby blues ca be severe and they may progress to experience depression, anxiety or psychosis. Feelings of sadness, guilt and lack of worth take over. This may impact not just the mother-child bond, but also the mother and child’s individual health.

Therefore, awareness about postpartum depression is important to recognise its signs and seek timely diagnosis and treatment.

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FDA approves first oral treatment for postpartum depression

Earlier in August 2023, the FDA announced the approval for the PPD pill. It is a progress from the IV injection used by certain healthcare facilities for postpartum depression treatment.

“Having access to an oral medication will be a beneficial option for many of these women coping with extreme, and sometimes life-threatening, feelings,” Tiffany R. Farchione, M.D., director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research, was quoted as saying.

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The efficacy of the pill has reportedly been demonstrated in two randomized studies in consideration of the safety of mothers and their child. FDA recommends a 50mg daily dose of Zurzuvae – once every day, for 14 days, in the evening with a fatty meal.

The pill does not come without side effects. FDA clearly states that it may lead to drowsiness, dizziness, diarrhea, fatigue, common cold, and urinary tract infection. In certain cases, use of Zurzuvae may even cause suicidal thoughts and behaviour, and fetal harm. “Women should use effective contraception while taking, and for one week after taking, Zurzuvae,” notes the FDA.

While this may be a positive step in the direction, there is still a long way to go before the pill may be authorised for use in India. Till that happens, efforts need to continue towards spreading awareness about postpartum depression, early detection and treatment.

What are common risk factors of postpartum depression

The risk factors for PPD are previous psychiatric illness, discord with a husband or other members of the family, financial burden, stillbirth, neonatal death and a previous episode of PPD, says Dr Pooja C Thukral.

Studies have even observed how birth of a female baby, lack of family support, sick baby or death of the baby, preterm or low birth-weight baby, unwanted or unplanned pregnancy can also increase chances of postpartum depression.

Common signs of postpartum depression

A woman going through postpartum depression could typically go through the following.

* Excessive crying
* Loss of appetite and sleep
* Suicidal thoughts
* Thoughts of harming the baby

Click here to read in detail about postpartum depression signs.

How to help someone with postpartum depression?

Immediate family members and close friends can play a key role in supporting the mother by taking her to a psychologist or psychiatrist to assess her condition and seek treatment.

“If the symptoms of feeling low, not being a good enough mother and excessive crying continue beyond two weeks, a visit to a psychologist is recommended. A mother will be evaluated by the psychologist and her need for medicines for (general) depression will be assessed,” Dr Thukral tells Health Shots.

From her own experience with postpartum depression patients, the expert says sometimes, new mothers just want to be heard without being judged. “A few of them just feel better after venting out and I advise some of them to see a psychiatrist right away depending on the severity of their symptoms.”

The stigma around PPD needs to be broken further. The Indian government should prioritize mental health of women at the national level by making mental health care centres especially for new mothers available, accessible, and affordable, says Dr Thukral.

Sharing some suggestions to reduce the burden of mental health challenges for a mother, she adds, “Timely recognition and referral to a specialist is important. Health care worker visits to households of women who can’t access healthcare facilities, especially screening for their mental health well-being, can be a tool to recognise PPD. Questionnaires can be designed to screen women for symptoms of anxiety/depression post childbirth too.”

After all, mental health matters!