Q&A with Dr. Hellerstein About New Medication Treatment for Postpartum Depression

We spoke with David Hellerstein, MD, Director, Depression Evaluation Service, New York State Psychiatric Institute and Columbia University Department of Psychiatry, about his Ganaxolone for postpartum depression study.

Q: What is postpartum depression and why is it important?

Postpartum depression is a type of major depression that affects women around the time they give birth. Despite its name it can actually begin before the baby is born, and in the weeks or months afterward. It’s very common (affecting 10% or more of women) and can be very disabling. Not only does it affect the woman herself but it can also have big effects on her ability to care for her new baby. The effects of untreated postpartum depression can last for years. So, it’s really important to identify postpartum depression and provide effective treatments.

Q: What treatments work for postpartum depression?

That’s the problem. Antidepressant medications like the SSRIs (such as Prozac or Zoloft) are often used, as well as psychotherapy, but they may not be particularly effective. It’s not entirely clear that postpartum depression is the same condition as other types of depression. For one thing, after the baby’s birth there are tremendous swings in hormone levels, and it is thought that these changes may cause or at least contribute to the depression in women who are vulnerable.

Q: The FDA recently approved a new medication for postpartum depression. What is different about it?

The new medication that was approved (Brexanolone) is one of a new class of medications that are very different from traditional SSRIs. They are actually hormonal medications. They are based on the hormone allopregnanolone. Interestingly, a woman’s levels of allopregnanolone increase throughout pregnancy, then drop very rapidly after the baby is born. Studies have shown that giving drugs based on this hormone to a woman with postpartum depression can quickly relieve her symptoms. If this pans out, this would be remarkable since traditional antidepressants take weeks to work.

Q: How is the treatment given?

The newly approved medication is given IV over a 60-hour period, which requires staying in a hospital for several days. Our group in the Depression Evaluation Service is studying another allopregnanolone-based medication, Ganaxolone, which is given IV for a much shorter period of time, followed by pills which are taken by mouth. So, it is possible that eventually these allopregnanolone-based medicines could be provided with very brief IV treatment or even entirely with pills, which could be a truly major advance.

To find out more about our DES study, see: https://recruit.cumc.columbia.edu/clinical_trial/1274

 The ColumbiaDoctors Women’s Program has developed a way to reduce postpartum depression by supporting effective parenting, teaching mothers how to get their babies to sleep and reduce fussing and crying. To learn more about the Columbia Women’s Program, click here: https://www.columbiadoctors.org/specialties/psychiatry-psychology/our-services/womens-program.