What is postnatal depression (Do PND Drugs work)?

Postnatal depression (PND), also known as postpartum depression (PPD), is a form of postnatal mental illness that many parents experience in the first year of having a new baby. This condition does’t just affect women; fathers and partners can experience postnatal depression too.

Learn more about fathers and postnatal depression (PND) by reading our article Postnatal Depression In New Dads.

Postnatal depression should be viewed separately from the transient condition of ‘baby blues’, which is considered normal in the first week or two after giving birth. About 50% of women will experience baby blues.

Feeling a bit down, tearful and anxious in the very early postpartum period is extremely common and these are classic symptoms of ‘baby blues’. However, if you’re experiencing depressive symptoms which extend beyond the first 2 weeks after your baby is born, or start later, you might have postnatal depression.

Most women with postnatal depression will recover fully with the right support and appropriate treatment.

Postnatal depression symptoms

Postnatal depression is a major depressive episode that can occur at any point during the first year after the birth of your baby, although symptoms can start during pregnancy. PND can affect people in different ways. It can manifest itself as cognitive, behavioural, emotional or physical health problems.

Some people might not realise they have the condition because the onset can be slow and gradual and symptoms, such as sleep disturbances, might be considered normal or to be expected with the common challenges of adjusting to life with a new baby.

Some signs of postpartum depression are:

Persistent low mood or rapid mood swings
Sleep disturbances
Lack of energy, or fatigue
Feeling unable to find joy in everyday things
Difficulties bonding with your baby
Self harm or suicidal thoughts
Frightening (intrusive) thoughts
Feeling irritable or anxious
Poor concentration or difficulty making decisions
Not wanting to socialise or leave the house
Excessive concern for your baby
Changes in appetite
Lack of personal hygiene, care for appearance or basic self care.

To learn more, read our article Postpartum Depression Symptoms | 9 Signs You Have PPD.

Where can I get help?

Pregnant women with a history of previous mental health problems, such as anxiety, depression or bipolar disorder are at an increased risk of developing perinatal depression. Other risk factors are: a family history of post partum depression; an unplanned pregnancy; hormonal fluctuations; sleep deprivation; a recent stressful event; and limited emotional support.

If you’re concerned about developing the condition, speak with your healthcare professional during your pregnancy.

If you feel like you, your partner or a family member might be experiencing postnatal depression, there is support available. You’re not alone, so don’t be afraid to reach our for help.

Seek urgent help from your midwife, health visitor, doctor or mental health professional. Postnatal health care professionals are trained to support postpartum women and families and are experienced in recognising the signs of postnatal mental health problems.

If you feel you need help, you can arrange a same day appointment with your GP or contact an out of hours or on call doctor. If necessary, you can go to your local emergency department.

How common is postnatal depression?

The rate of postnatal or postpartum depression varies throughout the world, suggesting there might be different social and environmental factors at play. We also know that both antenatal and postnatal depression are under reported and that poor screening and stigma related to diagnosis all have an impact on the official recorded rates.

It’s believed that 10-20% of women, globally, experience postpartum depression; the actual figures could be much higher. Many women struggle with feelings of guilt or shame for not being able to cope after birth, or are not supported to seek help.

In Australia, PND occurs in about 1 in 7 women.

How long does postnatal depression last?

Postnatal depression is not something that will go away on its own or pass, in time, without the appropriate support and treatment. Generally the earlier it’s treated, the more straightforward and effective treatment and recovery will be.

PND is a significant public health concern as its effects are broad, with both short and long term consequences – not just for the parents but also for the wider family unit and society as a whole.

Untreated PND can lead to more severe or long term mental health problems, such as postpartum psychosis. This is a severe form of PND, which can be life threatening and requires urgent treatment and medical attention.

PND also increases the risk of self harm, suicide, child abuse, maternal substance misuse and impaired mother-child attachment.

The length of the illness will vary from person to person and will depend on its severity; severe depression might involve a longer recovery. Most women with postnatal depression recover within a few months but, in 30% of cases, it lasts beyond the first postnatal year.

Postnatal depression treatment

Historically, postnatal depression has been treated in the same way as major depression (major depressive disorder) – that is, with antidepressant treatment or a psychological treatment, such as electroconvulsive therapy (ECT), cognitive behavioural therapy or talking therapy.

The most effective form of therapy will vary for each individual and will depend on individual circumstances.

Postnatal depression drugs (PND drugs)

Surprisingly, until now there hasn’t been a drug to target and treat postnatal depression specifically. Most women are prescribed anti-depressants to manage their symptoms, alongside psychological treatments, such as interpersonal therapy or talking treatments, which help to identify and address the things they are finding difficult.

Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for antenatal depression and depression in the perinatal period. Their effectiveness has been questioned, however, as they do not address the underlying chemical changes that occur following birth. Many are associated with a limited response, sometimes taking as long as 6-8 weeks before there is any kind of relief or improvement in mental health.

Brexanolone

In 2019, the Food and Drug Administration (FDA) in the USA approved the first ever PND drug to treat mothers.

Brexanolone (Zulresso) has been approved to treat moderate to severe postnatal depression in women in the USA; however, this has not yet been approved for use in the UK or in Australia. New drugs such as this are being hailed as a breakthrough treatment for the thousands of women dealing with PND every year.

How does Brexanolone work?

People with anxiety and depression are more likely to have low levels of GABA, which is a neurotransmitter or chemical messenger in the brain. It blocks certain signals in the central nervous system, producing a calming effect.

Brexanolone works to regulate GABA receptors responsible for communication between brain cells.

During pregnancy, hormone changes cause a decrease in GABA receptor activity. After birth, hormones decline, signalling the GABA receptors to come on-line.

When the GABA receptors turn on, they can be overactive and lead to depressive symptoms in women. Brexanolone is a synthetic compound made from progesterone, the main hormone responsible for this effect on GABA receptors.

Brexanolone is given intravenously, over 60 hours, and provides relief almost immediately, usually within 48 hours.

Postnatal depression medication: side effects

Although Brexanolone is being hailed as a breakthrough drug for PND, many health experts are cautious about it being a first line treatment.

Depressed mothers taking the new drug need to be under careful clinical management, due to the risks and side effects seen during the clinical trials.

Side effects include:

Dizziness
Extreme drowsiness or sedation
Nausea
Loss of consciousness.

Brexanolone limitations

The treatment might require separation of mothers and babies, as treatment is administered in hospital. Women might not be able breastfeed during the IV infusion, to prevent their baby having contaminated breast milk. At this stage, it appears only small amounts of the drug reach the breast milk but more research is required in this area.

In the USA, the drug will be priced at around $20,000 to $35,000 per treatment, with extra fees for staying in a medical facility for the time required.

Many health experts believe the drug should not replace psychological interventions and traditional antidepressants as the first point of treatment. However, for women with severe PND, or for those who haven’t responded to antidepressants, Brexanolone could be an additional effective option.

Does this drug treat the cause of PND?

One of the big challenges of PND is that its causes, and why it affects some women and not others, are not known. Every new mother experiences the same physical hormone changes during pregnancy and birth.

Some dads also experience PND, which indicates there are other factors involved in triggering PND. These include intense fatigue, financial and emotional factors and added stress.

PND can only be treated after symptoms appear and often the condition is quite severe before it’s diagnosed.

Preventing postnatal depression

Treating PND shouldn’t come at the cost of preventing it occurring in the first place. It’s very common for mothers with PND to be stretched thin both physically and mentally. Women who put on a brave face and pressure themselves to cope have often pushed themselves past their limits and are operating on very little in reserve.

When you have a baby, the most important thing to remember is that your body is recovering – not just from birth but also from pregnancy. There has been a huge nutritional demand placed on your body for almost a year while you were growing another human being. Immediately after birth, focus on getting your nutrient levels back up with high quality food intake and a supplement, if necessary. Seeking the support of a therapist, such as a naturopath, can be helpful at this time. This is especially useful if you’re breastfeeding.

Good health positively affects your mental wellbeing. Healing after birth takes time and supporting your emotional needs is equally important. It’s hard to feel good when you’re not getting enough sleep and a small baby can mean plenty of broken sleep.

Making peace with the fact your baby wakes at night is the first step to healthier sleep habits. The saying ‘sleep when your baby sleeps’ is there for a reason, mamas! Washing and cleaning can wait. If you’re tired and baby is sleeping, get a nap in. You and your health are important and you can cope with parenting much better when you’re feeling better.

Being supported in the early months of motherhood can go a long way to avoiding PND. Before having your baby, make a postnatal plan that takes into account how you and your partner will support each other during this huge transitional time. Often the focus is so much on pregnancy and birth, there is little thought given to how to get through the first months of parenthood. Enlist the help of family and friends, or hire a postnatal doula. Don’t struggle through it alone. Feeling pressure to cope and not ask for help can set you up for PND later.

Being a mother (or father) of a new baby is an amazing experience. It should be a joyful time, when you bond and spend time with your baby, watching your little one grow and develop. If at any time you are not feeling this joyful mood for more than a couple of days, please ask for help from your partner, and seek help from a health care practitioner.

Ross Walter is a Clinical Nutritionist, Naturopath and Herbalist, based in Brisbane. He has experience with PND as well as other mental health problems and in investigating and treating the root causes of such conditions. You can reach out to Ross online for a consultation, if required, via his website at www.rosswalter.com.au or his Facebook page: www.facebook.com/rawnutritionist