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New postpartum depression drug won’t help most mothers

It should be good news that the Food and Drug Administration has approved the first drug specifically indicated for treating postpartum depression, but it’s not that simple.

True, the fact that the FDA approved a drug specifically for postpartum depression is a step in the right direction. After all, postpartum depression, or PPD, affects 1 in 9 women, and I’m one of them. The headlines drew me in, hopeful that mothers like me might finally find lasting relief from the debilitating symptoms that can occur at an already vulnerable stage in life.

I was heartened that unlike traditional antidepressants, this new drug brexanolone (which will be available in June) has shown itself in studies to be almost immediately effective, regardless of when PPD symptoms begin. But in reading the details of the treatment, I realized this drug isn’t compatible with the reality most American mothers face. My own story illustrates this.

In 2007, I gave birth to my first son, and the postpartum depression set in almost instantly. Because I lived 120 miles from the nearest family member, didn’t grow up openly discussing mental health and was young — just 20 years old — I had no idea what was happening. I suffered untreated for 18 months. The symptoms kept me from doing the things I loved, like reading and yoga, and made me feel like I was losing a piece of myself, but I just thought I was dealing with the adjustment to new motherhood and its trials. I didn’t know that my experience was a diagnosable condition until I was sitting in a therapist’s office a few years later for an unrelated issue.

In 2016, when my second son was born, I was more prepared. While pregnant, I told friends and family what I’d experienced the first time. Postpartum depression hit me again when my new baby was about 6 weeks old. I thought I was in the clear until my husband quietly urged me to seek medical help after rattling off a list of symptoms he’d recognized from the first time. I was crying all the time. At one point, I’d looked at him and said that I thought the family might be better off without me because I was such a mess. I couldn’t stop worrying about the baby and he’d noticed it was keeping me up at night, even when the baby was asleep.

With both my children, finding one hour amid the breastfeeding, work hours and brain fog to go to the doctor in the first weeks or months of their lives seemed beyond impossible.

That’s why, when I read that the intravenous new treatment for postpartum depression, called brexanolone, involved up to 60 hours in a medical facility and will likely cost between $20,000 to $35,000 without insurance, I balked.

That cost would come on the heels of a childbirth process that is itself already expensive, even without any complications. And it will be up to each insurance company to decide whether this treatment will be covered and what the out-of-pocket costs would be, depending on the plan.

My postpartum depression lasted 18 months the first time, and nearly two years the second time. I’m also one of the relatively rare cases of a patient who can’t take traditional antidepressants. One family of medications causes a rare and potentially fatal side effect, and I haven’t responded well to the others.

Perhaps brexanolone would have helped me. But who knows if my insurance company would pay?

Even if the cost of the drug is covered, how about the hospital bill? I received a bill for $52,000 after my emergency C-section with my second son — a procedure that was necessary to save both our lives. My insurance covered a portion of it, but I’m still making payments to satisfy my portion of the bill.

Even if the hefty costs of a hospital stay and the drug itself had been covered, I would never have been able to take 2.5 days away from my family and my work for a drug treatment.

I would venture to say that most mothers are like me. Most mothers have some kind of limitation, whether it be financial challenges or a lack of external support, that could prevent them from reaping the benefits of such an important medical advancement.

I’m sure brexanolone is right for some mothers who experience postpartum depression. But consider that nearly a quarter of mothers in the United States have to return to work only two weeks after the birth of their children. Most families can’t afford to take the unpaid 12 weeks provided by the Family Medical Leave Act. So how are they going to be able to take extra days off from work and from their families to receive this treatment?

Brexanolone sounds like the kind of solution that will only help a small percentage of a large population of sufferers. Time and again, medical advancements in maternal health leave out those who are the most vulnerable — those who are low income, of color, and without insurance — and this just feels like another example.

 

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