Drug for postpartum depression in U.S. needed in Canada ‘ASAP’: doctor

The approval in the United States of a fast-acting, short-term drug to treat postnatal depression has prompted Canadian maternal and child health experts and advocates to make sure people north of the border can quickly access the same treatment. I hope to become

Zranolone is the first oral drug specifically designed for severe postpartum depression, showing symptom relief beginning on day three of a two-week dosing regimen, according to clinical trial results. Standard antidepressants can take up to three months to improve a woman’s mood, including thoughts of harming herself or her baby.

Pharmaceutical companies Biogen and Sage Therapeutics obtained approval from the U.S. Food and Drug Administration earlier this month for a new drug marketed under the brand name Zurzvae.

A Biogen spokeswoman said the companies are focused on having the tablets commercially available in the United States later this year and have not submitted an application for approval to Health Canada.

However, “Biogen continues to explore opportunities to bring the flies to patients outside the United States,” she said in an emailed response.

Maternal health and childbirth-related mortality have received increasing attention in recent years. But gaps remain in helping those trying to cope with the deep despair of postpartum depression, and this is partly due to hormonal changes that trigger emotional reactions far beyond the need for treatment “baby blues.” believed to be related.

Currently, there is only one drug for postpartum depression, launched by Sage in 2019. Zurlesso is approved in the United States and is administered intravenously for 60 hours at a medical facility at a cost of $34,000.

A Biogen spokeswoman said the price for zranolone has not yet been determined.

The drug was approved after a randomized controlled clinical trial in about 200 people with severe postpartum depression showed significant improvement in symptoms such as suicidal ideation, anxiety and insomnia. .

Participants in the study, published last month in the American Journal of Psychiatry, received 50 milligrams of zranolone per day or a placebo tablet for two weeks.

“Treatment with zranolone compared to placebo resulted in a statistically significant improvement in depressive symptoms at day 15,” the study states. The study involved multiple institutions and was led by behavioral scientists at the Feinstein Institute for Medical Research based in New York.

The study found that symptom relief lasted for 45 days after the first dose. A previous trial published in JAMA Psychiatry in 2021 showed that administration of 30 milligrams of zranolone also reduced symptoms over the same period.

According to Statistics Canada’s 2019 report on maternal mental health, nearly a quarter of those who gave birth between January and June 2018 were consistent with either postpartum depression or an anxiety disorder. It is said that he had feelings to do so. The proportion of respondents reporting these conditions varied by state, ranging from 16 percent in Saskatchewan to 31 percent in Nova Scotia.

The results are based on research in collaboration with Health Canada and Public Health Canada, where participants were surveyed 5 to 13 months after giving birth.

Postpartum depression has been treated with antidepressants called selective serotonin reuptake inhibitors, such as Prozac, but they are slow to work and often taken indefinitely.

Zranolone is thought to target GABA receptors in the brain, which are part of the major signaling pathways involved in regulating stress and mood. In doing so, it compensates for reduced levels of naturally occurring neurosteroids that protect the maternal and fetal brains from the stresses of pregnancy.

After being stuck at home for months after the birth of her daughter in 2010, Carol Duggar became obsessed with the idea of ​​being an “incompetent mother” and tried to bond with her baby. He said he thought about suicide several times.

“I felt completely alone, even though my mother and sisters came to my aid,” said the Toronto attorney. He was also overwhelmed with guilt over not being able to breastfeed.

After her husband insisted on seeing her primary care physician, Duggar was urgently referred to a psychiatrist at Mount Sinai Hospital, where she gave birth.

However, she was reluctant to try antidepressants for fear of “poisoning” her baby with her expressed breast milk. For her, her other option was to be hospitalized immediately, but she also resisted this, as she was worried about leaving her daughter behind at her home.

“I tried multiple antidepressants until I found one that worked for me,” Ms. Duggar said of the frustrating months of the process, including seeing a psychiatrist.

She hopes that if the drug company submits an application to Health Canada, it will be approved quickly, and the woman and her family won’t have to suffer for so long.

Those at highest risk for postpartum depression have a history of mental illness.

Duggar was born in Lebanon in 1977, shortly after the civil war began, and his family lived in an air raid shelter for seven years. They immigrated to Canada when she was 13.

She said much of the trauma she endured as a child resurfaced after her daughter was born, contributing to the postpartum depression she also experienced in 2014 after the birth of her second daughter. But by then she had accepted that the drug was effective,” said a lifesaver. ”

Diane Francour, Ph.D., CEO of the Canadian College of Obstetricians and Gynecologists, says that while zranolone offers some reassurance to women who fear long-term use of existing antidepressants, it is also effective against severe postpartum depression. He said that any drug should be used in conjunction with psychotherapy.

“I think we really need to recognize that depression can take a woman’s life. So developing a new drug is a celebration, especially if it actually works on day three.” Even more so,” she said.

“Baby development is expensive, so we need to be able to launch it in Canada as soon as possible.”

Daisy Singla, a clinical psychologist and associate professor of psychiatry at the University of Toronto, says the breakthrough drug looks promising, but “talk therapy” has proven to be part of the treatment for postpartum depression. said that

But Singra, who is also a senior scientist at the Center for Addiction and Mental Health in Toronto, said most treatments are not available due to high costs and long waiting times.

Singla is leading a US-funded study of more than 1,200 patients in Toronto, Chicago and Chapel Hill, North Carolina, receiving counseling from lay people, nurses, midwives and doulas. how well they perform compared to mental health professionals.

Singla said the patients have been in hour-long sessions for eight weeks, some of whom are on medication for severe postpartum depression and may already be seeing a psychotherapist.

Some therapy providers are referred by community groups and selected for skills such as empathy and cooperation before undergoing three to five days of training to help patients learn new coping skills. some people Sessions are supervised by experts.

The trial, which began in early 2020, is also comparing online appointments with face-to-face therapy for people who may have childcare or mobility difficulties.

Postpartum depression can start before giving birth, so it includes women who are still pregnant.

If you or someone you know is having suicidal thoughts, call Talk Suicide Canada at 1-833-456-4566 or text 45645 at night for 24/7 support can receive Residents of Quebec can call 1-866-APPELLE (1-866-277-3553) or visit suicide.ca for assistance via text him or online chat.

This report by the Canadian Press Agency was first published on August 17, 2023.

The Canadian Press’ health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.