Pregnancy is a beautiful but challenging journey for many women. While there’s plenty of information about what to expect during pregnancy, the challenges that come after giving birth aren’t as widely talked about. This lack of discussion leaves many new mothers unaware of conditions like postpartum depression, a common issue faced after childbirth. Fortunately, in this article, we will discuss a new resource, Zurzuvae, that provides support and guidance to women as they navigate the emotional changes post-birth, helping to promote health equity.

What is Postpartum Depression?

Postpartum depression (PPD) is a serious and potentially life-threatening condition that affects about 1 in 7 women (4). Although it often starts somewhere within the first three weeks after giving birth, postpartum depression can happen any time after childbirth and has the potential to disrupt any moments of motherhood and child development.

It is normal for women to feel sadness in the weeks after giving birth, however, it is important to note the difference between PPD and the “baby blues.” About 80% of women experience short-term dips in mood caused by the “baby blues”, experiencing a range of emotions including high moments of pride or low moments of guilt. The key difference that distinguishes one from the other is the severity of the emotions and for how long one feels them.
postpartum depression

What can PPD Look Like?

After childbirth, the higher range of emotions that women experience due to hormonal imbalances causes their minds and bodies to work in total opposition. An excessive amount of stress can manifest in the body, causing women to not be able to produce milk. Other Symptoms of PPD include constant dismissals of healthy self-care practices, prolonged feelings of sadness or isolation, anxiety, and guilt.

Not only does PPD impact women mentally, physically, and emotionally, but it also has a large impact on the child’s physical and emotional development by rupturing the maternal bond between the mother and child.

In extreme cases, it can even lead to acts of self-harm or suicide. All of these experiences call for a tremendous amount of grace and patience for oneself as a mother who is trying to navigate this foreign terrain.

Zurzuvae: A Pathway towards Normalcy

Many mothers have expressed that methods like therapy, communal support, and medication have been their saving grace during this difficult time. In response to this, Sage Therapeutics has introduced the newest FDA-approved medication brought forth to aid women who are battling PPD. Zurzuvae is administered via pill over 14 days and can deliver swift enhancements in symptoms of depression by the 15th day.

Women can potentially expect early signs of improvement appearing as soon as the third day, however. In comparison to the 4-6 week timeline that is advertised by other standard depression treatments, this drug has a much quicker turn-around time.

Zurzuvae is a revolutionary product with a brand new approach to PPD, targeting hormone function to relieve symptoms rather than targeting the brain’s serotonin system like other typical antidepressants do. It is the first oral medication indicated to treat postpartum depression whereas before, the only treatment provided was by IV injection administered by a healthcare provider. According to Tiffany R. Farchione, M.D., director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research, allowing women to take PPD medication orally is a “beneficial option for many of these women coping with extreme, and sometimes life-threatening, feelings.” (1)

 

The Price of Modern-Day Healing 

This product, however, comes with a hefty price tag. The 14-day regime costs $15,900 to complete. For half of women diagnosed with PPD, it’s their first time experiencing it, so spending nearly $16,000 on one medication program isn’t exactly ideal for the everyday woman. Those diagnosed with PPD will turn to their healthcare providers to help foot the bill, but insurance companies haven’t yet taken a liking to providing aid for the fast-acting medication.

Coverage policies and prior authorization guidelines are documents that insurers release to inform prescribing providers about the necessary conditions for a drug to be eligible for coverage and if prior approval from the insurance company is required. Although it is very clear that Zurzuvae has the potential to change the lives of a large group of women suffering from PPD, insurance companies have limited the use of the drug due to the poor guidance that has been provided thus far. Without these clear guidelines, it can be difficult for a patient to receive the treatment that is necessary for their condition.

According to a report done by the Policy Center for Maternal Mental, of the six largest health insurers only one (Centene) has issued coverage guidelines on Zurzuvae. The same study also states that out of the 1000+ insurers in the U.S., only 17 have published coverage guidelines for Zurzuvae. (3) That is only an astounding 1% of insurers. Even the companies that do provide guidelines are very restricted by the rules for getting coverage.

It is important to note that just because an insurer doesn’t post coverage guidelines does not mean that Zurzuvae will not be covered by the company. However, because of the high price of the drug and its brand name, it is more likely that there will be restrictions placed by the insurers and they will ask for the customer to co-pay for the treatment.

A common restrictive practice used by the 17 insurance companies with published guidelines is the “fail-first” requirement. This policy mandates a 4-6 week trial period of a cheaper medication, such as a Selective Serotonin Reuptake Inhibitor (SSRI) or an antidepressant. If patients fail to get better under the cheaper treatment, then insurers will move forward in approving the newer more expensive option. In other instances, guidelines can specify that psychiatrists must prescribe Zurzuvae instead of obstetricians, even though they are often the first doctors to witness symptoms of PPD.

These restrictive guidelines have the potential to delay treatment for patients, forcing them to try other alternatives when the medication they need is right there waiting for them. In the article published by NPR, many psychiatrists explained how “it is imperative to treat postpartum depression as quickly as possible to avoid negative effects, including cognitive and social problems in the baby, anxiety or depression in the father or partner, or the death of the mother to suicide, which accounts for up to 20% of maternal deaths.” (2)

postpartum depression

Support New Mothers With These Actions

With this information in mind, support new mothers now through actions as simple as a phone call. Not about the baby this time though, just them. Genuinely inquiring about how this new mom is doing or what she may need by making yourself available to listen lets her know she does not have to bear the weight of postpartum depression alone.

Remind new mothers, that you mustn’t neglect your body right now. Try to maintain the habits of your normal routine and take small steps to regain a sense of normalcy. Whether that involves finding quiet time to listen to music or read a book, prioritizing time for yourself is paramount for your healing.

Conclusion

Postpartum depression is a serious condition that impacts millions of women worldwide, but healing is possible. As mothers who will continue to cope with a plethora of new and confusing feelings post-childbirth, know that you are doing your absolute best as a woman and it is okay to acknowledge and admit that something may be wrong. With the support of those closest to you, intentional physical movement, and the right medication, your postpartum depression can be managed.

Thanks to the FDA’s approval, Zurzuvae is an effective clinically-proven treatment that is now readily available for consumption in the U.S. Though insurance companies have a responsibility to face reform to make this medication more accessible to the everyday woman who struggles with PPD, resources like those at the Office of Women’s Health (5), are available today.

We ask all women to join this conversation in the comments below and start talking to one another more about the joys and trials of motherhood. We may be surprised about what we learn from the women around us as we make the time to understand each other better.

REFERENCES

1. Commissioner, O. of the. (n.d.). FDA approves first oral treatment for postpartum depression. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression

 2. Dembosky, A. (2024, March 12). There’s a new prescription pill for postpartum depression. how will coverage work? https://www.npr.org/sections/health-shots/2024/03/12/1237702759/theres-a-new-prescription-pill-for-postpartum-depression-how-will-coverage-work

 3. Policy Center for Maternal Mental Health. (2024, March 7). Zurzuvae, the new postpartum depression drug now available in the U.S. – this is how insurers have responded. Policy Center for Maternal Mental Health – Formerly 2020 Mom. https://www.2020mom.org/blog/2023/12/15/zurzuvae-the-new-postpartum-depression-drug-now-available-in-the-us-this-is-how-insurers-have-responded

4. Postpartum depression. March of Dimes. (n.d.). https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression#:~:text=Postpartum%20depression%20(also%20called%20PPD)%20is%20a%20medical%20condition%20that,of%20yourself%20and%20your%20baby.

5. Office of Women’s Health. (n.d.). Talking Postpartum Depression.  https://www.womenshealth.gov/TalkingPPD?gad_source=1&gclid=EAIaIQobChMI6f_YiJLHhQMV95xaBR2DLg7gEAAYASAAEgKFB_D_BwE