Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's your host, Melanie Cole.

Melanie Cole, MS (Host): In August, the US Food and Drug Administration approved the first medication for those suffering from postpartum depression. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and we're talking about Zurzuvae today with Joy Burkhard. She's the Founder and Executive Director of the Policy Center for Maternal Mental Health.

Joy, thank you so much for being with us. We're talking today about the first oral medication for treating postpartum depression. I'd like you to start by kind of highlighting what those are. What are postpartum mood disorders? How common are they? Tell us a little bit about them.

Joy Burkhard: Thank you, Melanie. It's a pleasure to be here. And I'm so honored to talk about these important issues with you. Maternal mental health disorders include postpartum depression, and up to 20% of women will suffer from one of these disorders, postpartum depression and anxiety being the most common of these disorders. Less than 20% though are diagnosed, and less than 20% receive any form of treatment. So, we have a lot of work to do and it's an exciting time for the field given the new depression treatment is on the market.

Melanie Cole, MS: Before we talk about that, I'd like you to speak about symptoms, because I think women, we tend to feel, "Oh, this is baby blues," but there's a big difference. We tend to feel, "Oh, this is normal. 'But when it feels extreme and we don't really recognize it, and sometimes our loved ones are the ones who recognize what it is, what symptoms are we looking for in ourselves or in our loved ones that would say, "You know what? You really need to speak to your provider."

Joy Burkhard: I so appreciate that question. And this can be a very confusing time for new mothers and families alike. We know that we should be experiencing, you know, some sleep deprivation and, of course, we're healing from birth, which could be very involved; c-section or traumatic in some way. And so, all of those things can kind of conflate and confuse what the symptoms are of these disorders.

But postpartum depression specifically is a major depressive disorder. So, it looks very similar to a depression outside of this timeframe, but there are a few nuances. So, we like to first point out that real lack of energy. And again, it can be confusing because we're not getting enough sleep and we've just gone through something very significant with birth, but very drained, lack of energy, despair. So, women can feel just complete overwhelm, feel deep sadness. There's often anxiety present and it can be a precursor to depression if not managed and treated well. Also, something called intrusive thoughts are happening fairly often, research is showing us. And these are unwanted, often scary thoughts about harm coming to the baby, and it may be at the mother's hands. These are normal thoughts. And if they become debilitating, they're considered to be related to maternal OCD.

I also like to point out what maternal depression or postpartum depression is not. And up to 80%, some studies say 85%, of women will suffer from what's called the baby blues, so sadness and crying. But if those baby blues persist beyond two weeks, then we liken it to postpartum depression.

This is also not the same as postpartum psychosis. Postpartum psychosis is a break in reality, often tied to an unmanaged or undiagnosed bipolar disorder. There can be other triggers like severe sleep deprivation over time, because of a medical trauma, for example. That is a medical emergency and women are more likely to harm themselves or others around them, including their babies. We say it's similar to living in a nightmare. You're not in your right state of mind and it is a medical emergency. So, this is not the baby blues and this is not postpartum psychosis.

Melanie Cole, MS: Well, thank you for all those distinctions, because I think that's an important point that you were making. So, let's talk about Zurzuvae. So, what does it do? How does it work? How is it helping women with postpartum?

Joy Burkhard: Well, it's the first oral pill on the market to treat postpartum depression specifically. So, a very exciting time prior to the oral drug hitting the market, which happened in mid-December. We had antidepressants and SSRIs, and other drug treatments to treat generalized depression or anxiety, which if folks know, I think your listeners know those drug treatments could take weeks, up to six weeks to see any type of effect. And we would maybe find that there was no help or effect at all in a particular patient and need to try another drug.

So, what's so remarkable about Zurzuvae is the fact that it's a 14-day course of treatment, so it's not something that patients might take for months or even years, 14 days. And within three days, studies show women have some immediate relief. So, it's an extremely exciting time for the field. What we're also very excited about is the fact that prescribers like OB-GYNs, who we believe are the home base, we say, for detecting these disorders, starting in pregnancy or even prior to conceptions, if women are planning on getting pregnant. OB-GYNs, midwives can prescribe this treatment as well without needing to refer out to a psychiatrist. We all know that there's shortages of psychiatrists, super shortages of psychiatrists who want to treat these disorders. They'll often refer patients back to the OB-GYN, for example. So, this is really a game-changer for the field.

Melanie Cole, MS: So, how have been the outcomes? Have you seen any results from this?

Joy Burkhard: We've heard countless stories from women who've participated in the research about how they felt better immediately. Many of the women in the research studies had severe depression. And so, it was critical that they receive immediate help. We also want to point out that untreated depression and anxiety along with overdose or drug poisoning is the leading cause of maternal mortality. Maternal suicide is a real problem and opportunity for us to solve for, and this drug is going to help us solve for that crisis.

Melanie Cole, MS: Based on what you just said, and we did talk about symptoms, but if family members notice this, if you've got a sister, a brother, your spouse, partner, whoever notices, what should they do? How should they proceed? If it's true postpartum, this clinical depressive disorder, what do you want family members to know about how to proceed?

Joy Burkhard: Well, we definitely want them to feel comfortable speaking to their medical provider. Not all women, though, will for a variety of reasons, feel comfortable talking to their obstetric provider. There is a new national hotline called the National Maternal Mental Health Hotline through a federal agency referred to as HRSA. And that phone line is 1-833-TLC-MAMA, 1-833-TLC-MAMA. And it is staffed by trained counselors who can help patients find treatment or family members and parents find treatment resources. So, we definitely want to encourage that line to be utilized. And again, ask for screening. So, how providers detect these disorders is through a questionnaire. Patients can take this questionnaire online themselves or ask their providers to provide the questionnaire. In some states, it's mandatory that providers are screening to detect these disorders. And it's recommended that screening occur by the American College of Obstetricians and Gynecologists, for example. So, providers are ready for this and should be screening and can prescribe this new drug. We can talk a little bit about insurance coverage as well.

What we've been reading so far, and your listeners have probably read, that there is a pretty hefty price tag for this new novel drug, as other new novel drugs also have hefty price tags because of the research and development. The wholesale cost just under 16,000, but insurers and the pharmacy benefit management companies that they work with are negotiating lower prices, including this drug on their drug formularies, that's their list of approved drugs. There is, from what we're seeing, a prior authorization requirement, but it's simple from what we're seeing with most insurance companies. Prescribing providers only need to submit documentation that there is a postpartum depression diagnosis, and we're finding that insurers are covering this drug. So, we encourage providers to not be shy about submitting these requests and patients to not be shy about asking for this new treatment.

Melanie Cole, MS: Joy, this is such a great topic and such an important time and really, like you said, this is exciting. This is an exciting development that could help so many people that feel hopeless at this time. So, I'd like you to offer your best advice for new parents so they can recognize those signs and symptoms and to discuss this new medication with their providers. So important.

Joy Burkhard: Thank you for that important question. And what I encourage patients and new families to be thinking about is understand your risk for postpartum depression or a maternal mental health disorder, ideally before you become pregnant. You can look at the risk factor analysis that we have on our website that identifies who's at greater risk. If you've had a prior depression in your life or suffer from anxiety currently or depression, of course, right now, then you are more likely to suffer during the perinatal period in pregnancy or the postpartum period. So, understand your risk and have a conversation about this risk with your OB-GYN or midwife. You can take the risk assessment to your prenatal appointment or your postpartum appointment. If you start to feel any symptoms at all, we encourage you to have a conversation with your OB-GYN or midwife. You can also seek out mental healthcare on your own without going through your OB-GYN or midwife by seeing a talk therapist like a counselor. There are new clinical certification called a perinatal mental health certified provider, a PMHC. You can contact your insurance company or even search your local therapist to find out who in your community has that PMHC designation and outreach them directly. So, just know that help is available. This is the most common complication of pregnancy, and you can get help.

Melanie Cole, MS: Thank you so much, Joy. What an important topic this was and what an informative episode. Thank you so much for sharing your expertise with us today. And for more information about the Policy Center for Maternal Mental Health and postpartum depression, you can visit policycentermmh.org. That's policycentermmh.org. You can also visit the free health information library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for tuning in today.