Dr. Joseph M. Miller DO - ROOT Cause Supplements, LLC

https://drjosephmillerobgyn.com

Newer Antidepressants for Post-Partum Depression

Antidepressants are medications that can help relieve depression symptoms, like fatigue and emotional numbness. Several different kinds of antidepressants exist, but the most commonly prescribed are selective serotonin reuptake inhibitors (SSRIs).

Fluoxetine (Prozac) entered the market  as the first SSRI, and for the next 30 years, many experts considered SSRIs the “modern” antidepressant.

In 2019, the Food and Drug Administration (FDA) approved two new antidepressants, brexanolone and esketamine

Brexanolone

In 2019, the FDA approved brexanolone (Zulresso) as the first drug specifically designed to treat moderate to severe postpartum depression (PPD). Experts consider some SSRIs safe to take while pregnant or nursing, but these medications may not lead to much improvement for several weeks. When you have PPD, symptoms don’t just affect your own well-being — they can also have long-term effects on your bond with your baby.

Brexanolone, however, begins to take effect immediately. According to two randomized clinical trials published in 2018, this medication can significantly reduce PPD symptoms — benefits that held when researchers followed up with participants 30 days after treatment.

Esketamine

Esketamine (Spravato) is a chemical cousin of the anesthetic ketamine. The FDA approved esketamine in 2019 to treat treatment-resistant depression, or depression that persists after you try at least two different antidepressant treatments.

During clinical trials, doctors gave participants a nasal esketamine spray or a placebo spray. All participants also took an oral antidepressant they hadn’t tried before. Compared to people who took an oral antidepressant and used a placebo spray, those who used the esketamine spray reported greater symptom relief and longer symptom-free periods.

How it works

Esketamine sets off a chain reaction of chemicals that ultimately raises your levels of brain-derived neurotrophic factor (BDNF). BDNF helps your neurons make new connections, which in turn enables you to form memories, learn new information, and develop different habits.

Depression typically involves low BDNF levels, and your brain may have difficulty adapting to changes. Esketamine helps restore BDNF levels, along with overall brain plasticity.

As with brexanolone, you have to take esketamine in the presence of a healthcare professional. Your doctor or clinician will give you a dose between 56–84 milligrams (mg), which you spray into your nostrils. You then relax in a chair for 2 hours. Your care team will monitor your blood pressure and heart rate during this time.

This medication works quickly, with many people noticing relief right away. Treatment requires multiple sessions, typically twice a week for the first 28 days and then spaced out over time. The effects usually last until your next dose.

Safety and side effects

In clinical trials, participants tended to report mild to moderate side effects. You may feel sleepy, dizzy, or a bit “out of it” during your treatment session. These side effects often go away within 90 minutes after you take your dose.

On rare occasions, people have reported more severe side effects like:

• vomiting
• anxiety and confusion
• worsening depression or suicidal thoughts

Esketamine can also lead to significant increases in blood pressure during the treatment session, which is why you’ll need monitoring for 2 hours. If you have hypertension or another vascular condition, make sure to tell your doctor before receiving treatment.

Consult with your physician, as using other anti-depressants as maintenance, in tandem with these newer treatments, are often necessary and effective.