Novel drug speeds up recovery for new mothers with disordered moods
A new service at Johns Hopkins offers a novel method to treat postpartum depression: administering a rapidly-acting intravenous medication in inpatient psychiatry units, where patients can benefit from related services.
The postpartum period is one of several instances in life (the others are premenstrually and perimenopause) when hormonal fluctuations can increase the risk for psychiatric complications, explains psychiatrist Lindsay Standeven, director of the Adult Inpatient Brexanolone Service, and clinical and education director of the Johns Hopkins Reproductive Mental Health Center.
“We aim for a three- to five-day length of stay, which is pretty outstanding given that some women spend years with an untreated postpartum depression.” — Lindsay Standeven
In 2019, brexanolone became the first medication approved by the Food and Drug Administration for treatment of postpartum depression. It is a synthetic version of a breakdown product (also known as a metabolite) of progesterone, Standeven says.
“Although the mechanism of action is not fully understood, the medication was developed from research suggesting that women who develop postpartum depression may be sensitive to the drop in progesterone and particularly one of its metabolites, called allopregnanolone,” she says.
“By giving it back to them through a synthetic version in an IV infusion that lasts 72 hours, we can treat postpartum depression quickly. Clinical studies have shown upward of 70% of women had remission of their depressive symptoms by the time of infusion completion, and many had significant reductions of symptoms within 24 hours of starting treatment.”
Instead of offering brexanolone on the maternity ward, as some medical centers do, the inpatient service at Johns Hopkins provides the treatment and related services through two psychiatric units. Patients receive a thorough psychiatric evaluation to assess postpartum depression and receive related services including social work and occupational therapy, Standeven says. Staff members ensure there is an appropriate follow-up plan at discharge. Also, patients found to have other conditions such as an underlying bipolar disorder or post-traumatic stress disorder — and who may not be eligible for brexanolone — can be managed for those concerns while inpatients, without waiting.
The goal is to achieve remission, or at least subclinical levels of depression, before discharge, says Standeven.
“We aim for success with a three- to five-day length of stay, which is pretty outstanding given that some women spend years with an untreated postpartum depression,” she says.
Brexanolone acts more quickly than the typical antidepressants used to manage postpartum depression, which can take up to six weeks to achieve complete benefits. Additionally, patients may need to try more than one agent to find the best fit, Standeven says. Brexanolone initially was considered expensive, but insurers now cover it more regularly. Patients may qualify for the treatment if their onset of depression symptoms was between 26 weeks of pregnancy and six weeks postpartum, and if they score a 10 or higher on the Edinburgh Postnatal Depression Scale.
Standeven did a two-year fellowship in reproductive psychiatry, following completion of a psychiatry residency at Johns Hopkins. Beyond the clinic, she plays a larger role in this growing field, serving on the educational board of the National Curriculum in Reproductive Psychiatry.