Post-Partum Depression
We know the cause. We can anticipate PPD and at least, minimise it: let's do it!
I did a post on this subject on 11/16/23: the present note is by way of an update, (hopefully) more succinct and of greater clarity, presenting an easier “read”.
Back on November 08, 2023, Medscape News sent me a report by Khushi Mandowara, to the effect that a new pill named Zurzuvae, designed by Biogen-Sage Therapeutics, is available for treating Postpartum Depression.
It seems that Zurzuvae works very well, but the cost for a 14 day treatment will be $15,900 and the treatment may need to be repeated, for a further two weeks!
Background:
In pregnancy, maternal hormone production goes into overdrive: not only are Estradiol (the main Estrogen), Estriol (the most important estrogen during pregnancy) and Progesterone (the “pregnancy hormone”) increased: there is increased DHEA, Testosterone, Thyroxine and particularly, Allopregnanolone, which is derived from Progesterone.
Production of all these hormones begins to fall a couple of days before, and “bottoms out” just after, childbirth. The result for the mother is a sudden, acute hormone deficiency, which may be transient, may persist for a day or two, or may linger, with deficiency of one or more hormones.
Most women, delighted with the delivery of a healthy baby and buoyed by the long-awaited completion of the painful and stressful process which is childbirth, are joyful, although physically exhausted. However some mothers (a significant percentage) become psychologically distressed, to the point of depression.
The incidence of Postpartum depression (PPD) is amazingly variable: according to Ayan Myssayev et al., reporting from the town of Semey in Kazakhstan, the worldwide rate is between 0.5 and 63%! The US rate is approximately 1/10 overall, but is higher, unsurprisingly, among the poor and disadvantaged, those with a prior history of anxiety and/or depression and those subject to adverse environmental conditions, such as air pollution*.
PPD Is due to Allopregnanolone deficiency, and is related to stress. It occurs more frequently when the mother has been anxious, apprehensive, frankly depressed or significantly stressed, during the pregnancy. It is sometimes mild and transient; but often becomes chronic and severe enough to be termed “psychosis”: suicide and infanticide are significant risks. It may begin soon after childbirth, may present In the first few days, or may appear at some point within 12 months following the Birth.
Since the mother goes home within 24 – 48 hours of delivery, the diagnosis is missed in up to 50% of delayed-onset cases.
Treatment with Allopregnanolone relieves PPD quickly, but Allopregnanolone is extraordinarily expensive, only available in very small quantities and must be given intravenously. A synthetic Allopregnanolone, Zulresso, Sage therapeutics’ original product, works well; but it too is an intravenous medication.
Therefore from the standpoint of the Allopathic physician, Biogen-Sage’s “Zurzuvae” is a welcome addition to our drug armamentarium. However it will cost US$15,900, for a 2 week treatment, which may need to be repeated.
Hey, wait a minute!
US$15,900, (C$21,000 940.81) for 14 pills, “repeated”? Surely, there must be an inexpensive workaround!
Couldn’t we anticipate, and prevent, PPD?
If low Allopregnanolone is the cause of PPD, maybe could we simply prevent Allopregnanolone deficiency?
We know that there are production aberrations of multiple hormones just before, and during, childbirth: the active hormones, DHEA, Thyroid 3 (T3), Testosterone, Estrogen, Progesterone and Allopregnanolone all go down, while Cortisol goes up. So why not test mothers for hormone balance, in labour?
Let’s have a look at the hormones – first, how the “steroids” are made from cholesterol, then we’ll consider the hormones, one by one and Finally, we’ll put the whole thing together and figure out how to solve the PPD problem.
