One in eight American moms experience postpartum depression (PPD), a potentially debilitating condition marked by feelings of despondency, lethargy, emptiness and disinterest after giving birth. Some women also report memory problems and trouble bonding with their babies. In Virginia, over 11% of mothers surveyed by the U.S. Centers for Disease Control and Prevention in 2021 reported PPD symptoms. 

The first oral medication to treat postpartum depression, approved by the U.S. Food and Drug Administration last year and made available in speciality pharmacies in December, is a new tool to combat the common yet underreported problem.

“PPD is the most common complication of childbirth occurring in about 10 to 15% of all pregnancies, with higher rates in women with a preexisting mood disorder like major depression or bipolar disorder,” explained Dr. Jennifer Payne, a reproductive psychiatrist, professor and vice chair of research in the University of Virginia’s Department of Psychiatry and Neurobehavioral Sciences. 

PPD isn’t just just feeling sad; it can contribute to serious behavioral health challenges for women that are sometimes deadly. 

“Mental health conditions including suicide and substance abuse remain the leading cause of maternal mortality during and after pregnancy, and PPD is a key player in that statistic,” said Payne.

Study shows sharp increases in maternal deaths over two decades

More than mothers are affected. Babies of mothers experiencing PPD may also have lower IQ, delayed language development and psychological problems.

While the clinical description of PPD sounds scary, the reality of living through the experience is terrifying. I was diagnosed with PPD six weeks after the birth of my first baby. To this day, my memory of those early days is clouded, and I regret what I simply can’t recall due to the illness; what I can almost makes me shudder.

What I remember most clearly are not the newborn snuggles and blissful bonding with the tiny human I’d grown inside my body and brought into the world in a torrent of the most severe pain and complete joy I’d ever experienced. Instead, I recall the utter exhaustion, our disorientingly blended days and nights, and the sinking feeling that I was already failing my child, whom I was sure deserved a better, more capable mama. 

A voracious reader since my elementary school days, I lost all interest in books and didn’t read any of the novels I’d stockpiled throughout my pregnancy. I withdrew from my family, even my husband, somehow convinced that I should be able to care for my baby with as little assistance as possible. I anxiously counted down the days until my maternity leave was up and cried more than I ever had; my son’s little face was often wet with my tears and his.

My OB-GYN pinpointed the problem as PPD and prescribed an antidepressant pill, though not one designed specifically for postpartum depression and anxiety. The medication took a while to fully integrate into my system and start working: Although I gave birth in January, it wasn’t until mid-May that I started to feel like myself again. Had the newly approved PPD pill, zuranolone, been available then, it could have saved me months of struggle.

“Unlike standard antidepressant treatments, zuranolone has a very quick response — most women taking it for PPD have responses as early as three days after starting the medication,” Payne told me. “This is far faster than standard antidepressant treatments, which take weeks to even months to initiate response.” 

Not all mothers with PPD may be able to access the new treatment, as the cost — $15,900 per 14-day course without insurance — could be prohibitive, especially for low-income families or those without insurance or access to health care. (For Virginia families who need it, the state offers the FAMIS MOMS program, which provides prenatal care to uninsured pregnant mothers who aren’t eligible for Medicaid up to a year after birth.) Sage Therapeutics and Biogen, the drug’s creators, offer financial assistance programs to help offset the hefty cost, but terms and conditions apply and not all mothers may be eligible.

It’s unclear exactly how many providers in Virginia have prescribed zuranolone (known commercially as Zurzuevae) or which medical facilities offer it, since it so recently became available. Payne said the drug will “absolutely be available through the UVA Perinatal Mental Health Clinic,” and hopefully, other institutions in the state will follow suit. 

Beyond medication, there are also legislative efforts underway now in Virginia’s General Assembly session to boost awareness of PPD and other maternal health issues women in Virginia experience. One such measure is freshman Democratic Del. Destiny LeVere Bolling’s House Bill 935, which would require insurance companies to cover state-certified doula care for pregnant people. The same measure failed in last year’s session, when lawmakers rejected the bills and instead ordered a state study of mandated health insurance benefits.  Virginia Medicaid currently covers doula care.

Doulas — trained workers who provide non clinical support and guidance to moms before, during and after pregnancy — have been found in studies to reduce rates of postpartum depression and anxiety in mothers by as much as 57.5%.

Birthing while black: African-American women face disproportionate risks during pregnancy

Bolling is also carrying House Joint Resolution 44, seeking to designate April 11 through April 17 of each year as Black Maternal Health Week in Virginia. Not only are Black women in Virginia twice as likely to die during or after childbirth than white women, but nationally, Black women are less likely to receive proper treatment for PPD. Bolling’s bills are as timely for the public good as they are personal for her. 

“A large portion of my district is African American (48.2%) and, of those, the majority are women, making this a key concern for the people of my district,” Bolling, whose District 80 spans Henrico County, wrote to me in an email. Additionally, she experienced PPD after losing her first son, Noah, who was delivered stillborn at 19 weeks and two days. 

Additionally, “I have since miscarried during the holidays before the General Assembly session began,” she wrote.

I can’t imagine wrestling with PPD and grieving my infant simultaneously; few would want to. But I can understand exactly why maternal-related policy is a priority for her.

Bolling believes that the new PPD pill “can be an important tool in helping support the maternal health efforts in Virginia” but — correctly, in my view — thinks other measures are needed to alleviate maternal health issues statewide. Take it from me, a mother of three and a PPD survivor: Medication is nice, but guaranteed paid maternity leave and more compassion for mothers in the workplace would be even better. 

Prescriptions can blunt PPD, but so could expanded, affordable child care options for Virginia families. Zurzuevae might be an excellent aid to childbearers; so too are doulas, and every mother should have access to their services (my third pregnancy and birth experiences were amazing, thanks in large part to my equally amazing doula).

There is no magic pill that can cure PPD or other maternal health challenges. Instead, we must use what we have — namely, the creation and implementation of sound public policy, coupled with continued societal support  — to birth a better future for moms and children, which means a better future for all of us.