Postpartum Depression: Is Brexanolone the Answer?

“…if females can be induced to believe that their sufferings will be diminished, or shortened, and their lives and those of their offspring, be safer in the hands of the profession; there will be no further difficulty in establishing the universal practice of obstetrics. all the prejudices of the most ignorant and nervous female, all the innate and acquired feeling of delicacy so characteristic of the sex, will afford no obstacle to the employment of male practitioners.”

–Dr. Hugh L. Hodge 1838

In the 1940s, my grandmother birthed my mother under general anesthesia through a uterine incision that spanned from her breasts to her pubic bone. Crossing the threshold into new motherhood certainly wasn’t the empowering initiation to adulthood that it could have been. In fact, she had no meaningful narrative of the experience beyond the pain of recovery and the disorientation of a life-altering transition that she was not present for.

It would be comforting to imagine that we have made significant medical and cultural progress, that we have seen the error of our ways, and that our awkward memories of crude behavior are fading in the light of our refined sensibilities. It would also be comforting to dismiss the statistics that implicate American maternal and newborn care as being the most dangerous in the developed world. It would be comforting to trust our regulatory agencies, our doctors, and our hospitals to do the right thing when we need help.

This is, however, a distinctly uncomfortable time in human history.

And we have a choice — allow ourselves to be narcotized into somnolence, hearing, seeing, and speaking nothing of the trouble we sense, or shake off the fog and ring the alarms. I believe it is time for us to say ENOUGH. To ask why a woman is struggling, and to respond with a sincere cultural effort to meet her basic human needs before telling her she is broken and in need of medication.

The Realness of Postpartum Struggles

There is, perhaps, no despair more intolerable than the struggle of a new mother. A woman who, instead of ooing and ahhing at her soft, sweet-smelling newborn, is withdrawn, apathetic, or on edge, obsessively preoccupied with all that could go wrong. All those around her feel a reflexive need to help her — to make her okay, and to do something to make sure her infant is safe. This response is likely hard-wired into each and every one of us: Protect mothers. Protect children.

But what if the kind of help we are offering struggling new mothers is actually harming? What if there are variables outside of the realm of biology and chemistry that are disabling these women? Setting them up to fail?

One of the primary shortcomings of psychiatry is its seeming inability to acknowledge that anything is wrong with the way we are living. Instead, researchers and clinicians unwittingly collude with the reductionist perspective that there is something wrong with YOU. That you are broken, never mind the fact that we are living lives bereft of meaning, connection, and purpose, cogs in capitalistic machinery that is systematically destroying our planet.

Women today are mothering without the wisdom of generations before them, without the support of their female family, friends, and community. In fact, they are spending large swaths of time alone with their infants. It is likely, however, that a number of survivalist danger signals would be set off if a woman found herself alone with a baby. In fact, it’s likely that we are now setting historical precedent as a woman has likely never been left alone with a baby — without surrounding tribeswomen — in the history of humanity.

Something is indeed wrong, and postpartum depression, anxiety, and even psychosis may be a reflection of mismatch with diet, with chemical exposures, with psychospiritual support, and the unraveled communities that once held birth as a collective affair.

New Insight Into What We Are Calling Postpartum Depression

A 2017 study of postpartum depression¹ (a growing target for psychiatric antidepressant medication) illustrates why psychosocial resources, like self-esteem, optimism, gratitude, and forgiveness can be more profoundly effective than drugs… without the inherent risks.

Researchers from UCLA and Hope College looked at how religious and spiritual beliefs and behaviors influence mental health. Specifically, the study focused on postpartum depression, which affects as many as 20 percent of postpartum women. But this study, involving 2,399 postpartum women 18–40 years of age, confirmed what many women have intuitively understood for centuries. It revealed that religious beliefs and spirituality, offering psychosocial resources such as optimism, perceived control, and social support, predicted lower depressive symptoms throughout the entire first postpartum year.

To define whether women were more religious and spiritual, researchers applied the Fetzer Multidimensional Measurement of Religiousness/Spirituality for use in Health Research.² This tool uses a 16-item self-report measure, the Daily Spiritual Experience Scale (DSES), which has been used in more than 300 published studies. The DSES assesses personal experience of such things as gratitude, mercy, awe, inspiration, deep inner peace, connection with the transcendent, and compassionate love.³

Postpartum women who identified as religious and spiritual had significantly higher levels, for example, of mastery, optimism, and self-esteem. Attributes which facilitate everyday management of stress and promote long-term health. Not surprisingly, the presence of those resources predicted significantly lower symptoms of depression.

We need to feel meaning in order for suffering to end. We need to understand why. The absence of this inquiry is truly crazy-making.

Underlying Causes of Postpartum Depression

It is no measure of health to be well adjusted to a profoundly sick society.

– Jiddu Krishnamurti

The study adds to a growing body of work that establishes a link between spirituality and enhanced health and well-being, particularly with regard to depression. This may be especially relevant to postpartum depression, since childbirth so intimately and meaningfully relates to religious and spiritual beliefs and rituals. Our cultural ancestry, and the vital ways that positive, healthy components of it are absent in modern society, deserves a more prominent role in the treatment of postpartum depression.

That includes certain aspects of ancestral diet, versus today’s habitual model of processed, chemical-laced, nutrition-depleted factory food. Unfortunately, most research on pregnancy-related mood disorders doesn’t control for such key factors as metabolism, inflammation, diet, or routine exposure to environmental toxicants. The body is wired to express mismatch and disharmony. One of the most common ways this is expressed postpartum is through thyroid dysfunction and associated autoimmune diagnoses. Postpartum thyroiditis is common, and is likely, not coincidentally seated in the fifth chakra, the energetic center of self-expression. This diagnoses is also eminently reversible through lifestyle interventions from the physical to the spiritual.

Drugging our Mothers: Brexanolone for Postpartum Depression

As I wrote in a recent Instagram post:

Three trials (not a single long term), an unknown mechanism of action, and an increasing societal need to silence the sensitive women whose souls scream out NO when the veil is thinnest in the postpartum window = FDA-approved sedation for postpartum women. When women feel intensely, even if that experience is one of profound disconnection, IT IS FOR A REASON. That reason can range from physiologic imbalance like autoimmunity all the way to a felt expression of the wrongness of communities and tribes dismantled, leaving women alone to do the job that was once the collective’s. Drugging new mothers, what I myself specialized in during my conventional training, is a disturbing symptom of our struggle with feminine power and with the energy of emotions. Women have pain, they have fear, they have rage, and it is real, even if they collude in demanding that it be suppressed. There is a better way to put out the fire rather than simply trying to turn off the smoke alarm… especially when our next generation is in the house.

Conventional psychiatry has been unilaterally focused on pharmaceutical interventions, despite a conspicuous lack of high quality research to support this approach (including only three randomized, placebo controlled trials of antidepressants in the postpartum population and compelling evidence that antidepressants can actually accelerate what may be merely a temporary adjustment, sometimes into experiences of violence against self and infant).

One of the newest drugs rushed to market for the treatment of postpartum depression is called brexanolone. In September of 2017, brexanolone failed its clinical trial⁴ as a treatment for super-refractory status epilepticus, but just two months later, the drug was being touted as a cure for postpartum depression, gaining fast-track status from the FDA.⁵ That’s despite the fact that the more trials were conducted, and the larger the sample of women they tested became, the less statistical significance the drug’s effect showed… compared to an ordinary placebo.⁶ As one publication that tracks biotech for investors explained, “The data contain a few blemishes that, while unlikely to derail the drug, raise questions about the extent to which it will improve the lives of people with PPD and where its peak sales will top out.” If stockholders have concerns, women who are potential candidates for the drug should have even greater concerns.

In fact, according to the FDA briefing document: “Although the difference from placebo at Day 30 was not significant, it appears that the effect of brexanolone was maintained while the placebo group improved.” Yes, you read that correctly… placebo outperformed the sedative impact of an IV infusion after 60 hours, without side effects that include loss of consciousness.

After three randomized trials inclusive of only 247 women, the drug has been approved for the treatment of postpartum depression, with an unknown mechanism of action, a $20-50,000 treatment price tag, and unknown effects on breastfed infants. Because of the drug’s risk profile, women must receive the 60-hour infusion under medical supervision and “cannot function as her child(ren)’s primary caregiver.”

This is a means and a method, albeit unintentional, to unravel the fabric of a mother’s power, her intuition, and her in-built agency. Isolate a woman, pathologize her, disconnect her from her infant, drug her and she will spend the rest of her life a psychiatric patient dependent on the very system to which she unknowingly gave her power.

But when you know better, you do better. In the end, the matter of responding to struggle comes down to what you believe.

I stand, as someone who specialized in medicating pregnant and postpartum women because I thought that their symptoms were a problem. Now I stand for women who choose to believe, instead, in themselves. In the integrity of their body, mind, and spirit as messengers tapping, nudging, and demanding alignment, healing, and connection.

The pharmaceutical industry is preaching a different belief system, one that fails to recognize the relevance of context, the wisdom of ancients, and the meaning of symptoms to express mismatch and imbalance that is correctable. This drug-supportive dogma says that women should blindly accept the idea that a possible if not probable state of the body is emergent, inevitable disease… not wellness and self-determination. The more we buy into this modern fairy tale, the more it reinforces a false culture of fear that spreads like a virus and makes us all the more co-optable by the latest scare-tactic driving consumerism and industry-dependency.

Nurturing a Culture of Healthy, Natural Psychosocial Support

Studies like this one from UCLA and Hope College highlight the fact that when a woman experiences symptoms of postpartum depression, we should take a broader, more holistic view. That includes a thoughtful examination of her psychosocial and spiritual resources. A woman’s social environment and culture play a critical role in her overall health.⁷ But women today are constantly exposed to the fear-based, profit-driven culture of corporate pharmaceutical medicine.

In previous generations and societies, mothers were embraced by a cohesive, multilayered psychosocial and psychospiritual support network. Some cultures incorporate rituals that include preparing special food for preconception women, to physiologically prepare them for motherhood. But that gesture of healthy, intentional support also provides multiple levels of psychosocial security.

We’ve wandered off the path as a species. We are meaning-seeking beings and birth is an in-built form of initiation. Initiation to a woman’s innate power, and also to her greater connection in the web of being-ness, and perhaps even to cosmic energies. If she is struggling after this experience, it may very well be related to a thwarted birth experience, to lack of support and isolation, and to her body’s overwhelming stress.

The good news, highlighted by the recent study, is that women who are more in-tune with their spirituality and enjoy the support of a spiritually-minded community show fewer symptoms of postpartum depression. They also show significantly higher levels of optimism, self-esteem, and feelings of control over their lives… at a time so critical to the newborn’s healthy development.