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FDA Approves First Oral Treatment for Postpartum Depression

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Re: FDA Approves First Oral Treatment for Postpartum Depression

#211

Post by psychphysic »

habinero wrote: post #205
psychphysic wrote: post #200

Earlier quoted context omitted.

I dug into the FDA docs and relevant studies over the post few months. As far as I can tell that warning might be just boilerplate for antidepressants these days. Similarly for foetal harm it's on animal studies and they advice effective contraception for 1 week after last dose while they collect data.

The suicide warning for antidepressants is misleading. They don't cause it, but what happens is antidepressants start giving you more energy and more ability to function before it starts helping with mood. So if you're already suicidal, you can get the ability to act on it before you start getting relief from ideation.

Good points.

It's also worth remembering that many people do benefit very fast from SSRIs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211759/

The idea that improvement was endogenous or exogenous is itself important for that person's resilience and esteem. So I wonder if there is a bit of a white lie there?

Re: FDA Approves First Oral Treatment for Postpartum Depression

#212

Post by haldujai »

psychphysic wrote: post #206
xyzzy_plugh wrote: post #142

Since every top level comment here is a borderline tire fire, let me be the first to say: This is great news. We need better treatments for PPD, which is real and very serious that can cause long term lasting effects in serious cases without treatment, and can sadly even be fatal. Quality of life has risen steeply over the past several decades but mothers still walk an unpaved road. It's deeply worrying the lack of s…

> We need better treatments for PPD It was compared to placebo. People are rightly highly suspicious of Big Pharma. I like the idea of a novel class but I won't pay attention to this new, expensive drug until it proves significant efficacy over older cheaper drugs (like Alprazolam and Zolpidem/Zopiclone). Technically it's a Z-drug (like Zolpidem/Ambien) which are non-benzodiazapine positive allosteric modulators of G…

> People are rightly highly suspicious of Big Pharma.

Absolutely, but that should only trigger scrutiny which in this case would provide several answers for why this is a good thing and not a BigPharma scam.

> efficacy over older cheaper drugs (like Alprazolam and Zolpidem/Zopiclone).

This drug, and the IV formulation it is based on (Zulresso), are not the same as and have different mechanisms from sedative-hypnotics which as an aside are not indicated as monotherapy for PPD (or any depression, don't give a downer to someone down). The mainstay of treatment is SSRIs.

This class (which is the only FDA approved drug class for PPD) is an analogue of the endogenously produced metabolite of progesterone and the mechanism is not fully understood.

To your point of head to head trials, you are correct they do not exist at this time and will eventually be done however all of these are still new.

What we have right now are indirect comparative analyses which while limited show stronger magnitude effects than SSRIs.

https://www.frontiersin.org/articles/10.3389/fphar.2022.9500...

Re: FDA Approves First Oral Treatment for Postpartum Depression

#213

Post by xenadu02 »

gillytech wrote: post #81
yieldcrv wrote: post #59

Earlier quoted context omitted.

I'm actually curious about the AIDS one, which part is the lie out of curiosity? The existence of acquired immunodefiency from HIV? something else?

[flagged]

Almost none of what you've claimed is true.

There was a large gap between discovery of HIV in human populations, including people getting AIDS and dying of trivial infections due to their immune systems being wiped out. Once people started looking deeper it was also discovered that it was far from a "gay" disease. All of this happened before a single human tried AZT for an HIV infection.

Beyond all the scientific evidence we have real world Darwin Award trials: various HIV denialists infected with HIV have refused to take drugs to treat HIV and they have died. Others got very sick and were cured almost immediately after starting standard treatment.

We also have numerous clinical cases of people with undiagnosed HIV infections getting sick from common bacterial/fungal infections, get diagnosed as HIV positive, start the standard drug regimen, and their problems go away.

Not to mention SIV (the simian relative of HIV) causes an AIDS-like disease in some primate species which gives us both another line of direct evidence and almost certainly the original source of HIV.

You're just plain wrong.

We can squirt HIV in a dish and watch it kill the normally unkillable T cells. We know 100% what happens when your T cells collapse: your immune system stops working and some normally benign organism takes over your body then you die. We've sequenced HIV. We know how it mutates so rapidly. We know why it is able to attack T cells.

There is no mystery and no need for conspiracy. All lines of evidence point to HIV as the culprit.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#215

Post by Caligatio »

RcouF1uZ4gsC wrote: post #24

I wonder how much of post-party depression is caused by isolation. In the past, new mothers were surrounded by a whole village of women who would help care for the woman and the baby. Many times now, women are isolated with maybe the father present. And even then there are pressures to get back to work. This isn’t to discount or minimize postpartum depression, but if we as a society set up people for failure which re…

Without any data, I suspect the incidence rate of PPD is unaffected by social factors but having a support system definitely helps mitigate the effects on the family (i.e. more hands to help with the baby). Fortunately my family has never had to deal with it but it's definitely not some minor illness for people.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#216

Post by ShivTheShiv »

zpeti wrote: post #193
mtlmtlmtlmtl wrote: post #177

Earlier quoted context omitted.

Look. It's not some earth shattering revelation that "SSRIs don't work for many people". This has been known since SSRIs first appeared on the scene. This is also true of any other treatment you can think of. The reason they became the first choice as far as antidepressants go is they were a lot safer and better tolerated than the older alternatives. Besides, there's a lot more to psychiatry than just SSRIs. But with…

I agree with you, but what we are arguing about is how much, and when? Looking at how many people are medicating for mental health issues in the west (or world), I find it extremely unlikely this is because all these people have gone through therapy, exercise and diet and they have to take medication. No. It’s the easy route to some sort of medicated happiness, and it’s profitable, so everyone does it. But this many…

This particular drug is about post partum depression. Sleep deprived women, often functioning as milk machines, while experiencing major hormonal changes and possibly recovering from major abdominal surgery. These are not people “taking the easy route”. Save the bootstraps talk for other patients.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#217

Post by maxbond »

gillytech wrote: post #182
maxbond wrote: post #79

Earlier quoted context omitted.

You've failed to demonstrate that this is authoritarian. And I haven't criticized you for criticizing the FDA. I've criticized you for defending your position with misinformation, and for deploying marginalized people as a smokescreen. If your best rebuttal is to put words in my mouth and frame my criticism as censorious, it's time to reevaluate. It's a form of motte-and-bailey argument, you've abandoned your positio…

Marginalized people? What are you talking about? The first cases of AIDS was identified in homosexuals. That's a fact. My position is not that there have been no breakthroughs in the treatment of HIV at all. My argument is that HIV does not cause AIDS. When you don't have empirical evidence to support your fake claim that HIV causes aids then yeah, you need to go authoritarian. Hence endless government and para-gover…

> What are you talking about?

The LGBTQ community doesn't at all benefit from you spreading misinformation about HIV. You are using their marginalization to your unrelated rhetorical ends, because for whatever reason you have a gripe with the FDA. That's messed up.

> My position is not that there have been no breakthroughs in the treatment of HIV at all.

That's rather at odds with this statement you made:

> It's a multibillion dollar industry and 0 progress in the treatment of AIDS for decades.

https://news.ycombinator.com/item?id=37057238

"At all" is a goalpost you've introduced, but the difference between "at all" and "for decades" is negligible at any rate.

> When you don't have empirical evidence to support your fake claim that HIV causes aids then yeah, you need to go authoritarian.

I think it's interesting that you say that, when you haven't responded to the specific and factual claims made by 'kstrauser (https://news.ycombinator.com/item?id=37057357). 'kstrauser, I will readily admit, made the superior argument to mine, and responded more directly to your empirical claims.

If the empirical evidence is on your side, I have a hard time understanding why you're talking to me and not them.

> When your argument is built on BS you need to argue at the upper levels and never look at the foundation.

It's been my experience that people with BS arguments are likely to gish gallop between incredibly narrow and specific claims, which are often true or half true, and broad sweeping generalizations. This gives the impression of supporting the generalizations, but when they're placed in the proper context it becomes clear they are massive leaps.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#218

Post by psychphysic »

haldujai wrote: post #212
psychphysic wrote: post #206

Earlier quoted context omitted.

> We need better treatments for PPD It was compared to placebo. People are rightly highly suspicious of Big Pharma. I like the idea of a novel class but I won't pay attention to this new, expensive drug until it proves significant efficacy over older cheaper drugs (like Alprazolam and Zolpidem/Zopiclone). Technically it's a Z-drug (like Zolpidem/Ambien) which are non-benzodiazapine positive allosteric modulators of G…

> People are rightly highly suspicious of Big Pharma. Absolutely, but that should only trigger scrutiny which in this case would provide several answers for why this is a good thing and not a BigPharma scam. > efficacy over older cheaper drugs (like Alprazolam and Zolpidem/Zopiclone). This drug, and the IV formulation it is based on (Zulresso), are not the same as and have different mechanisms from sedative-hypnotics…

I don't think we disagree the more arrows in a quiver the better.

But the network meta analysis did not show zuranolone beating placebo due to wide effect size.

I'm old enough to remember the studies in the 90s where we so the saw the same thing with benzos and TCAs and SSRIs.

Alprazolam beats SSRI for depression with significant anxiety and insomnia with faster onset but treatment must be time limited.

That's uncanny to me esp as both are PAM for GabaA

Re: FDA Approves First Oral Treatment for Postpartum Depression

#219

Post by maxbond »

dna_polymerase wrote: post #199
gillytech wrote: post #182

Earlier quoted context omitted.

Marginalized people? What are you talking about? The first cases of AIDS was identified in homosexuals. That's a fact. My position is not that there have been no breakthroughs in the treatment of HIV at all. My argument is that HIV does not cause AIDS. When you don't have empirical evidence to support your fake claim that HIV causes aids then yeah, you need to go authoritarian. Hence endless government and para-gover…

You used the r-word. You come here with claims that go against the status quo and provide zero evidence to support your claims. Just admit it, you don't like gay people. No need for this idiotic 'AIDS is fake' charade.

This is too far a leap, that haven't said anything overtly homophobic. It's likely they aren't homophobic, who knows.

When we make leaps like this we risk the conversation devolving into something where the germane criticisms are lost. It's a lot easier to critique their position and rhetoric than to interrogate the content of their soul, and they will always have the home court advantage there.

I'm not the rhetoric police, but that is my advice.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#220

Post by heavyset_go »

rysertio wrote: post #137
01100011 wrote: post #3

https://en.wikipedia.org/wiki/Zuranolone "An orally active inhibitory pregnane neurosteroid, zuranolone acts as a positive allosteric modulator of the GABAA receptor." Interesting. I was expecting another SSRI or something similar.

Benzos directly hammer on GABA receptors while pregnanes use G coupled progesterone receptors to transduct signals to the GABA system.

Benzos attach to the benzodiazepine subunits on GABA receptors, and according to this paper[1], neurosteroids like this one also attach to similar subunits on GABA receptors[2]. Both act as positive allosteric modulators when activating their respective subunits on GABA receptors.

This cited paper[3] also tested similar neurosteroids in progesterone receptor knockout mice and still found anxiolytic effects.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139029

[2] See Figure 3A in [1]

[3] https://pubmed.ncbi.nlm.nih.gov/15617723

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