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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

#231

Post by Traubenfuchs »

psychphysic wrote: post #196
Traubenfuchs wrote: post #162

Does a positive allosteric modulator of the GABAa receptor cause addiction the same way any old GABA agonist does? I love GABA agonists from benzos, benzo likes to phenibut and really wonder how it feels. If it feels the same way, then it feels like being wrapped in comfortable cotton, with all worries gone -heaven on earth. Hence the extreme addiction risk.

Note that benzos and Z-drugs are indeed positive allosteric modulators of GABA_A. So one would assume so. The risks are reduced due to it being event related treatment (delivery) and time limited license (14days). Alprazolam similarly has antidepressants effects and similar might work for PPD given its insomnia/anxiety predominant features. FDA approved it based on placebo studies as there are no licensed pills for P…

> Note that benzos and Z-drugs are indeed positive allosteric modulators of GABA_A.

I tried to read up on it but I am left utterly confused. Are benzos and z-drugs GABA agonists, GABA positive allosteric modulators or both?

Re: FDA Approves First Oral Treatment for Postpartum Depression

#232

Post by zrail »

zpeti wrote: post #222
ShivTheShiv wrote: post #216

Earlier quoted context omitted.

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.

Sorry, but no. I have two children. I as a father probably had mild PPD, and so did my wife after our second child. You know why my wife had PPD? Because being a mother is hard, and she also had a lot of unresolved anger and issues towards her own mother, and she was reminding herself of her own mother and causing quite a bit of anxiety. We were also at an extremely difficult part of our relationship, we basically ha…

Different people have different experiences. Some people don't experience PPD or PPA at all. For many people PPD and/or PPA are significantly harder than what you experienced, and for a tragically high number it can be fatal for them and sometimes for others, including children and other family members.

You and your spouse have had your experiences which are completely valid and true. Your truth does not invalidate others' truth. This medicine is for them, not you.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#233

Post by haldujai »

amanaplanacanal wrote: post #227
zpeti wrote: post #222

Earlier quoted context omitted.

Sorry, but no. I have two children. I as a father probably had mild PPD, and so did my wife after our second child. You know why my wife had PPD? Because being a mother is hard, and she also had a lot of unresolved anger and issues towards her own mother, and she was reminding herself of her own mother and causing quite a bit of anxiety. We were also at an extremely difficult part of our relationship, we basically ha…

The resources to send everybody to therapy simply don’t exist. There aren’t enough therapists, nor money to pay them, for what you are suggesting. People aren’t taking the easy way out, they are taking the only path available.

As GP may be aware therapy is recommended first-line either in isolation or combination with pharmacotherapy for every type of depression.

To further illustrate the accessibility point when I lived in Canada therapy was not covered by the public health system and is entirely out of pocket.

In the US it obviously depends on the highly variable coinsurance/copay and assumes you can either take time off work or find a provider that works outside of business hours.

A 30-day supply of Lexapro is $4.50 and also has evidence that it works.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#234

Post by serf »

mtlmtlmtlmtl wrote: post #150
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…

Thank you. I'll never understand why there's such a dominance of luddite thinking, bad takes and conspiracy theories on HN, when it comes to the topic of mental health. Especially when it comes to drug treatments. Psychiatry no doubt has a lot of problems with it. But it's also the only game in town for a huge amount of people. What's the alternative? Prayer circles? Ayahuasca tourist traps? Cannabis? Homeopathy? Giv…

>What's the alternative? Prayer circles? Ayahuasca tourist traps? Cannabis? Homeopathy? Give me a break.

PPD aside, if we're talking about the issues that psychiatry seeks to alleviate, every one of those 'solutions' has had thousands of advocates/adherents/patients that claim to have gained positive effect.

and before I get considered a proponent of any of those; i'm not -- but I recognize the cohort of people who claim to have gained benefit just as I recognize the group who claim to have benefited from psychiatry.

mental health needs not be a monopoly; many people go through issues that they fix through specific personal events or patterns that are specific only to them.

You can complain about the style of thinking that you encounter on HN without disparaging the things that have helped people outside of clinical settings.

Mental health and well-being is one of the most mysterious things that we study, if a suicide or otherwise bad decision is staved off by chanting in makeup and visiting exotic locations then so be it, that's what worked for them.

And another aside : psychiatry will never incorporate extreme things that may help certain individuals, nor should they -- but that means that the breadth of things that are helpful is greater than the breadth of things that will ever fall within the umbrella of clinical mental health; so you should probably hold off on judging things based on whether or not the industry has adopted them.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#235

Post by psychphysic »

Traubenfuchs wrote: post #231
psychphysic wrote: post #196

Earlier quoted context omitted.

Note that benzos and Z-drugs are indeed positive allosteric modulators of GABA_A. So one would assume so. The risks are reduced due to it being event related treatment (delivery) and time limited license (14days). Alprazolam similarly has antidepressants effects and similar might work for PPD given its insomnia/anxiety predominant features. FDA approved it based on placebo studies as there are no licensed pills for P…

> Note that benzos and Z-drugs are indeed positive allosteric modulators of GABA_A. I tried to read up on it but I am left utterly confused. Are benzos and z-drugs GABA agonists, GABA positive allosteric modulators or both?

It's not your fault the terminology is used loosely especially as it can take time to fully characterise the action.

Benzos and Z-drugs are considered PAMs, it's possible some have some intrinsic activity but otherwise they simply potentiate other agonists.

The big benefit here is that they are far less likely to cause death when taken alone.

The confusion is that any positive effect is typically called agonist and any negative effect called an antagonist when discussed informally.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#236

Post by happytiger »

This is fantastic. Anything that helps folks through postpartum depression will save lives — if you’ve never seen it in person or experienced it yourself you can’t understand how intense this stuff is.

The standard or care is education and it’s… well… well intentioned but deeply insufficient sometimes.

I’m so happy to see some additional treatments.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#237

Post by Sakos »

flangola7 wrote: post #209
zpeti wrote: post #165

Earlier quoted context omitted.

It’s very easy to explain. By going straight to medication you are treating the symptom not the cause. And you don’t even know if it works. SSRIs don’t work for many people and we only found out 2-3 years ago. Opioids were prescribed to half of America for back pain. That gives scope for healthy scepticisms at least. Just because you might have some anecdotal evidence of some chemicals working, doesn’t mean it works…

While I agree there are often additional deeper causes, picking up a prescription will begin faster than waiting for capitalism to be done away with.

Shit, I needed SSRIs before I was in any way capable of processing and dealing with my internal issues. I wasted a decade before giving in and trying the SSRI route and I regret not doing it sooner. It would've saved me and my loved ones a lot of suffering.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#239

Post by psychphysic »

haldujai wrote: post #225
psychphysic wrote: post #218

Earlier quoted context omitted.

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 uncann…

> But the network meta analysis did not show zuranolone beating placebo due to wide effect size. It did not, using 1 of the studies, but my optimism is that the drug it was based on (brexanolone) was significant and is unfortunately only available IV (so difficult to access and expensive), so the hope is that this will play out similarly and why I feel is sufficient reason to give Big Pharma the benefit of the doubt…

Agreed time will tell.

Re: FDA Approves First Oral Treatment for Postpartum Depression

#240

Post by refurb »

flangola7 wrote: post #214
refurb wrote: post #130

Earlier quoted context omitted.

Government should pay me 100% of wages for 18 years!

Why do you think that was an acceptable comment to make? Read the room.

Isn’t that the ideal? Not letting work interfere with raising your kid?
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