Dr Rachel Dalthorp Details Her Approach to Closing Gaps in Postpartum Mental Health Care

Rachel Dalthorp, MD, executive medical director of specialty services, LifeStance Health, discusses how the barriers to care for postpartum depression (PPD) can be addressed now that zuranolone (Zurzuvae; Sage Therapeutics/Biogen), the first oral FDA-approved treatment for PPD, has been on the market for months.

This transcript has been lightly edited for clarity.

Transcript

What have you noticed in relation to the trends of patients seeking and accessing care for postpartum depression?

We have a big problem: for every 20 moms with PPD, only 1 is going to be identified and treated to remission. That's only 5%. So, 95% of moms—and keep in mind, this is 1 out of every 5 pregnancies—are not going to get the treatment that they need. So, we have a lot of work to do. I think as prescribers become comfortable with this medication, as they see how easy it is to prescribe, I think that they'll kind of adapt it into their day-to-day operations with their patients, and treatment planning, and discussions of how to treat.

What we have found with our patients is they can meet criteria fairly easily if they have depression, and we haven't had insurance companies that are saying no, because it's the only FDA-approved medicine, I think that's part of it. The medication—we send a prescription to a specialty pharmacy, and we haven't had any barriers in terms of getting that medicine to moms. The pharmacists we've worked with are great; they actually mail the medication directly to mom at home, and then she's able to take that. It's a 14-day course; we recommend our moms take it in the evening, and they need to take it with a meal that's a certain number of calories and about 50% fat for absorption. And then they need to make sure that they're not driving for at least 12 hours.

But we've seen within about 3 days, these moms start to feel better. And I've always been excited about this type of medicine, because while it's not FDA approved for anxiety, we see so many moms who have depression and anxiety, and we see a great benefit for their anxiety in addition to their depression. So all in all, I think it's easier to access for patients. It's effective, it's rapid acting. And you know, for our health care system, it's less expensive than the prior medicine that required that 60-hour infusion in a monitored setting. So, it's really a win for everyone and I hope we dramatically see increased access and adoption of this medicine for patients.

What are the next steps to addressing the gaps in care for patients seeking treatment for postpartum depression?

Yeah, so I think there's 2 things. We have to continue to talk about PPD and decrease stigma—that's number 1. The second thing is we need to remove barriers for access to care, and in my mind, there's 2 ways to do that. We need to get these moms even when they're pregnant; we need to start taking the time to talk about this to educate and be prepared and watching for it. And then schedule patients who are at risk 2 weeks postpartum, right? So, at 2 weeks postpartum, if they didn't develop depression during that third trimester, we might catch them. It's not going to be the baby blues if they're still having issues. And that's the time that we can rapidly get them started on treatment in the OB [obstetrics] office. And that really starts with talking about it, decreasing stigma in the office, and screening.

The second thing we need to think about is getting creative in how we provide access to care for moms. One of the great things about telehealth is it's really easy for moms to utilize it. So if you have a newborn, it's difficult to get out, right? You have to pack a bag you have to worry about diapers and formula, or where are you going to breastfeed the baby. And so with telehealth, it removes that barrier of getting out of the house and makes it really easy for moms to connect with someone and get treatment for their mental health. So, those are the 3 things: stigma, access in the OB office, and then utilizing telehealth to improve access as well.