In her 19 years at UNC, Dr. Samantha Meltzer-Brody has accomplished a lot. She is the founder and Director of the UNC Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders. She is the Ray M. Hayworth and Family Distinguished Professor of Mood and Anxiety Disorders. She served as the academic principal investigator of clinical trials for brexanolone, the first drug ever developed for women suffering from postpartum depression. Continuing with her unwavering dedication to women’s health and mental health in general, on October 1, 2019, she became the Assad Meymandi Distinguished Professor and Chair of the Department of Psychiatry. She is the first woman in the department’s history to hold this position.
Within this impressive portfolio, being able to serve women who suffer from postpartum depression is her biggest passion. “The birth of a child is such a profound time in a family’s life. Women are so vulnerable and even at its best, it can be hard. It is devastating for women suffering from severe postpartum depression and my greatest privilege is being able to work with women at such a pivotal time in their lives,” she says.
One in eight women who give birth will experience postpartum depression. Common symptoms of PPD – a mood disorder in women that may be triggered by fluctuations in reproductive hormones – include low mood, feeling overwhelmed, anxious and ruminating thoughts, potential withdrawal from her family and the baby, and suicidal thoughts in the most severe cases. The risk is higher for women who have experienced past trauma, live in poverty, or do not have social support. Dr. Meltzer-Brody has seen a huge shift with increased awareness of postpartum depression since she founded the UNC Perinatal Psychiatry Program in 2004, but the United States still lags behind other developed countries in supporting woman after giving birth. She is grateful that UNC seized the opportunity to lead the way in supporting maternity care. UNC Hospitals opened the first inpatient perinatal psychiatric unit in the United States in 2011—nearly 60 years after a similar unit opened in the United Kingdom.
The opening of this unit was pivotal in conducting clinical trials for what would become the first drug ever approved to treat postpartum depression.
Brexanolone works differently than existing anti-depressant medications. “With current anti-depressant SSRIs (selective serotonin reuptake inhibitors) it could take four to six weeks to get a treatment response,” said Meltzer-Brody. “The weeks and months following birth are a critical period for mother-infant bonding, so finding a fast-acting treatment is crucial for both mom and baby. In the trials, we saw patients starting to feel better within days.”
Women in the unit received a 60-hour IV infusion of brexanolone. The result was “unlike anything I had ever seen,” says Dr. Meltzer-Brody. In three days, women went from being profoundly depressed and completely withdrawn to eating, walking around, and interacting with their newborn child. “They went from a wilted flower to one reaching up for the shining sun,” she says.
The FDA approved brexanolone, now marketed as Zulresso, on March 19, 2019, and it became commercially available in June of this year. The pharmaceutical company that developed the drug, Sage Therapeutics, is now working on an oral drug with similar properties that might treat depression in both men and women. If it works, postpartum depression will have provided a roadmap for a deeper understanding of general depression.
Dr. Meltzer-Brody sees many more opportunities to expand the care and support for women experiencing postpartum depression. She dreams of creating a comprehensive follow-up program for those who leave the inpatient perinatal psychiatric unit, providing case management and social support that would augment clinical care for the women while also supporting their family members. Offering ongoing support like this requires funding for a position that would lead and deliver follow up programming. Given UNC’s proven leadership in maternal care, Meltzer-Brody knows she is in the right place to dream of programs like these—programs that she hopes will soon become a reality for the women and families suffering from postpartum depression.