Monday, August 7, 2023

By Don Sapatkin

Good Monday morning! In today’s Daily: The first pill to treat postpartum depression wins FDA approval. Around the country, teens are left to detox cold turkey after ERs reverse their overdoses. Families hire private detectives to find their homeless, mentally ill adult children. And psychiatrists prescribe a popular obesity drug to treat weight gain caused by psychiatric meds. Plus: Petting a dog – even your neighbor’s – can boost your mental health.

FDA approves a pill for postpartum depression

The FDA approved the first pill to treat postpartum depression, a common and debilitating condition that can be accompanied by deep anxiety, difficulty sleeping, suicidal thoughts and shame, the New York Times reported. It can prevent new mothers from appropriately nurturing and bonding with their newborns.

Zuranolone, to be sold as Zurzuvae by Sage Therapeutics and Biogen, takes effect in about three days compared with the two weeks typical of most antidepressants, and is taken for just two weeks. Postpartum depression afflicts 10% to 15% of women a year in the U.S. but is substantially under-recognized. Experts think a medication marketed specifically for the condition and taken for just two weeks might be more acceptable to women who don’t seek help for fear of being stigmatized.

Data from two company-funded clinical trials – just 350 patients followed for 45 days – found that 72% of women in one trial and 57% in the other experienced a 50% or greater improvement in a standard depression measure after two weeks without the withdrawal symptoms common with other antidepressants. The FDA said the most common side effects include drowsiness, dizziness, diarrhea, and urinary tract infection, and that use could cause suicidal thoughts and behavior. No price has been announced.

Other mental health problems also affect new moms. About one in five in the U.S. – the most dangerous high-income nation in which to give birth – suffer from mood and anxiety disorders during pregnancy and for up to a year after, according to a Wall Street Journal story, The Tragedy of Being a New Mom in America. “Obstetricians may not take ownership. Pediatricians may not take ownership. Psychiatrists may not take ownership,” Joy Burkhard, founder of the nonprofit Policy Center for Maternal Mental Health, told the Journal. “All of them are punting the mother to each other, and moms fall through the cracks.”

Teens with addiction left to detox on their own

Overdosing teenagers who are transported to emergency rooms usually receive the opioid-reversal drug naloxone and are discharged with a list of providers to call for follow-up care. But many don’t call and soon begin suffering from withdrawal – and cravings drugs to relieve their agony. Even if they seek help, most treatment centers don’t offer detox, so many go back to opioids, hoping their next OD won’t be fatal, KFF Health News reported.

Facilities that offer medically managed withdrawal for patients under 18 are lacking in most areas of the U.S,, a recent study found. “I’ve been doing adolescent substance treatment here in Denver for 20 years,” said Christian Thurstone, director of Denver Hospital’s behavioral health services. “I wouldn’t know where to send somebody for adolescent detox.” After several former patients died of fentanyl overdoses, Denver Health recently opened what officials believe is the nation’s first adolescent inpatient detox unit.

Desperate families pay private contractors to find adult children living on the street

Vicki Lucas is part private investigator and part street clinician and calls herself a crisis interventionist. Families whose adult children are homeless, mentally ill or addicted – often all three – and can afford to pay thousands of dollars for her services hire her to search the streets and get their loved one into treatment. 

The LA Times followed Lucas as she searched for a 52-year-old woman who years ago deteriorated into a street life of addiction and untreated mental illness – but could not be held against her will under California law. Lucas is largely self-taught and believes her experience as a recovering addict makes her effective. She works with 140 private contractors around the country who assist her on two to three interventions a week. She does what it takes to help desperate families – exchanging cash or cigarettes for information, tricking people to go to a hospital for treatment. Success is far from guaranteed.

No one tracks the numbers of “crisis interventionists.” The L.A. Times interviewed five – two of whom declined to be identified – and described it as an emerging field. But the need is great: More than 120,000 adults in California were admitted to psychiatric facilities for evaluation and treatment in the 2020-21 fiscal year, according to state statistics, and 72,000 were released after 72 hours. Thirty-day holds were authorized for only 3,300.

“When I see people who are addicted to drugs and out of their minds, I feel like they don’t have the ability to make good choices,” Lucas said. “This is why they are where they are, and it’s my responsibility to get them in a safe place, get them stabilized and then talk to them about their choices.” 

Doctors prescribe obesity drugs for weight gain caused by psych meds

Interest in the new class of weight-loss drugs that includes Ozempic, Wegovy and Mounjaro is soaring, according to a Kaiser Family Foundation poll published Friday. Seven in 10 adults have heard about them and nearly half said they’d be interested in safe and effective weight-loss drugs – although those numbers plummet if the drug must be self-injected or isn’t covered by insurance. 

Psychiatrists are increasingly prescribing Wegovy to patients whose medications for conditions like schizophrenia and bipolar disorder cause them to gain weight, Reuters reported. Weight gain is one reason patients say they discontinue their meds, and it can raise the risk for diabetes and heart disease, the No. 1 cause of death for adults with schizophrenia. Yet some psychiatrists said their prescriptions were rejected by insurance plans. And Wegovy’s popularity can make it hard to find.

The clinical trials that led to Wegovy’s approval excluded psychiatric patients, a common practice in drug development, and the FDA cautioned prescribers to monitor patients for depression and suicidal thoughts. Psychiatrists told Reuters they found Wegovy to be helpful to their patients – one suggested it be prescribed alongside the psychiatric drugs even before a patient gains weight. But psychiatrists specializing in eating disorders worry it could worsen their anorexic patients’ focus on weight loss.

In other news

Pet a dog – any dog – and it may boost your mental health.

Mounting evidence shows that cortisol, a key stress hormone, drop in people after 5 to 20 minutes interacting with dogs, Nancy Gee, director of the Center for Human-Animal Interaction at Virginia Commonwealth University, told NPR.

Levels of oxytocin, the “love hormone” that promotes mother-baby bonding before and after childbirth, rise as well. (Bonus effect: Oxytocin increases in dogs when they interact with humans, too.)

Sexual minority women were more likely to be screened for depression during postpartum care than heterosexual women – and far more likely to screen positive for depression, according to a retrospective study of 18,234 women who gave birth at an academic medical center in Chicago in 2019. Just 1.5% of them were identified in the medical records as having sexual minority status, which the authors of the JAMA Psychiatry research article defined as “including women who identify as lesbian, bisexual, queer, pansexual, asexual, demisexual, and kinky as well as other-identified women who have sex with women.” Besides their finding that rates of postpartum depression were unusually high among this group, the authors highlighted the need for developing measures of sexual orientation “because reliance on medical record review has substantial limitations” for research.

Therapy 15 months after bariatric surgery reduced rates of  disordered eating and psychological stress that can accompany regained weight, a multi-state study in JAMA Network Open found. The 152 patients who received six weekly, hourlong cognitive behavioral therapy sessions by phone – plus one “booster” session a month later – scored significantly lower on measures of disordered eating and psychological stress than the 154 controls who received standard post-op care. There was no difference in weight gain between the randomized groups.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...