Postpartum Depression Fix

At Utah’s drug utilization review board last month the committee had a fascinating discussion about how to improve access to an oral drug used to treat postpartum depression. There have been growing reports of rising incidence of postpartum, including a jump in hospitalizations in states like Utah, where the postpartum rate (~15% of moms) is slightly above the national average.

Utah's pregnancy-associated mortality ratio is approximately 46.2 deaths per 100,000 live births and an estimated seven out of 10 of these maternal deaths are often related to postpartum factors.

Sharon Weinstein, MD, asked if requiring PCPs to get a psychiatrist consult before prescribing the drug Zurzuvae would hinder access. Jennifer Brinton, MD, agreed that PCPs ought to be on the list of physicians able to request the medication. Primary care may not have time to consult with a psychiatrist, and the medication is “more preferred for treatment due to its rapid onset, which is great for treating severe postpartum depression,” according to Susan Siegfreid, MD. Most of the hospitalizations and suicides from postpartum occur after the mom leaves the clinic without a solution. Dr. Siegfreid suggested that a mental health prescriber consult could be another option to improve access, rather than restricting to just a psychiatrist. But if the PCP’s scope of practice involves postpartum depression then the state should not, in her opinion, require a consult. Ultimately, the group landed on eliminating the consult requirement entirely, given other criteria that should help enforce appropriate prescribing of the medication. This led the committee to dive into the drug’s utilization history when Siegfried motioned to eliminate the requirement for psychotherapy as part of the treatment plan. The motion passed unanimously.