COLORADO SPRINGS – In this Your Healthy Family, we are wrapping up what has been a remarkable first few months of 2019 in terms of new treatments for severe and postpartum depression getting approval from the Food and Drug Administration.
Dr. John Fleming, MD, DLFAPA at the Southern Colorado TMS Center tells me, “The good news is there are now many options for women with postpartum depression. I think each woman and each family member and each doctor is going to figure out, which ones make the most sense for their particular situation.”
The two latest treatments to get FDA approval are called Zulresso and Sprayvato.
Zulresso is a hormone based treatment and is the first drug specifically developed for severe depression after childbirth. Zulresso requires a patient to be admitted to the hospital for a 3-day infusion, that has shown results in a short amount of time.
Dr. Fleming says, “It’s a sixty-hour inpatient IV iinfusion. Zulresso shows lots of promise for helping women get better, in the short run. It is time-consuming to be in the hospital for nearly three days and be hooked up to an IV. and the entire time and you’re also doing your (new arrival) child care in the hospital. But it’s shown very good results within 4 or 5 days.”
Spravato, a nasal mist was also approved in March and was fast tracked by the FDA as part of the first new class of antidepressant drugs in more than three decades.
Dr. Fleming explains, “The Srayvato or Esketamine also requires that you go into a clinic, but you only have to do it twice a week for a month, and then once a week for a month and then every other week for the rest of the time that you are suffering from depression.”
Sprayvato is related to Ketamine that’s been used “off-label” to treat severe depression for a few years now. Dr. Fleming says, “The FDA approval of Sprayvato or esketamine nasal spray, is half of the Ketamine drug we currently use. In those it’s 50% Esketamine and 50% Arketamine. The nasal spray is the Esketamine only.”
For postpartum depression and drug resistant severe depression, r-TMS and Ketamine infusions are two other treatment options. Repetitive Trans-cranial Magnetic Stimulation or r-TMS has FDA clearance while Ketamine infusions do not.
In the past we have detailed patient’s stories who have used r-TMS to overcome severe postpartum depressions, and Ketamine infusion therapy to treat severe depression.
All of these treatments are available here in southern Colorado, and 3 of the 4 are now cleared by the Food and Drug Administration. Dr. Fleming tells me that getting insurance companies on board is often a complicated and time-consuming process. “We don’t know how long it will take insurance companies to get on board with the FDA approval. Each individual insurance company makes their own decisions. Treatments usually go through a process that takes 4 to 5 years to get FDA approval, if they get it. Once that happens it usually takes between 2 and 4 years for the treatment to come into general use. That doesn’t mean that some people don’t have the opportunity to use it pretty quickly, but things do move slow. I don’t like that but I’m enough of a realist to know that’s what tends to happen.”
Dr. Fleming also says that doesn’t mean it’s not available to those who need it most. “If an individual patient has serious interest – and I’ve already got several patients who have serious interest in either one of these new treatments — then we’re going to push hard and devote energy and time with insurance companies to try to get it approved for them. Sometimes the answer we get back is, ‘It’s just too new’, or ‘We have to have a drug approval committee review the literature, and we only do that every 6 months’, so it can be pretty frustrating for patients and for me too.”
Dr. Fleming says, sometimes the answer is yes, but the biggest take away is there is help available for those struggling with severe depression in many forms, and new treatments are showing promise and good results where other traditional medications and therapies have failed in the past.
If you have questions you can follow up with the staff at the Southern Colorado TMS Center.
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