The first pill for patients suffering from postpartum depression is expected to be available by the end of 2023. Zuranolone (Zurzuvae) is a synthetic form of a mood hormone that rises during pregnancy and plummets after delivery. In mimicking this hormone, it is believed that the more extreme symptoms of postpartum depression can be averted.

第一种用于产后抑郁症患者的药物预计将于2023年底上市。祖拉诺酮(Zurzuvae)是一种合成的情绪激素，在怀孕期间升高，分娩后下降。通过模仿这种激素，人们相信可以避免产后抑郁症的极端症状。

California is one of several states that requires health care providers to screen patients for depression during pregnancy. Those who screen positive at UCSF Health may find themselves connected to psychiatrist Margo Pumar, MD, medical director of perinatal psychiatry, and a self-described wife, mother, sister, daughter, friend, large-dog owner and mental health advocate. She discusses zuranolone’s potential, as well as other treatments for postpartum depression.

加州是要求医疗服务提供者在怀孕期间对患者进行抑郁症筛查的几个州之一。那些在加州大学旧金山分校健康中心筛查呈阳性的人可能会发现自己与精神病学家Margo Pumar有联系，Margo Pumar是围产期精神病学的医学主任，她自称是妻子、母亲、姐妹、女儿、朋友、大型狗主人和心理健康倡导者。她讨论了唑诺酮的潜力，以及其他治疗产后抑郁症的方法。

What characteristics are associated with a higher risk for postpartum depression?

哪些特征与产后抑郁症的高风险相关?

Very young patients may be more overwhelmed and hence higher risk, but I also see those who may be older and view themselves as competent until they have their first baby and then they feel that they’re “not very good at this.” Also at higher risk: first-time parents, people with complex pregnancies or with babies who have special medical needs, as well as patients with previous or pre-existing depression or anxiety.

非常年轻的病人可能会更不堪重负，因此风险更高，但我也看到那些年龄较大的人，他们在生第一个孩子之前认为自己很有能力，然后他们觉得自己“不太擅长这个”。风险较高的还有:初为父母的人、怀孕情况复杂的人或有特殊医疗需求的婴儿的人，以及以前或已经患有抑郁症或焦虑症的患者。

I’m concerned about patients with a shaky support system. Having grandparents living across the street who can hold a crying baby offers an opportunity to catch up on sleep. But here in the San Francisco Bay Area, I see many patients with no nearby family support.

我担心的是那些支持系统不稳定的病人。住在街对面的祖父母可以抱着哭泣的婴儿，这给了他们补觉的机会。但在旧金山湾区，我看到许多病人没有附近的家人支持。

Do you expect the new drug will be helpful for some patients?

你认为这种新药对某些病人有帮助吗?

Zuranolone is sedating so it should be taken at bedtime. This means refraining from driving for 12 hours, so it may be inconvenient for some patients.

舒诺酮有镇静作用，所以应该在睡前服用。这意味着12个小时内不能开车，所以对一些患者来说可能不方便。

The drug works on the same receptor as the benzodiazepines, medications like Xanax, Ativan and Valium, and it is possible patients will develop tolerance after a while, requiring them to take increased doses to achieve the same effects. But currently it is approved only for two-week usage. We don’t know if patients remained depression-free beyond four weeks.

这种药物与苯二氮卓类药物、阿普唑仑(Xanax)、阿拉西泮(Ativan)和安定(Valium)等药物作用于相同的受体，患者可能会在一段时间后产生耐药性，需要增加剂量才能达到同样的效果。但目前它只被批准使用两周。我们不知道患者是否能在四周后保持无抑郁状态。

Zuranolone may be very expensive, since approval to expand usage to patients with major depressive disorder was denied. It is possible insurers will require patients to show they have failed other treatments before providing coverage.

祖拉诺酮可能非常昂贵，因为批准扩大对重度抑郁症患者的使用被拒绝了。保险公司可能会要求患者在提供保险之前出示其他治疗失败的证明。

A major limitation is that we do not know how much of the drug is transferred into breastmilk or what the risks are, so it’s only recommended for those who don’t intend to breastfeed or who are willing to “pump and dump.” Overall, zuranolone may be helpful, but most likely only for a small subset of patients until we know more.

一个主要的限制是，我们不知道有多少药物会转移到母乳中，也不知道风险是什么，所以只建议那些不打算母乳喂养或愿意“抽吸和倾倒”的人服用。总的来说，祖拉诺酮可能有帮助，但在我们了解更多之前，很可能只对一小部分患者有效。

Are other postpartum depression drugs safe for breastfeeding patients?

其他产后抑郁药物对哺乳期患者安全吗?

We know that some SSRIs (selective serotonin reuptake inhibitors), like Zoloft and Celexa, have been used in lactating patients since the 1990s. Traces of these drugs have been detected in breastmilk and side effects are generally minimal. We have to weigh the risk of untreated postpartum depression against the risks and the benefits of these drugs. I can say that I have seen SSRIs make a big difference to my patients with postpartum depression.

我们知道一些SSRIs(选择性血清素再摄取抑制剂)，如Zoloft和Celexa，自20世纪90年代以来一直用于哺乳期患者。在母乳中发现了这些药物的痕迹，副作用通常很小。我们必须权衡未经治疗的产后抑郁症的风险与这些药物的风险和益处。我可以说，我已经看到SSRIs对我的产后抑郁症患者产生了很大的影响。

What other measures can be taken to minimize the risk of postpartum depression?

还有什么其他措施可以降低产后抑郁症的风险呢?

Postpartum depression can be mild, so medication is not required in all cases. I advise all parents-to-be to start building their village if they don’t have one. Join a moms’ or dads’ group. Some cities have LGBTQ parents’ groups that welcome those who identify as nonbinary. Sleep will likely be an issue, so tag-team if you have a partner or consider a night doula if you can afford it. Exercise! This will ease anxiety and help you sleep. Some supplements may help. Magnesium is safe to take during lactation and may relieve some symptoms of anxiety.

产后抑郁症可能是轻微的，因此并非所有情况下都需要药物治疗。我建议所有的准父母们，如果他们还没有自己的村庄，那就开始建造吧。加入一个妈妈或爸爸的小组。一些城市有LGBTQ家长团体，欢迎那些自认为是非二元的人。睡眠很可能是一个问题，所以如果你有伴侣，可以选择跟随团队;如果你负担得起，可以考虑请一位夜间助产师。锻炼!这样可以缓解焦虑，帮助你入睡。一些补充剂可能会有帮助。在哺乳期服用镁是安全的，可以缓解一些焦虑症状。

I’m a big believer in therapy. Medication alone may not be enough to help new parents deal with the negative thinking that may accompany postpartum depression.

我非常相信心理治疗。药物本身可能不足以帮助新父母处理可能伴随产后抑郁症的消极想法。