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Kristina Leos gave birth to her third child unexpectedly early. All she wanted was to be thankful she and her new daughter were healthy, and to be enveloped in a bubble of newborn joy. But almost immediately, a dark cloud settled over her.
“I just remember sitting in my [hospital] room, and everything just felt super overwhelming, and I was very tearful,” Leos recalls. “I thought to myself, ‘I need help. I can feel it already.’”
“It” was postpartum depression, or PPD, characterized by feelings of sadness, hopelessness, or anxiety that last longer than two weeks and start around the time of delivery, according to the Office on Women’s Health (OWH). Leos, 39, who lives in Midlothian, Texas, and works as a nurse in a neonatal intensive care unit (NICU), had experienced it twice before, when her two older children were born.
But even though she recognized PPD this time, it still took Leos months to feel better. Here’s what she wants everyone to know about this emotional experience.
You might feel *everything*—or nothing at all
PPD—also sometimes called perinatal depression—can occur anytime during pregnancy or in the year after, explains Jill Zechowy, MD, a physician, perinatal psychotherapist, and author of Motherhood Survival Manual: Your Prenatal Guide to Prevent Postpartum Depression and Anxiety. “It’s characterized by exhaustion, feeling overwhelmed, sometimes tearful, other times numb,” Zechowy says. “These moms feel like they are failures as mothers.”
Other new moms might experience anger, rage, or anxiety, which often shows up as disturbing, intrusive thoughts. “These can be really scary images that women have in which they imagine harm coming to the baby,” she says.
The smallest tasks, like taking leftovers out of the fridge to reheat for dinner, were overwhelming for Leos—if she had the motivation to do them at all. “I would start a task, and forget what I was doing, so my house got really crazy. I didn’t have a lot of motivation to do tasks to begin with, so once I actually got the motivation, it was even worse, because I couldn’t finish them,” she says.
She remembers cloudy moments of brain fog when she felt like she was living outside of her body, watching her family from afar without feeling the joy or love she usually felt being with them.
That was a big difference from the emotional peaks and valleys she had experienced after her first two deliveries. About eight weeks after having her first daughter, Kristina talked to her OB/GYN about how she was feeling and started a type of antidepressant called a selective serotonin reuptake inhibitor or SSRI. After her second delivery, she started the antidepressant right away. (Once you’ve had postpartum depression once, you’re more likely to have it again, Dr. Zechowy says.)
It’s more common in certain people
No one knows exactly what causes postpartum depression, and it’s probably a combination of many factors. Experts think the major hormone changes that happen so quickly after giving birth likely trigger mood changes, according to the OWH.
You’re also more likely to develop postpartum depression, per the OWH, if you have a family history of depression (even in male relatives; had an unplanned, difficult, traumatic, or premature pregnancy or delivery; don’t have much support from your partner, family, or friends; or are facing other life stressors, like financial challenges or relationship problems.
Leos conceived her third child through IVF, and her daughter was born premature. Parents who go through IVF and those who deliver before full-term are both more likely to have postpartum depression symptoms, according to an August 2023 Acta Psychologica2 study and a January 2022 Scientific Reports1 study, respectively. “Everything just happened so fast for me this time, and I wasn’t expecting it at all,” Leos says of her third delivery.
Finding the right treatment can take time
What didn’t happen fast was finding an effective treatment. Leos delivered her second daughter in March 2023. She went back on the SSRI after delivery, and she says she would feel some improvement, then feel a little worse. Her OB/GYN kept increasing her dose. They added a second medication to her routine, but the same pattern—one step forward, two steps back—repeated. “I would feel a little bit better, but then I would just slide backwards,” she says. “It was a roller coaster, down and up and down.”
Her OB/GYN suggested speaking with a psychiatrist. At first, Leos didn’t feel comfortable opening up to a stranger. “It was hard enough for me to open up to [my doctor], and I trusted her so much,” she says. “But I realized at some point that this was beyond what she could offer to me.” She started seeing a psychiatrist in the summer of 2023. The psychiatrist adjusted the doses of her medications, tried some different options, and still couldn’t relieve Leos’s symptoms.
In December 2023, Leos remembers her psychiatrist looking at her and saying, “This is not working. We need to do something else.” Her options included electroconvulsive therapy, ketamine treatment, and hospitalization. “I couldn’t believe I had gotten to a point in my life where I could have to be in the hospital for Christmas without my kids,” she says.
She remembered hearing about a relatively new postpartum depression treatment called zuranolone on Facebook, so she asked her psychiatrist for more information. The psychiatrist hadn’t prescribed it to anyone yet—it had only been approved by the FDA for PPD treatment that August—but after looking into it more, they determined Leos would be a good candidate.
Zuranolone, sold under the brand name Zurzuvae, “is the first oral pill that the FDA has specifically approved for postpartum depression,” Dr. Zechowy says.
Previously, the only medication specifically approved for PPD was a 60-hour intravenous infusion that had to be delivered in the hospital, according to Yale Medicine.
Rather than target the neurotransmitter serotonin, zuranolone works on different feel-good receptors in the brain that depend on the hormone allopregnanolone, Dr. Zechowy explains. Allopregnanolone levels drop dramatically after giving birth. Consequently, “it works much quicker than SSRIs,” she says. “Whereas they may take two to four weeks to start becoming effective, sometimes zuranolone works as quickly as in three days.”
Plus, you only take zuranolone for 14 days, compared to the 12 months or so you’d probably be treated with SSRIs, Dr. Zechowy estimates. This makes it an especially exciting development for people with severe postpartum depression who need relief quickly, she adds.
Leos started taking zuranolone in January 2024. By day three, she could already tell she was feeling differently. “Every day, I got better and better, and then at the end, I was just like, wow, I don’t feel like [I’m having] an out-of-body experience.”
Treatment, in some cases, is a life-or-death matter: “Most families are not aware of the harm of untreated postpartum depression,” Dr. Zechowy says. But perinatal mental health concerns (which includes PPD as well as postpartum anxiety and postpartum psychosis) are the top cause of death among new moms via suicide or overdose, according to the American College of Obstetricians and Gynecologists. “I know someone who died from postpartum depression a few weeks ago,” Leos says. “It really, really shook me hard, because it could be any of us.”
There are some side effects of the PPD pill to be aware of
Leos decided to start treatment when she had five days off from work in a row, to give herself some time and space in case she experienced any side effects.
The biggest side effects of zuranolone are dizziness and sedation, Dr. Zechowy says. Because of these concerns, you shouldn’t drive within 12 hours of taking the pill (which you take every evening with a meal rich in fat to help your body absorb the medication, per the manufacturer’s website), which simply might not work for everyone, she says.
“My main thing was dizziness, but the side effects were not as bad as I thought they would be. For me, the benefits outweigh the little side effects,” Leos says.
Breastfeed with caution while on zuranolone
Breast and chestfeeding people were left out of the original studies on zuranolone, but that doesn’t mean it’s not safe to take while breast/chestfeeding. According to the National Library of Medicine, the amount of zuranolone that makes it into milk is low, so it’s not expected to cause side effects in infants. That said, until more data is available, most medical experts support breast/chestfeeding with caution, monitoring your baby for any signs of excessive drowsiness or sedation.
In Leos’ case, she decided to be extra careful. “I pumped and dumped, and it was just for two weeks, so it wasn’t that long,” she says. Still, it was challenging emotionally for her: “When I felt like such a failure, one thing I could do for my daughter was to provide milk. So the fact that I couldn’t breastfeed made me not want to take zuranolone. But I realized I could pump and dump, and for two weeks, you can do anything.”
Your doctor can help you decide if taking zuranolone while breastfeeding is right for you and your baby.
There’s a hefty price tag for the pill, but insurance can help
The wholesale price of Zurzuvae was announced at $15,900 by manufacturer Sage Therapeutics. They do have a financial assistance program, and anecdotally, at least, Dr. Zechowy says most insurance companies are covering the cost if your doctor gets approval from them first (called a prior authorization).
Leos didn’t have to pay that much, but she thinks it would have been worth it. “Now that I’ve taken it, I would gladly pay $16,000,” she says. “I’d have to take out a loan, but I would gladly pay that, because you can’t put a price tag on your life.”
You are not alone if you have PPD
One in 8 new moms experiences symptoms of PPD, per the OWH, but it can feel like you’re the only one struggling. Postpartum depression was isolating for Leos. “I didn’t want to burden anyone by telling them how I was feeling,” she says. “My best friends, my husband—they didn’t know the extent of my issues. But it’s a time [when] you need the most help and you need someone to talk to.”
Shame often keeps new parents from speaking out about how they’re feeling, Dr. Zechowy says. “Women see a significant part of their value as a human being by their role as a mother, and postpartum depression makes you feel like you’re a terrible mother. You don’t realize you’re depressed. You just think you’re not good at this.”
Leos just overcame that shame recently. “I only started talking about my experience a few months ago,” she says. There were many opportunities when someone in the health care system could have extended more support to her. For example, she says, she scored high on measurements of depression during multiple evaluations, but providers shrugged it off as normal. “I think people are just afraid to talk about it,” she says. “I started to think maybe I shouldn’t be worried about it.”
That’s emboldened her to speak up publicly and at work. “As a health care professional who works with postpartum women, I think it’s important to bring up postpartum depression to them, and tell them that it’s real,” she says. “In our discharge instructions, I think there’s, like, one line about postpartum depression. Now I just take a lot more time to actually educate moms [about it].”
Need support for PPD? Call or text the Postpartum Support International helpline at 1-800-944-4773 or the National Maternal Mental Health Hotline at 1-833-852-6262.
—reviewed by Andrea Braden, MD, OB/GYN
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