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Sept. 4, 2023

Dr. Stephanie Waggel Explains the First Oral Drugs Approved for Postpartum Depression

Dr. Stephanie Waggel Explains the First Oral Drugs Approved for Postpartum Depression

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Today, we invite you to join an enlightening discourse with our esteemed guest, Dr. Stephanie Waggel. We discuss the groundbreaking science behind the new medications approved to treat postpartum depression, which are sparking new hope for postpartum depression patients. Dr. Waggel adeptly unravels the science behind these drugs, making complex medical terms digestible and fascinating.

In our dialogue, we also step into the realm of controversies and implications of these FDA-approved drugs. We question the potential effects on breastfeeding mothers and scrutinize the role of pharmaceutical companies in these developments. We hope to enrich your understanding of postpartum depression and its promising new treatments. Join us for this profound conversation; let's embark on this knowledge journey together.

To connect with Dr. Waggel, go to 
improvelifepllc.com

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Medical Disclaimer:
This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman’s medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.

Chapters

00:00 - New FDA-Approved Drug for Postpartum Depression

15:40 - Medication Controversies and Considerations

27:17 - Discussing Medical Topics and Mispronunciations

Transcript
WEBVTT

00:00:00.480 --> 00:00:04.894
Hello, Today I have with me yet again Dr Stephanie Waggle.

00:00:04.894 --> 00:00:10.769
Dr Waggle is the mother of two and a psychiatrist specializing in perinatal mental health.

00:00:10.769 --> 00:00:16.070
To connect with Dr Waggle, go to improvelifepllccom.

00:00:16.070 --> 00:00:17.975
This will also be in the show notes.

00:00:17.975 --> 00:00:26.664
Today she's returning to share important information about the new drugs that have been FDA approved to specifically treat postpartum depression.

00:00:26.664 --> 00:00:29.975
Dr Waggle, welcome and thank you for joining me.

00:00:30.257 --> 00:00:43.786
Hi, I'm so excited that I get to actually do a topic on a medication that's FDA approved for postpartum depression, because this is the first time in world, medication has actually ever been approved for postpartum depression, so it's big news.

00:00:44.087 --> 00:00:45.369
I know I'm so excited.

00:00:45.369 --> 00:00:46.493
I can't wait to hear about it.

00:00:46.679 --> 00:00:52.512
So what I want to do, but I can't, is to tell you what I've seen clinically like.

00:00:52.512 --> 00:00:56.448
Oh, I've had some patients on it and this is what happened and this is how it works.

00:00:56.448 --> 00:01:06.141
But it is not available for 90 more days, so I will not be able to tell you about any of my actual personal experiences prescribing it.

00:01:06.141 --> 00:01:12.873
But what I can get into is some of the studies that have occurred regarding it's.

00:01:12.873 --> 00:01:15.852
Zuranolone is what we're going to be talking about.

00:01:15.852 --> 00:01:20.546
For short, I guess you could just call it ZOO, in case you don't want to say the whole thing.

00:01:20.546 --> 00:01:29.941
So I'm going to start off by saying that the typical treatments for postpartum depression would be your everyday round the mill.

00:01:29.941 --> 00:01:51.944
Most people know SSRIs, sertraline, fluoxetine, those sorts of things and then you also have SNRIs, atypical and endopressants, and the medications are typically for depression and they're just using them for postpartum depression, although they are not specifically FDA approved for postpartum depression.

00:01:51.944 --> 00:01:54.632
But that's just the standard right now.

00:01:54.632 --> 00:02:06.121
So the medications I'm going to talk about and Zuranolone is one of them they work differently than your typical antidepressant that you're familiar with.

00:02:06.121 --> 00:02:13.305
But before we get started with how it works, I just want to explain some well known examples of steroids.

00:02:13.305 --> 00:02:22.521
There are sex hormones, like most people know about testosterone, progesterone, estrogen, and this is just to get a warm up for people that aren't familiar with these kind of things.

00:02:22.521 --> 00:02:29.826
Pogestrone is an endogenous meaning, like occurring in your body, steroid hormone produced by adrenal cortex.

00:02:29.826 --> 00:02:36.509
I will try not to get too technical, although I probably still will, but whoever doesn't want to hear it, I guess, can just fast forward.

00:02:36.509 --> 00:03:04.182
So, talking about progesterone and I think anybody who's taking a break control pill is at least familiar with progesterone there is something called allopregnanolone and this is also endogenous meaning, in the body, naturally occurring inhibitory neuro steroid, and it kind of works as an anti anxiety sort of mechanism.

00:03:04.182 --> 00:03:10.395
So instead of thinking allopregnanolone, you can just think anti anxiety.

00:03:10.395 --> 00:03:17.191
So this anti anxiety hormone drops after childbirth.

00:03:17.191 --> 00:03:23.046
So if something that gets rid of your anxiety decreases, your anxiety probably is going to increase.

00:03:23.046 --> 00:03:37.629
The drop that occurs after childbirth leads to overactivity of the HPA axis and that leads to anxiety and depression not in everybody, obviously, but that's just the thinking of what is going on here.

00:03:37.629 --> 00:03:47.520
So for following me so far, you have this hormone that decreases anxiety and then it decreases after you have a baby, so then anxiety increases.

00:03:48.223 --> 00:03:59.772
Now they made a medication called brexanolone, which is like this allopregnanolone that occurs in your body anyway, to administer to women postpartum.

00:03:59.772 --> 00:04:01.639
But there is a problem with it.

00:04:01.639 --> 00:04:03.402
Well, there's a couple problems with it.

00:04:03.402 --> 00:04:09.014
One is that it's IV infusion the last 60 hours.

00:04:09.014 --> 00:04:12.247
You can't really do that at home, you have to go into the hospital.

00:04:12.247 --> 00:04:17.932
So I have a hard enough time convincing women to get their postpartum depression treated.

00:04:17.932 --> 00:04:20.319
It can be real hard to convince them.

00:04:20.319 --> 00:04:22.788
Why just short hospital stay?

00:04:22.788 --> 00:04:24.031
Why not Side up?

00:04:24.031 --> 00:04:24.673
It'll be fun.

00:04:24.673 --> 00:04:27.901
And then the other thing is it's $30,000.

00:04:27.901 --> 00:04:29.685
So pretty pricey.

00:04:29.685 --> 00:04:32.310
I wouldn't say it's easily accessible.

00:04:32.310 --> 00:04:35.822
But the idea is there and it's a good one.

00:04:35.822 --> 00:04:41.562
So we're talked about that hormone that occurs, that drops, and how there's something similar.

00:04:41.562 --> 00:04:46.961
But you got to take an IV and you got to sell your car to get it, the brexanolone.

00:04:46.961 --> 00:04:52.413
So let's see, I'm going to explain how it works in a little bit.

00:04:52.413 --> 00:05:10.338
So the big breakthrough here is that the Ziranolone is like that IV infusion, only it's in pill form, which is so much more readily accessible and hopefully cheaper than $30,000.

00:05:10.338 --> 00:05:19.942
So brexanolone is the IV very expensive, but they have taken a similar mechanism of action, made Ziranolone, and it's a pill.

00:05:19.942 --> 00:05:22.766
It'll be out hopefully in the next 90 days.

00:05:22.766 --> 00:05:26.338
Now, hopefully no one falls asleep here.

00:05:26.490 --> 00:05:28.458
The way it works is it's a neuro-steroid.

00:05:28.458 --> 00:05:32.915
So I talked a little bit ago about sex hormone steroids, that sort of thing.

00:05:32.915 --> 00:05:37.622
So GABA is what's called an inhibitory neurotransmitter.

00:05:37.622 --> 00:05:46.295
A neurotransmitter is a chemical in your brain and, just very simplistically, think GABA, think calming effect.

00:05:46.295 --> 00:05:59.375
Okay, zaranolone is what is called a positive allosteric modulator of GABA, which is a fancy way of saying that it just enhances the activity of GABA, which means enhancing a calming effect.

00:05:59.375 --> 00:06:06.374
So it works both intracynaptically and extra synaptically and that's important.

00:06:06.435 --> 00:06:15.819
In a second and just for funsies, an allosteric modulator is a group of substances that bind to a receptor and changes their receptor's ability to respond to a stimuli.

00:06:15.819 --> 00:06:24.817
Just in case anybody's sitting around wondering what the allosteric modulator is, okay, I promise I'm gonna try to speak in English.

00:06:24.817 --> 00:06:30.593
So I think most people probably know what Xanaxes if they ever listened to music.

00:06:30.593 --> 00:06:39.834
So if you think about a benzodiazepine, I'm gonna try not to say brand names, but I mean, if I wanna relate to people, people know what Xanaxes.

00:06:39.834 --> 00:06:42.194
So that also works on GABA.

00:06:42.615 --> 00:06:44.521
Gaba A receptor specifically.

00:06:44.521 --> 00:06:48.961
So benzodiazepines only work intracynaptically.

00:06:48.961 --> 00:06:58.451
But the Zuranolone, the medication that I'm talking about today, we're just gonna nickname it zoo so it's easier to understand the zoo.

00:06:58.451 --> 00:06:59.997
It works on both.

00:06:59.997 --> 00:07:09.475
So benzodiazepines are only working intracynaptically, whereas the zoo is working intracynaptically and extra synaptically.

00:07:09.475 --> 00:07:12.017
So it's got this extra mechanism of action.

00:07:12.017 --> 00:07:13.755
That's new and exciting.

00:07:14.290 --> 00:07:18.281
Okay, now Zuranolone for postpartum depression.

00:07:18.281 --> 00:07:26.338
So pathophysiology, postpartum depression, which is, like you know the things that are going on here multifactorial.

00:07:26.338 --> 00:07:38.096
So, like I said before, with that decrease in that particular hormone that could be causing it and the extra HPA access, which is like stressing people out.

00:07:38.096 --> 00:07:40.297
So this kinda addresses that.

00:07:40.297 --> 00:07:47.019
Now, like I said, it should be available in 90 days, since it acts similar to benzodiazepine.

00:07:47.310 --> 00:07:48.997
Benzodiazepine is a controlled substance.

00:07:48.997 --> 00:07:51.557
Zuranolone is also going to be controlled.

00:07:51.557 --> 00:08:01.439
So you would need a prescriber that has a DEA license and that sort of thing, and it's gonna require closer monitoring than your typical run-in-the-mill antidepressant.

00:08:01.439 --> 00:08:09.173
So, because it's not out yet, I don't have any data from any patients who've taken it, which is something I'd love to come back and talk about once.

00:08:09.173 --> 00:08:09.815
I gather that.

00:08:09.815 --> 00:08:16.838
But we have to at least wait a couple months until it's out and then a couple months to see how my patients did.

00:08:16.838 --> 00:08:20.980
But I can talk about the trials that have occurred.

00:08:20.980 --> 00:08:24.238
So, just so that people can follow along.

00:08:24.870 --> 00:08:27.740
There's different phases of clinical trials.

00:08:27.740 --> 00:08:34.678
There's the preclinical phase one, phase two, phase three and then phase four is like after it's already out there.

00:08:34.678 --> 00:08:41.917
So phase two, that's seeing if it works and there's like maybe a hundred, a couple hundred patients involved.

00:08:41.917 --> 00:08:48.136
And then phase three is to see the safety and efficacy, and that involves more patients.

00:08:48.136 --> 00:08:54.200
So I'm gonna be talking about phase two, phase three trials of this new and exciting medication.

00:08:55.169 --> 00:08:57.717
Okay, so Zuranolone for postpartum depression.

00:08:57.717 --> 00:09:02.279
There was a study in June 30th 2021.

00:09:02.279 --> 00:09:09.278
So this study was basically Zuranolone versus placebo Placibos just sugar pills with nothing in them.

00:09:09.278 --> 00:09:17.178
So they had women that were postpartum less than six months, ages 18 to 45 years.

00:09:17.178 --> 00:09:24.616
76 of them were taking placebo sugar pill that doesn't do anything, and 77 of them were taking Zuranolone.

00:09:24.616 --> 00:09:31.496
In this particular study, the dosage was 30 milligrams and you have to take it each evening with food.

00:09:31.496 --> 00:09:34.719
I will tell you why you have to take it in the evening in a little bit.

00:09:36.013 --> 00:09:43.937
In this study found a significantly greater reduction from baseline ham D17, and you're probably like what's a ham D17?

00:09:43.937 --> 00:09:49.062
So that is a scale to assess depressive symptoms.

00:09:49.062 --> 00:09:59.000
So a reduction would indicate a less depressive symptoms, and they found this as soon as 15 days after.

00:09:59.000 --> 00:10:11.855
So significantly, the people that were taking actual medication the zoo versus the people that were just taking sugar pills in 15 days, the people that were taking the zoo were doing much, much better.

00:10:11.855 --> 00:10:26.234
And this is a big deal, because most antidepressants like I mentioned at the beginning, your typical SSRIs, the fluoxetine, sertraline, your normal antidepressants that you typically think of oh, I mean they take six to eight weeks to start working with this.

00:10:26.234 --> 00:10:29.259
This actually spoiler alert.

00:10:29.259 --> 00:10:31.173
There's another study that starts working about three days.

00:10:31.173 --> 00:10:31.956
It's really fast.

00:10:31.956 --> 00:10:46.597
And so this study that I'm talking about now, at day 45, 54% of the women in the serenaline group were seeing remission, whereas only 30% in the sugar pill group were seeing remission.

00:10:46.597 --> 00:10:48.336
So that's one study.

00:10:48.429 --> 00:10:54.754
There's another phase two study also found a significant change in the ham D, which is the depression scale.

00:10:54.754 --> 00:10:59.520
Also found that it starts working as early as three days.

00:10:59.520 --> 00:11:04.011
And another thing is that they only have to take it for two weeks.

00:11:04.011 --> 00:11:08.456
A lot of people, pretty much everybody, was like how long do I have to take this antidepressant?

00:11:08.456 --> 00:11:21.835
I mean, sometimes people take antidepressant their whole life, sometimes it's yours, this particular one Two weeks, it's so nice, it'll be easy to follow because after two weeks you don't have to take it anymore.

00:11:22.250 --> 00:11:24.759
There was another is this one's a phase three study?

00:11:24.759 --> 00:11:26.195
It's called the Waterfall Study.

00:11:26.195 --> 00:11:31.735
It also showed an early onset of efficacy at three days it starts working.

00:11:31.735 --> 00:11:34.437
And antidepressants starts working in three days.

00:11:34.437 --> 00:11:35.413
That sounds nice.

00:11:35.413 --> 00:11:39.859
And then another phase three study called the Coral Study.

00:11:39.859 --> 00:12:03.653
That actually looked at people on the regular run of the mill antidepressants that you think about versus people on those antidepressant plus Zoranolone, and so those are the two groups, and the people on the zoo plus the antidepressant also had a rapid onset and the reduction in depressive symptoms maintained.

00:12:03.653 --> 00:12:04.817
It was maintained over time.

00:12:04.817 --> 00:12:08.394
So we have some studies that's like sugar pills versus the zoo.

00:12:08.394 --> 00:12:14.398
We have some studies that are antidepressants versus the zoo plus antidepressants.

00:12:14.398 --> 00:12:16.798
So they looked at a variety of things in these studies.

00:12:16.798 --> 00:12:25.595
And then finally, there was the Shoreline Study and that looked over a longer period of time to see how long does it last.

00:12:25.595 --> 00:12:30.299
It's great it starts lasting in three days, but does it last after that?

00:12:30.299 --> 00:12:32.697
And so this was a year long study.

00:12:32.697 --> 00:12:39.940
80% of the patients responded to the treatment positively and 80% only required one or two treatments.

00:12:39.940 --> 00:12:53.475
Remember, the treatments are about two weeks long, so the one 14 day or perhaps two separate 14 day treatments were enough to sustain the decrease in depression for at least a year.

00:12:53.475 --> 00:12:57.039
So some of the studies show, ok, it starts working quickly.

00:12:57.039 --> 00:13:00.580
But this study shows, hey, it even lasts a while.

00:13:00.580 --> 00:13:02.255
So this is all very good.

00:13:02.255 --> 00:13:06.394
So fast and lasting this is nice.

00:13:06.394 --> 00:13:09.294
This is something new 45 days.

00:13:09.950 --> 00:13:18.836
The effects of the oral medication, the zoo, are similar to the effects of the IV1 that I was speaking about at the beginning.

00:13:18.836 --> 00:13:24.794
Hopefully it's cheaper than $30,000 when it comes out, but definitely it's not something you need to be in the hospital for.

00:13:24.794 --> 00:13:28.318
So everybody's like what are the side effects?

00:13:28.318 --> 00:13:39.732
So the side effects shown in the studies are similar to what the side effects of just having a baby are anyway, like drowsiness, headache, dizziness, that sort of thing.

00:13:39.732 --> 00:13:42.599
They kept saying it's generally well tolerated.

00:13:42.599 --> 00:13:44.857
There were two big adverse problems.

00:13:44.857 --> 00:13:51.198
One was that somebody got pancreatitis, but they were on the placebo group, so it wasn't the the Rana one that caused it.

00:13:51.198 --> 00:13:55.480
And then another person had, like some, altered consciousness.

00:13:55.480 --> 00:13:58.539
They were very disoriented and that sort of thing.

00:13:58.629 --> 00:14:02.080
So remember earlier I said you got to take it at night.

00:14:02.080 --> 00:14:09.595
That's because it causes sedation, which may be a good thing, because a lot of women suffer from insomnia.

00:14:09.595 --> 00:14:11.515
So if it helps you go to sleep, that might be good.

00:14:11.515 --> 00:14:18.700
But if it helps you go to sleep, you definitely don't want to take it when you wake up in the morning and you don't want to take it before operating heavy machinery.

00:14:18.700 --> 00:14:19.091
You just like.

00:14:19.091 --> 00:14:22.255
Pretty much every medication says don't operate heavy machinery.

00:14:22.255 --> 00:14:26.658
Okay, I know it was an exaggeration, but a lot of medications say don't operate heavy machinery.

00:14:26.658 --> 00:14:33.389
I mean it would be annoying if you have to go to work, but it's about 12 hours.

00:14:33.389 --> 00:14:36.049
So if you take it at night, you should be able to drive the next day.

00:14:36.049 --> 00:14:40.429
Of course it affects everybody differently, but those are some of the biggest drawbacks.

00:14:40.429 --> 00:14:46.317
However, maybe you can recruit somebody else to take the night shift.

00:14:46.317 --> 00:14:48.230
I imagine that it would just.

00:14:48.230 --> 00:14:51.679
One of the factors would be you have a new baby.

00:14:51.679 --> 00:14:54.070
You got to wake up, take care of the baby.

00:14:54.070 --> 00:15:05.235
But maybe you can recruit in-laws or husbands or friends or somebody to take the night shift, because if you're going through substantial postpartum depression, you need sleep anyway.

00:15:05.235 --> 00:15:07.798
So maybe sedation isn't the worst side effect.

00:15:07.798 --> 00:15:10.818
So this all sounds fantastic.

00:15:12.269 --> 00:15:16.034
The studies were done by the pharmaceutical companies that are manufacturing it.

00:15:16.034 --> 00:15:21.001
So, yeah, a little bit controversial.

00:15:21.001 --> 00:15:26.554
I mean, it's not uncommon occurrence for the manufacturer to be the one doing the studies.

00:15:26.554 --> 00:15:31.397
You just have to keep in mind that these studies were conducted by the people selling it.

00:15:31.397 --> 00:15:36.110
So that's why I'm going to come back and tell you what I see in real life like.

00:15:36.110 --> 00:15:38.798
Does it reflect what was found in the studies?

00:15:38.798 --> 00:15:48.535
So we'll see when, hopefully, the studies reflect, because if they do, then that's going to be really promising Fast acting, long lasting.

00:15:48.535 --> 00:15:49.418
Well, I'll stop.

00:15:49.418 --> 00:15:50.692
I'll take any questions.

00:15:50.692 --> 00:15:52.034
That was a lot.

00:15:52.056 --> 00:15:52.897
All right, thank you.

00:15:52.897 --> 00:15:53.759
I'm happy to defund.

00:15:53.759 --> 00:15:54.561
Can I raise my hand?

00:15:54.561 --> 00:15:56.595
Is there anything that I hear?

00:15:56.595 --> 00:15:58.354
I took notes.

00:15:58.354 --> 00:16:00.876
I was like, all right, we're going back to med school.

00:16:00.876 --> 00:16:03.456
Ok, let's see.

00:16:03.456 --> 00:16:11.538
So when we talked about scheduling this episode, I was bragging to my coworkers and so they wanted to be able to ask questions.

00:16:11.538 --> 00:16:16.157
Oh OK, labor delivery nurses would like to know.

00:16:16.157 --> 00:16:18.937
You already talked about how it works and what is it.

00:16:18.937 --> 00:16:21.356
They want to know if you can breastfeed on it.

00:16:21.970 --> 00:16:30.936
That is a fantastic question because I had the same one and it is actually unknown because they had the women in the studies.

00:16:30.936 --> 00:16:33.317
They actually asked them to stop breastfeeding.

00:16:33.317 --> 00:16:39.277
They were like, well, this, we didn't commit to all this, we just want to find out if it works.

00:16:39.277 --> 00:16:42.736
We're not ready, we just need to get it out there.

00:16:42.736 --> 00:16:50.072
We're not ready to do the studies to see if it affects or if it is transmitted in the breast milk.

00:16:50.559 --> 00:17:12.646
I mean that would be good, but you have to remember what they're putting their time and effort into and I think that I don't want to speak on behalf of the researchers or the pharmaceutical companies, but I would surmise that they were just efficacy, safety for mom and then the whole like can you breastfeed?

00:17:12.646 --> 00:17:14.426
And we'll figure that out later.

00:17:14.426 --> 00:17:28.498
Now, if I had to take an educated guess, the biggest issue that I have, if I have to prescribe somebody a benzodiazepine while they're breastfeeding, I always say look for how your baby responds and your baby's super sleepy.

00:17:28.498 --> 00:17:33.490
That might be an indicator that it's transmitting and having an effect on your baby.

00:17:33.490 --> 00:17:38.310
And you have to remember that this medication works similarly to the benzodiazepines.

00:17:38.539 --> 00:17:48.343
The biggest issue I have with benzodiazepines is I worry that it's going to knock mom out and she's going to be breastfeeding and fall asleep with the baby and drop the baby on the floor or whatever.

00:17:48.343 --> 00:17:50.628
You want mom to not be knocked out.

00:17:50.628 --> 00:18:11.048
So my worry wouldn't be so much transmission of the milk I mean, probably make the baby really sleepy but my worry would be mom would be super, super tired and if she's breastfeeding while on this medication she might just be like, ah, you know, and then the baby will be like, excuse me, what's going on, mom?

00:18:11.087 --> 00:18:11.549
Why are you?

00:18:11.549 --> 00:18:16.269
You know, and even if the baby's like crying, if you're knocked out, you're knocked out right.

00:18:16.269 --> 00:18:20.028
So that would be my concern with breastfeeding on this medication.

00:18:20.220 --> 00:18:26.932
So anybody that is a co-sleeper probably would not want to co-sleep during the treatment period.

00:18:26.932 --> 00:18:28.415
Right, because you roll over.

00:18:28.415 --> 00:18:30.039
I'm not advocating for co-sleeping.

00:18:30.099 --> 00:18:34.940
Well, I was going to say I mean, but I am acknowledging, you're acknowledging it's, I'm acknowledging the existence.

00:18:34.940 --> 00:18:36.470
You have to because it happens.

00:18:36.859 --> 00:18:39.106
You have to because it does happen, right, yeah.

00:18:40.619 --> 00:18:42.326
So if you take this, you roll over yeah.

00:18:43.339 --> 00:18:45.548
Anyone that co-sleeps knows they're not supposed to co-sleep impaired.

00:18:45.548 --> 00:18:48.500
It is a parental choice that I am acknowledging.

00:18:48.500 --> 00:18:50.747
It's similar to alcohol.

00:18:50.928 --> 00:18:57.387
Exactly, alcohol also works on the same receptor, so it would be like analogous to getting drunk and then falling asleep next to your baby.

00:18:57.828 --> 00:18:59.792
You don't want to do that Exactly.

00:18:59.792 --> 00:19:05.846
Additionally, my wonder is I've always asked this, and this is probably a little rabbit trail that we might need to do another podcast for.

00:19:05.846 --> 00:19:06.807
Well, that's okay.

00:19:06.807 --> 00:19:09.079
I like that We'll just do it Right.

00:19:09.079 --> 00:19:13.730
So my thought is they have those little milk strips that you can use to test for alcohol.

00:19:13.730 --> 00:19:14.592
They do.

00:19:14.592 --> 00:19:17.227
Why are we not doing that for everything?

00:19:17.227 --> 00:19:22.928
Because we can't test the baby, and I think the answer is money and time and research.

00:19:22.948 --> 00:19:24.451
Women are the consumers.

00:19:24.451 --> 00:19:27.367
Yeah, women harness our power as women consumers.

00:19:27.367 --> 00:19:30.444
Women can fix harder Like let's put the money into this?

00:19:30.444 --> 00:19:32.190
Yeah, let's do it.

00:19:32.190 --> 00:19:34.065
We should be able to test for everything.

00:19:34.385 --> 00:19:38.028
Yeah, I'm sure that there is a way to correct it in breast milk.

00:19:38.028 --> 00:19:39.665
I'm sure that it exists.

00:19:39.665 --> 00:19:44.912
Does a company want to put in the research and development into that?

00:19:44.912 --> 00:19:45.561
I don't know.

00:19:45.561 --> 00:19:54.492
Maybe if we showed them that there would be a demand for such a thing, but until then it's not as if it's impossible or scientifically impossible.

00:19:54.492 --> 00:19:58.549
It could happen, but somebody has to want to do it and that somebody has to be pretty rich.

00:19:58.549 --> 00:20:01.227
So we'll see.

00:20:01.227 --> 00:20:21.682
And that was another point that my immediate, before doing any research, my immediate thought was this is a great sign that they came out with this, because that means somebody somewhere cares about pregnant women enough to put this in, Because you know it's 2023 and this is the first pill that's ever been approved for postpartum depression.

00:20:21.682 --> 00:20:24.267
Someone finally cares about us.

00:20:25.323 --> 00:20:27.124
It's great, it's so crazy.

00:20:27.124 --> 00:20:31.108
Maybe they figured out that the mom being well affects the baby.

00:20:31.148 --> 00:20:31.770
Oh my goodness.

00:20:31.770 --> 00:20:40.540
But even with that, we please care about mom though, so that, but like I mean if the only way we can get some care while we're by way of the baby.

00:20:40.721 --> 00:20:42.467
I guess it's better than nothing.

00:20:42.667 --> 00:20:43.068
Right.

00:20:43.068 --> 00:20:46.990
Well someone cares, and I'm delighted about it, someone cares.

00:20:47.599 --> 00:20:50.088
Well, I think you've kind of answered the other questions.

00:20:50.088 --> 00:20:56.311
The next two questions are can it be used antipartum and why don't we put everybody on it?

00:20:56.311 --> 00:21:04.309
But I think maybe you could kind of spell it out for us, like why we wouldn't be able to use it antipartum probably because of the hormone levels, right?

00:21:04.579 --> 00:21:06.287
Well, so that's a good question.

00:21:06.287 --> 00:21:09.470
The studies did use different time frames.

00:21:09.470 --> 00:21:12.099
That was less than six months postpartum.

00:21:12.099 --> 00:21:19.525
Again, it's probably they were like we just we have a very narrow objective Does it work postpartum?

00:21:19.525 --> 00:21:24.507
We didn't ask if it's okay for breastfeeding, we didn't ask if it's okay for pregnant women.

00:21:24.507 --> 00:21:29.250
We're just focusing and so that would be really good for future studies.

00:21:29.250 --> 00:21:34.712
So, again, if I had to take an educated guess, but the hormone doesn't drop right.

00:21:34.779 --> 00:21:36.185
The hormone drops after childbirth.

00:21:36.400 --> 00:21:37.684
That hormone is higher.

00:21:37.684 --> 00:21:46.790
It goes like this If we had a graph, yeah, so it goes up and then it drops, and I think that taking hormones while you're pregnant is generally a no-no.

00:21:46.790 --> 00:21:52.480
However, at least because it has the extra mechanism of action that benzodiazepines don't have.

00:21:52.480 --> 00:22:02.948
But at least we know benzodiazepines aren't fantastic for taking while pregnant, but I mean, you can if that's all that works.

00:22:02.948 --> 00:22:08.084
So taking it while pregnant and taking it breastfeeding have not been studied.

00:22:08.084 --> 00:22:12.701
However, once it's out and about in the world, it's going to happen, and then that's.

00:22:12.701 --> 00:22:19.464
That would be the last phase in the clinical trials, the phase four when it's already out.

00:22:19.796 --> 00:22:20.156
Yeah.

00:22:20.156 --> 00:22:23.637
The phase four, experimenting on regular people yes.

00:22:23.678 --> 00:22:25.644
Post-marketing research.

00:22:25.644 --> 00:22:28.617
Where it is, you index the substance Exactly.

00:22:29.259 --> 00:22:29.642
Right.

00:22:30.636 --> 00:22:32.743
Those are good questions, and nobody wants.

00:22:33.878 --> 00:22:36.701
Yeah, then the question of why don't we put everybody on it and-.

00:22:37.016 --> 00:22:37.779
I can answer that.

00:22:37.779 --> 00:22:44.964
One is not everybody has postpartum depression, which you wouldn't want to treat somebody for something they don't have.

00:22:44.964 --> 00:22:55.480
The other is that I am going to guess that it's only 14 days, but benzodiazepines are pretty addictive Because it works similarly.

00:22:55.480 --> 00:23:01.044
I'm not saying it's addictive, but I'm saying that I can see people getting addicted to it.

00:23:01.044 --> 00:23:05.365
You don't want to just give an 11-year-old a pack of cigarettes.

00:23:05.365 --> 00:23:11.398
You don't want to get started somebody on something that they might not have an easy time quitting.

00:23:11.398 --> 00:23:20.765
I do like the idea, like, yeah, prophylactically and for people listening, that means to stop something before it starts prophylactically.

00:23:20.765 --> 00:23:27.767
Yeah, let's just put everybody on it, but not everybody needs it and some people may become dependent on it.

00:23:27.767 --> 00:23:33.474
Let's have a happy Goldilocks zone where not everybody's on it but not nobody's on it.

00:23:33.474 --> 00:23:36.644
Let's have them in the middle where people that need it are on it.

00:23:36.644 --> 00:23:40.164
I hope, really hope, it's not $30,000.

00:23:40.596 --> 00:23:41.880
Yeah, I hope so too.

00:23:41.880 --> 00:23:42.462
That would suck.

00:23:42.462 --> 00:23:51.897
It's like yeah we have this great med nobody can afford it so just kidding, we're just going to dangle the carrot for a little bit and then, well, we did our duty.

00:23:51.897 --> 00:23:54.003
So too bad, you can't afford it.

00:23:54.003 --> 00:23:58.260
That happens with yeah, I know insulin and stuff like the new insulins and stuff.

00:23:58.260 --> 00:23:59.460
They're super expensive.

00:23:59.881 --> 00:24:02.301
Oh yeah, I know, that's just the example that comes to my head, right?

00:24:02.301 --> 00:24:07.946
Yeah, you know they can make these things cheaper.

00:24:07.946 --> 00:24:14.665
I don't want to go off on a tangent, I don't want to start sounding too cynical, because this is my happy talk.

00:24:14.665 --> 00:24:16.663
I'm excited about this medication.

00:24:16.775 --> 00:24:17.598
I don't want to be a friend.

00:24:17.598 --> 00:24:19.579
We can stay in the happy zone.

00:24:19.579 --> 00:24:20.041
That's fine.

00:24:20.041 --> 00:24:21.821
Did you have anything else that you wanted to add?

00:24:22.135 --> 00:24:30.126
I really want to come back and talk about what I've actually seen, not just what I read in a study that was one by the people that are selling it.

00:24:30.126 --> 00:24:44.207
But the idea makes a lot of sense from a scientific standpoint, like it's solid, but we just have to trust that the study was done morally and ethically.

00:24:44.387 --> 00:24:45.548
Yeah, we'll see.

00:24:45.548 --> 00:24:46.109
We'll see.

00:24:46.109 --> 00:24:52.515
Well, I'm really glad that you had the opportunity to nerd out on the HPA access, because you teased me with that in the first interview.

00:24:52.714 --> 00:24:54.921
I play a hypothalamic pituitary analysis.

00:24:56.994 --> 00:24:59.644
So I was like, oh, you're not saying anything.

00:24:59.644 --> 00:25:00.881
And so this time I was prepared.

00:25:00.881 --> 00:25:04.700
I was like I'm taking notes, we're going to talk about it this time.

00:25:05.694 --> 00:25:13.826
Well, I just want to say I teach medical students but then I also try to teach patients and I always ask my husband did normal people know what idiopathic means?

00:25:13.826 --> 00:25:17.885
Because you get to this point and you just don't know what terms.

00:25:17.885 --> 00:25:20.462
What I said on my Facebook the other day.

00:25:20.462 --> 00:25:26.515
I was just randomly talking to my husband and I said incominantly and he's like what, and I met co-occurring?

00:25:26.515 --> 00:25:27.798
And he's like that's not a word.

00:25:27.858 --> 00:25:40.047
Normal people say Like sequelae, like I just come up with it Right, but I hope I don't actually think I knew how to pronounce what is it concomitantly?

00:25:40.047 --> 00:25:42.602
I always said concomitantly.

00:25:42.602 --> 00:25:46.022
I never used the word like verbally.

00:25:46.022 --> 00:25:49.737
I always just read it and I was always too shy to try to no.

00:25:49.877 --> 00:25:55.786
I don't want to read one of those jargonapies, so hopefully I was able to make it make sense.

00:25:55.786 --> 00:25:58.759
I like analogies, so I'm trying to do more.

00:25:58.921 --> 00:26:00.999
Yeah, yeah, it makes sense to me.

00:26:00.999 --> 00:26:02.558
I was taking notes.

00:26:02.558 --> 00:26:03.798
I do recommend that.

00:26:03.798 --> 00:26:18.884
If I mean I took notes also so that I can put it out in social media, kind of written with like a diagram, so that people can kind of follow along, so yeah, hopefully, hopefully I'll get that taken care, but yeah, I mean just go back and listen a couple of times until it sinks in.

00:26:18.884 --> 00:26:22.042
I suppose that's what I'm going to do.

00:26:23.015 --> 00:26:27.355
Yeah, we're fine, all right, you can do something else concomitantly.

00:26:27.454 --> 00:26:30.282
I can do something else concomitantly, now that I know how to pronounce that.

00:26:32.016 --> 00:26:36.287
Wait, but appease you on me, not appease you on me.

00:26:36.736 --> 00:26:39.178
See, we all have our things we need to pronounce that is true.

00:26:39.178 --> 00:26:43.425
Hey, you are ratting yourself out right now because I took that out of the last episode.

00:26:43.635 --> 00:26:46.765
No, I would never claim that I can pronounce all of the things.

00:26:46.765 --> 00:26:49.103
Actually, I read something really interesting.

00:26:49.103 --> 00:26:57.463
It said don't be embarrassed if you mispronounce something, because that meant that you read it in a book Exactly and I thought oh, that's how to I did.

00:26:57.615 --> 00:27:02.507
I read concomitantly in a book and I've never heard it pronounced out loud until now.

00:27:02.507 --> 00:27:04.583
Sweet that just means that you read.

00:27:04.714 --> 00:27:06.700
I do read Yep.

00:27:10.320 --> 00:27:16.722
Well, dr Waggle, if there's not anything else, I'm going to let you go so you can get to your next appointment, because I know you're a busy gal.

00:27:16.994 --> 00:27:19.863
Yeah, I'm going to talk about this medication.

00:27:19.863 --> 00:27:21.226
It's very promising, yeah.

00:27:21.535 --> 00:27:24.924
And then definitely throw me your ideas, because I'll have you on any time.

00:27:24.924 --> 00:27:28.528
All right, I'll let you know once I get some clinical data from this.

00:27:29.036 --> 00:27:30.311
Thank you for having me.