Tim Tai, Senior Photographer

Content warning: This article contains references to suicide.

The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 988. 

Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7 and confidential.

To talk with a counselor from Yale Mental Health and Counseling, schedule a session here. On-call counselors are available at any time: call (203) 432-0290.  Appointments with Yale College Community Care can be scheduled here.

Students who are interested in taking a medical leave of absence should reach out to their residential college dean.

Additional resources are available in a guide compiled by the Yale College Council here.

As Alexis Joy D’Achille was about to give birth, a complication temporarily cut off her then-unborn daughter’s breathing. Though her daughter survived the birth without complications, Alexis blamed herself. 

Like one in seven new mothers across the nation, Alexis began suffering from postpartum depression. This is the most common complication associated with pregnancy, said Katrina Furey, a psychiatrist at the Yale School of Medicine. It is also undertreated. 

“Almost immediately, things were different,” said Steven D’Achille, Alexis’s husband. “She started to become very anxious. She couldn’t shake the thought that her very first act of motherhood was harming our daughter.”

Doctors prescribed Alexis the medication Zoloft, which is intended for major depressive disorder. But after starting on the medication, her condition worsened dramatically. Instead of switching her medication, her doctors doubled the dose.

For Alexis, though, the common treatments for major depressive disorders did not help with postpartum depression. In 2013, just six weeks after giving birth to her daughter, Alexis died by suicide.

Her husband hopes that the Food and Drug Administration’s recent approval of zuranolone — the first oral medication to specifically target postpartum depression — could prevent more stories like this one.

“I’m so excited for it because at least someone’s trying to do better,” said Steven D’Achille. “I’m sure there’s women that are alive today because of that drug.”

Postpartum depression manifests in the weeks and months after childbirth, Furey said, and it can be debilitating. The condition can lead to a loss of interest or pleasure, difficulty sleeping, feelings of worthlessness or guilt, fatigue, impaired concentration or indecisiveness, suicidal ideation and changes in weight or appetite. 

Unlike brexanolone, the alternative treatment for postpartum depression, zuranolone is typically taken orally for two weeks, Furey told the News. Patients can take the pill at home, whereas brexanolone requires patients to recieve doses intravenously for 60 hours in a hospital. During clinical trials, zuranolone showed promising results in treating symptoms in as few as three days.

According to Furey, zuranolone reduces symptoms of postpartum depression by tapping into the biology that causes the condition. 

During the third trimester of pregnancy, estrogen and progesterone levels are at their peak. When labor begins, and the baby is delivered, these hormone levels drop significantly and cause a major shift in the body’s chemistry. Some women are sensitive to this hormonal shift, which can lead to postpartum depression and other mental health issues.

  Zuranolone acts like a synthetic version of the hormone allopregnanolone, a byproduct of the hormone progesterone that is known for its calming effects. Women with postpartum depression tend to have lower allopregnanolone levels in their blood, so zuranolone is designed to supplement allopregnanolone levels in mothers with postpartum depression.

However, zuranolone was ineffective in people with major depressive disorder. 

“When they took pregnancy out of it, they didn’t see that effect,” Furey said. “It suggests there’s something unique about postpartum depression’s biology.”

As in Alexis’s case, doctors often prescribe medications for major depressive disorder to mothers with postpartum depression — but the results can be mixed. 

While Zoloft may have been ineffective for Alexis, it was difficult for her to receive treatment at all. After calling mental healthcare professionals for weeks while she was alive, Steven received calls back as late as two months after Alexis’s funeral. And when she talked to providers, Steven added, they often dismissed the idea Alexis was suffering from postpartum depression.

That situation is not unique to Alexis, Forey said. Only about 25 percent of women who are positively screened for postpartum depression receive treatment. In comparison, 61 percent of people who screened positive for major depressive disorder received treatment.

Some experts believe that developing an accessible drug that targets postpartum depression might help validate mothers’ experiences with the condition. 

“It will destigmatize things because there’s a medication that validates that experience,” said Dr. Joan Combellick ’91, an assistant professor of nursing at the Yale School of Nursing. “In a way, there’s part of me that is discouraged that we rely on a medication to validate something like a mental health condition.”

Zuranolone, however, might not be a panacea. There are still concerns surrounding the drug, Furey said.

None of the studies on zuranolone so far have looked at their safety for nursing mothers. While Furey would still recommend it to women, she acknowledged that some providers might be hesitant to prescribe it given the lack of testing on nursing mothers.

Still, Steven believes that zuranalone will offer a long-term net positive, even if it does not become a leading treatment.

“If it’s not zuranalone, there’s something good that’s going to come from it,” Steven said. “There are a lot of moms in the crowd that it did help.”

Zuranolone was developed by the biotechnology company Biogen.