Discussing Postpartum Depression (PPD) with Lene, a Patient Ambassador for ZULRESSO ® (brexanolone) injection, for intravenous use, CIV

Deb Discenza, CEO of PreemieWorld

This blog post made possible by Sage Therapeutics.

When a pregnancy and birth does not go the way you expect, it can be a real shock.
Not in a “I have a birth plan and I want only that birth plan” kind of way. More like things
go completely awry and suddenly you have to absorb new realities about your body and your unborn baby. For preemie moms, a sudden birth can cause a massive amount of emotional upheaval whether or not the baby has to go to the Neonatal Intensive Care Unit (NICU). And for new mom Lene, a ZULRESSO Patient Ambassador, her pregnancy experience led to a struggle with PPD and ultimately she was treated with ZULRESSO, a prescription medicine used to treat PPD in adults.

As a disclaimer, Lene’s statements are based on her own experience and individual
results may vary. Speak with your doctor to see if ZULRESSO is right for you. Please
see below for Important Safety Information for ZULRESSO including information on
serious side effects.

Deb Discenza (DD): Lene, it is an honor to speak with you. Can you give us a
glimpse into your story surrounding the birth of your daughter?

My daughter wasn’t actually labeled a preemie. She was small because of limitations from intrauterine growth, and I was induced to deliver early.

Up to week 31, everything was fine. I fell off my exercise bike at home and went to
the hospital. That’s when we found she wasn’t growing. I was very confused as to
what was happening and what it all meant for the rest of my pregnancy and her life. I
had weekly visits to monitor how she was doing and if she would start growing
again. The visits went on until week 37 at which point I was induced.

On the one hand, I was excited because I was going to meet my daughter sooner
than expected. But on the other, I didn’t know what would happen. There was a lot of
anxiety. A lot of fear. I wanted to get her out so I could feed her and she could
continue growing.

We tried to have a vaginal delivery, but they had to do an emergency C-section. But
then, my anesthesia was too high and that caused other problems. It was not the
birth I had hoped for. It put a damper on my pregnancy and birth, but I had my baby with me.

My daughter didn’t have to go to the NICU even though she was born at only 37
weeks. She was an intrauterine growth restricted baby.

DD: What were your emotions like just after she was born? Did you know what
the signs and symptoms of PPD were at the time?

When she was born, I tried to feed her every two hours. It was painful because she
was so small. Her latch was very shallow. There was bleeding and lots of pain. Even
with feeding her every two hours, the doctors wanted me to pump for 30 minutes
after each feeding.

I was in awe and in love with her immediately. I was so concerned for her health and
well-being that I wasn’t thinking about myself. I wanted to make sure she would
survive and put on weight.

And I was completely exhausted. I barely got any sleep. I realized those first few
days that my nights were never going to be the same. Well, at least not for a long
time. That gave me a lot of anxiety too.

There was a moment when I was pregnant when I felt depressed. I was lying in bed
looking at my bathroom. I felt depressed all of a sudden. It only lasted a moment. I
brushed it off. I didn’t really notice anything after she was born. I had no notion that
PPD might become a part of my life. I wasn’t eating like I should. I wasn’t really
thinking about myself at all. I wasn’t paying attention to how I was feeling. I just didn’t
notice.

DD: What started you down the journey to finding help and what worked for you?

I was about four months postpartum. I was constantly taking her to and from
different doctors’ appointments. One night, she was sleeping soundly next to me, but
I couldn’t go to sleep. I was anxious and terrified of what would happen the next day.
She wasn’t eating as much as the doctors wanted her to and I was worried.
I felt trapped by my depression and fear. I was terribly unhappy. I asked my husband
to stay home that next day to help me and give me a break. And I went upstairs to
our guestroom, but I still couldn’t sleep. I researched PPD until 8am when I called my doctor. They worked me in that same day.

When I got to the appointment, I took the PPD screener. They diagnosed me right
then and there. They talked to me about different medications. The doctor was
informed about ZULRESSO, which is a treatment for women with PPD, and the
doctor thought I would be a good candidate for the medication. But in the meantime,
I started with an initial antidepressant.

I’d never been on antidepressants before, but I needed help, so I filled my
prescription. That was on Friday, and they asked me to come back the next week to
talk about getting ZULRESSO approved by my insurance. In the meantime, my
doctor told me about the possible side effects of ZULRESSO, including the serious
risk of feeling very sleepy or passing out, and that it is given by an IV for 2.5 days. I
was also informed that I would need to have someone monitor my child while I was
receiving treatment.

DD: What was the process like for you in accessing ZULRESSO? What was your
experience prior to, during and after treatment?

Because I was unfamiliar with the process, I didn’t know what to expect. Everyone
was constantly in touch with me. My Sage Central case manager. The hospital. My
doctor’s office. Everyone was calling me and coordinating the logistics for my
ZULRESSO infusion. I felt a big team supporting me.

The infusion felt like uninterrupted time to focus on myself. The hospital staff was
amazing. And I was being monitored by my doctor throughout the infusion. I did get
sleepy at some moments during treatment, which my doctors kept a close eye on.
In the middle of the night, a few days after the treatment, I remember just feeling
better. It was as if there was a shift and the PPD symptoms like my depressed mood
started to go away. This is just my experience. Other women’s experience may be
different.

DD: How have things changed for you since your PPD diagnosis and treatment
with ZULRESSO?

I feel like with the help of my medical team, that I it was able to overcome PPD. I learned to prioritize my self-care. In the beginning, I was so focused on my daughter and her health that I didn’t take care of myself. If I’m not happy and healthy, my family won’t be happy and healthy. I have to take care of myself so that I can show up and be a better mom.

DD: What would you tell another Mom about your journey with PPD?

Don’t be hard on yourself. So many mothers have gone through it and experienced
these feelings. It might last what seems like a brief moment, or it might have lasted
weeks or months.

Don’t feel guilty for feeling depressed. It’s normal. It might be due to hormone
fluctuations. And there are places to get help. Don’t look down on yourself. We
should normalize this. Being your own self-advocate is a huge part. Even when you
feel different than how someone else is telling you how to feel, that doesn’t make
your feelings wrong and you should trust yourself.

There are so many different ways that people can deal with PPD. It’s important to
work with your doctor to find the right treatment option for you.

DD: Is there anything else you would like for the community to know about your
story, your experience? To professionals? To parents?

In general, being a first-time mom is so hard because everything is so new. It’s new
and scary. And you don’t know if you’re going to mess up. But trust your baby. I feel
like I did my daughter a disservice by not listening. I was forcing her to drink milk
when she was already full. Now, I love being a mom, and I take cues from my
daughter.

Doctors have our best interests at heart and the best of intentions. But they need to
listen to our thoughts and feelings. I’m very lucky because I had a great medical
staff. I’m so grateful that they were there to answer questions—my millions of
questions. They were great to have, but I didn’t just accept what they said. I asked
questions and wanted to understand. We have to advocate for ourselves.
Looking back, I’m super grateful for my friends and family who supported me. Also,
when I shared my story, I was shocked at how many people have suffered with PPD.
You are not alone. There’s not something wrong with you, but everyone is so silent and that makes us feel alone. I wish there wasn’t this weird stigma about PPD.

DD: Your story is a powerful example of why there must be continued open
discussion regarding PPD and potential treatment options so the stigma
surrounding maternal mental health can finally be erased. I appreciate you taking
the time to share your journey with us, Lene.

Lene’s story speaks to the sense of urgency in identifying the signs and symptoms of
PPD, to feel safe in reaching out for help and, most importantly, for finding and
accessing treatment. In an age where social media pushes people to speak
authentically, perhaps that can be extended to replacing the improbable idea of an
overburdened mother who “can do it all with a smile” and, instead, a mother who
confidently advocates for her own health as well as her baby’s.

SELECT IMPORTANT SAFETY INFORMATION
These are not all the side effects of ZULRESSO.

ZULRESSO can cause serious side effects, including:
Excessive sedation and sudden loss of consciousness. ZULRESSO may cause
you to feel very sleepy (excessive sedation) or pass out (loss of consciousness). Your
healthcare provider should check you for symptoms of excessive sleepiness every 2
hours while you are awake.

– During your infusion, tell your healthcare provider right away if you feel like you
cannot stay awake during the time you are normally awake or if you feel like you
are going to pass out. Your healthcare provider may lower your dose or stop the
infusion until symptoms go away

– You must have a caregiver or family member with you to help care for your
child(ren) during your infusion

• Because of the risk of serious harm resulting from excessive sedation or sudden loss
of consciousness, ZULRESSO is only available through a restricted program called the
ZULRESSO REMS.

ZULRESSO can cause other serious side effects, including:
• Increased risk of suicidal thoughts or actions. ZULRESSO and other
antidepressant medicines may increase suicidal thoughts and actions in some people
24 years of age and younger. Pay close attention to and tell your healthcare
provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
− Attempts to commit suicide, thoughts about suicide or dying, new or worse depression, other unusual or sudden changes in behavior or mood.
Keep all follow-up visits and call your healthcare provider between visits as needed,
especially if you have concerns about symptoms.

The most common side effects of ZULRESSO include:
• Sleepiness, dry mouth, passing out, flushing of the skin or face
Call your doctor for medical advice about side effects. You may report side effects to
FDA at 1-800-FDA-1088.

Before receiving ZULRESSO, tell your healthcare provider about all your medical
conditions including if you drink alcohol, have kidney problems, are pregnant or think
you may be pregnant, or are breastfeeding or plan to breastfeed. It is not known if
ZULRESSO will harm your unborn baby. If you become pregnant during treatment, talk
with your healthcare provider about enrolling with the National Pregnancy Registry for
Antidepressants at 1-844-405-6185.

While receiving ZULRESSO, avoid the following:
• Driving a car or doing other dangerous activities after your ZULRESSO infusion until
your feeling of sleepiness has completely gone away
• Do not drink alcohol

Tell your healthcare provider about all the medicines you take, including
prescription and over-the-counter medicines, vitamins, and herbal supplements.
ZULRESSO and some medicines may interact with each other and cause serious side
effects.

Especially tell your healthcare provider if you take other antidepressants, opioids, or
Central Nervous System (CNS) depressants (such as benzodiazepines).

Please read the patient Medication Guide, including information about serious
side effects, in the full Prescribing Information.
For more information go to www.ZULRESSO.com and you can follow ZULRESSO on
Facebook.

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