Celebrating Utah moms with new efforts to treat maternal mental illness

As Americans celebrate the mothers in our lives, health care professionals here in Utah are increasing their commitment to improving treatment and understanding of the mental health challenges women experience during and after pregnancy.

Each year in the United States, it is estimated that more than 400,000 babies are born to depressed people. Postpartum depression is often underdiagnosed and undertreated, according to the most recent statistics compiled nationally and locally. Research has confirmed an alarming trend. Maternal mental illness is now considered the leading cause of pregnancy-related deaths in the US

Nationally, one in five women suffer from perinatal and postpartum mood disorders. Here in Utah, the statistics show that this is more than just psychological struggles. Between 2015 and 2016, 75 percent of pregnancy-related deaths in the state were associated with mental illness, and many of them were preventable.

“By 2022, in 14 states, including Utah, suicide and overdose were the two most common reasons women died in the first year after giving birth,” according to Jamie Hales, LCSW, clinical director of the Institute of Huntsman Mental Health (HMHI) and co-chair of the board of Postpartum Support International Utah.

In March, the state expanded comprehensive Medicaid coverage for postpartum women from 60 days to a full 12 months. Motherhood certainly doesn’t end with childbirth and it doesn’t end 60 days after a baby is born. The effort to expand Utah’s Medicaid coverage was supported by lawmakers in the state Senate and House of Representatives during the 2023 session.

“This is something that Utahns are paying attention to,” said Utah State Representative Rosemary Lesser, MD, who is an OB/GYN. “When I was taking care of women on Medicaid, we would be struggling to meet our health care goals in 60 days.”

Applying for Medicaid is not easy. But it can be worth the effort. The federal poverty level for an individual is $14,580. Today, the average birth in the US costs between $10,000 and $16,000. It’s not hard to see why women dealing with postpartum mental health issues can often struggle to get the long-term care they desperately need.

As a result of the federal government’s approval of Utah’s expanded Medicaid coverage, 4,000 additional women in the state will now be eligible for a full year of postpartum coverage. Medicaid currently covers 41% of all births in the United States, and with the approval of Utah’s plan, 691,000 women in 45 states, the District of Columbia and the U.S. Virgin Islands will have a longer life expectancy postpartum care

US Health and Human Services Secretary Xavier Becerra applauded Utah and the state’s medical community for supporting this critical program. “With this step, thousands of Utah women will now have the security and peace of mind that continuous coverage provides, during one of the most important times in a new parent’s life,” she said.

Left untreated, postpartum mood disorders can negatively affect the critical period when women recover from childbirth, deal with any complications of childbirth, bond with their newborn, and transition care obstetrics in primary care. That’s why conversations about postpartum depression are vital. Utah women will now benefit from greater access to health care professionals during the postpartum period.

These conversations can pave the way for individual women to make decisions about their treatment. “We can talk about everything from conservative options like improving your sleep and diet to getting outside and doing some type of exercise,” said Lauren Gimbel, MD. “We can also talk about therapy, and for some individuals, we talk about medication.” Gimbel provides obstetrics and gynecology care to patients at University of Utah Health. She is also the Obstetric Clinical Lead for Perinatal Mental Health at U of U Health in collaboration with HMHI.

Gimbel added that the most effective form of treatment is usually to use all of these strategies, with a combination of therapy and medication being the most effective. Medication is another area where significant progress has been made over the past year. In August 2023, the Food and Drug Administration approved Zuranolone (Zurzuvae), the first oral drug for postpartum depression, and it became available for prescription in December.

The once-a-day pill is taken for 14 days at home and works much faster than other antidepressants. Antidepressants can typically take two to four weeks to show improvement in symptoms, and some patients simply do not want to use traditional antidepressants. “For some patients, the main advantage of Zuranolone may be that it works faster,” Gimbel said.

Providers and their patients expressed concern after Sage Therapeutics, the developer of Zuranolone, announced that the wholesale cost of a 14-day treatment would be $15,900. However, as of March 1, 2024, Zuranolone is covered by Utah Medicaid’s list of previously authorized drugs. For private insurance plans, a healthcare professional can explain that you need Zuranolone and request an exception, even if the drug is not currently listed as covered.

Gimbel hopes researchers will take the time to study the long-term response to Zuranolone in women currently taking the drug. During the FDA trials, patients were only studied for 45 days. “Anytime someone is treated with an antidepressant and has good outcomes, we really try to make sure that they have that stability for 6 to 12 months once their mood is stable,” he said. “This decreases the chances of repetition.”

The message sent through all of this work by caregivers at both the state and federal levels is simple: Moms matter.

With greater access to care, new interventions, and insurance coverage during all stages of pregnancy, the goal of healthier, happier parents and babies can be achieved here in Utah and across the country.

If you or someone you know may be struggling with perinatal/maternal mental health issues, you can learn more about programs that address maternal mental health and find a provider through the Huntsman Mental Health Institute. For a list of local agencies and support groups available, visit Postpartum Support International Utah.

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