For years, Dr. Samantha Meltzer-Brody had treated mothers with postpartum depression with traditional anti-depressants when doctors at UNC Hospitals asked a mother to try a new drug that would help her symptoms more immediately. Her swift improvement was “unlike anything I’d ever seen,” Meltzer-Brody said.
That first IV infusion — more than five years ago — paved the way for more extensive clinical trials, leading up to last month’s FDA’s approval of Zulresso, the first drug specifically developed to treat postpartum depression. Meltzer-Brody calls the drug a a “game-changer.”
Meltzer-Brody, who holds several roles at UNC’s School of Medicine, was the academic lead investigator for the clinical study of the drug. For the first time, new mothers can have more immediate relief — albeit an expensive option — for the sadness, anxiety and other “disabling” symptoms that one in nine women experience after their babies are born.
The U.S. Food and Drug Administration approval drew national attention, and Meltzer-Brody was interviewed with media outlets like CNN, NBC News and CBS.
It also drew some criticism for the expected price. The company that developed it said it will cost an average of $34,000 per patient.
“Because women’s health is so neglected, so understudied, so largely ignored, to have the first drug developed specifically for postpartum depression is a big deal,” Meltzer-Brody said.
Meltzer-Brody, 50, has been an innovator in the study and treatment of postpartum depression and an advocate of promoting women’s mental health. For that reason, she is The News & Observer’s April Tar Heel of the Month, which honors people who have made significant contributions to North Carolina and the region. She will be considered later this year as Tar Heel of the Year, the news organization’s annual honor named in December.
Meltzer-Brody founded the Perinatal Psychiatric Program at UNC in 2004, which led to UNC opening the country’s first hospital unit in 2011 for women who need inpatient treatment.
She helped lead a team to develop a mobile app that screens women for postpartum depression and solicits DNA samples from volunteers for genetic study.
She’s been to sub-Saharan Africa four times in the last two years to develop maternal mental health programs. Meltzer-Brody said she enjoys international travel and seeing different cultures. Her travel stories, whether they’re about France or Malawi, have something to do with work on maternal mental health.
“It’s incredibly restorative,” she said.
And she’s president of the North American chapter of the Marce Society for Perinatal Mental Health, an international organization that promotes research and support for mothers, their babies and families.
She is modest, often deflecting the attention she has received. On the short walk from the North Carolina Women’s Hospital lobby to her office, she is friendly and direct, saying she doesn’t want this article to be all about her.
“All of this is collaborative team efforts,” she told The News & Observer this month.
Wendy N. Davis, an Oregon psychotherapist, uses the term “building bridges” to describe Meltzer-Brody’s talents, saying she excels at making connections to help advance understanding and treatment of postpartum depression.
“She’s really a unique person,” said Davis, who is executive director of Postpartum Support International. “Communication, creating bridges between science, research, academic settings, moms and advocates. Those are really essential qualities in any leader — create those bridges and communicate.”
Fighting the stigma
Meltzer-Brody feels strongly about reducing the stigma for women seeking help for their postpartum depression and speaks to national audiences on the topic. The deep depression and anxiety some mothers experience, which can lead to suicidal thoughts, often is at conflict with romanticized myths about motherhood, she said.
“This is supposed to be a happy time of life and everyone’s supposed to be joyful and if you are not, if you’re struggling, there’s an enormous shame and stigma surrounding it and a real reluctance to reach out and get help,” she said.
She talks about the science behind postpartum depression and the need to help mothers and families with equal enthusiasm.
“People may not be able to get back to work,” she said. “It can impair mother and infant bonding, setting that child up for long-term adverse health consequences.”
Dr. David Rubinow, head of psychiatry at the UNC School of Medicine, said she is a perfect person to carry that message to the public.
“She is able to speak in very clear terms,” Rubinow said. “She’s just an extraordinary clinician. She speaks plainly. She’s not shrink-y. She’s able to clearly articulate what the issues are and to identify them and translate them in ways them actionable on the part of her patients.”
Meltzer-Brody traces her interest in women’s health to her undergraduate education at a women’s college. She grew up in Ohio, where her family owned jewelry stores, and attended Simmons College (now Simmons University) in Boston.
At Simmons, there were discussions about disparities in women’s health treatment and how women of reproductive age historically are excluded from drug studies, she said.
“That meant that there was a huge gap in our understanding,” she said.
After medical school at Northwestern University, she did her residency in psychiatry at Duke University Medical Center. There, she worked with the late Dr. Marian “Mimi” Butterfield who ran the women’s health clinic at the Durham Veterans Affairs Medical Center.
“She helped me see what it would be like to run a center and a program focused on women’s health,” Meltzer-Brody said. “She was a really important role model.”
She started UNC’s first clinic for mother’s with perinatal depression when her own two children were young and “all my friends were having babies.” Her husband is Dr. Seth Brody, an OB/GYN and the chief medical officer at WakeMed Cary.
The outpatient clinic grew from what Meltzer-Brody called “a small operation,” where she saw patients a half-day a week, to clinics in several locations in the Triangle and the inpatient unit that opened in 2011.
Having hospital beds set aside for women with postpartum depression is still unusual in the United States, though they are more common in some European countries. Women from throughout the country are referred for treatment at UNC.
Having a unit where women are together and can support one another, and where they can see their babies, is important, said Dr. Mary Kimmel, the unit’s medical director.
“We’ve really piloted a lot of things in terms of treatment,” Kimmel said. “It’s still very much a unique resource.”
‘Compassionate and humble’
Meltzer-Brody went beyond the clinics in her treatment, developing PPD Act, a mobile app to aid genetic studies of postpartum depression. She hoped to understand the underlying biology and the genetic signature of postpartum depression, but collecting enough data through traditional methods can take years or decades, she said.
“The idea was, can we do this fast?” she said. “Can we conduct the first genetic study that would recruit via an app and really reach the population at large?”
The app was first available on iPhones in 2016 with the Android version a year later. The app screens users for postpartum depression, and asks some if they will participate in a genetic study. If they agree to participate, women get a “spit kit” and send it back to the National Institutes of Health. Thousands of women have contributed to the research project, and the app is in use in Canada, Australia, Denmark and Sweden, she said.
Meltzer-Brody worked with Dr. Patrick Sullivan, a psychiatric geneticist at UNC, to lead the app design and study.
Meltzer-Brody was key to assembling the team that designed the app, and getting all the work done on a tight deadline, said Carol Lewis, executive director of the UNC Center for Health Innovation.
“Samantha was the brainchild behind the app,” Lewis said. “She is so eager to jump into the deep end of the pool and get everyone else to jump in with her. It was just amazing to work with her on that effort.”
Meltzer-Brody has also been an important mentor to other psychiatrists and researchers, Davis said.
“Her brain just works at the speed of light,” Davis said. “She’s just so quick, and she’s so compassionate and humble.”
Help at a vulnerable time
Meltzer-Brody said brexanolone, the drug she studied that’s marketed as Zulresso, works faster than traditional anti-depressants. She said it’s frustrating to wait weeks or months for that treatment to work while women with new babies suffer with severe symptoms.
“Symptoms can be chronic and disabling,” she said. “It’s such a vulnerable time, and it quickly becomes a family crisis.”
Sage Therapeutics of Massachusetts developed Zulresso, which is expected to be available this summer.
Zulresso is given through an IV over 60 hours, or two-and-a-half days, and will require women to be checked into a medical center and be constantly monitored. Possible side effects include excessive sedation and sudden loss of consciousness. Health care centers that administer the drug have to be part of a special program.
The announcement of the new drug came with some criticism, though, with critics focusing largely on its cost. It’s not clear yet whether private insurance and Medicaid will pay for it.
Sage Therapeutics told The News & Observer in an email last week that it has been talking to insurance providers for more than a year, and now that Zulresso is approved, “Sage is continuing to engage payers, because the priority is that patients have access to treatment. Sage feels confident that patients will be able to access the treatment.”
Still, the approval of the drug is important to increasing awareness of postpartum depression, Meltzer-Brody said.
“Just the fact that it’s been developed and will be part of available treatment tools really is sort of changing the conversation, and certainly all the discussion about it has increased awareness,” she said. “The way I’ve seen it, every time we talk about it, every time it’s discussed in the news, someone who is at home suffering or has a family member that’s suffering may hear this conversation about it and reach out and get help.”
Hometown: Canton, Ohio
Family: Husband, Dr. Seth Brody; a son who is a college freshman; and a daughter who is a high school junior
Education: Simmons College; medical degree from Northwestern University; master’s degree in public health from UNC
Occupation: Founder and director of UNC Perinatal Psychiatry Program of the UNC Center for Women’s Mood Disorders; Ray M. Hayworth and Family Distinguished Professor of Mood and Anxiety Disorders; Associate Professor in the Psychiatry Department at the UNC School of Medicine; Executive Medical Director for the UNC Well-Being Program; President of Marce of North America