Samantha Meltzer-Brody

• MD, MPH
• Managing Director at University of North Carolina at Chapel Hill

Task-sharing and telemedicine can increase access to effective psychotherapies. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) is pragmatic, multisite, noninferiority, four-arm trial that tested the non-inferiority of provider (non-specialist vs. specialist providers) and modality (telemedicine vs. in-person) in de...

Background Zuranolone is an investigational positive allosteric modulator of synaptic and extrasynaptic GABAA receptors and a neuroactive steroid in clinical development as a once-daily, oral, 14-day treatment course for adults with major depressive disorder or postpartum depression (PPD). The randomized, double-blind, placebo-controlled SKYLARK St...

Depressive disorders present an enormous global public health burden. A notable treatment gap exists between the prevalence of depression and our ability to provide rapid-acting, effective treatment that achieves remission. Brexanolone and zuranolone, the first US Food and Drug Administration–approved drugs for postpartum depression, signify a crit...

Postpartum depression (PPD) is a mood disorder affecting one in seven women after childbirth that is often under-screened and under-detected. If not diagnosed and treated, PPD is associated with long-term developmental challenges in the child and maternal morbidity. Wearable technologies, such as smartwatches and fitness trackers (e.g., Fitbit), of...

Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocia...

Aims Estimate relative efficacy of zuranolone, a novel oral, Food and Drug Administration-approved treatment for postpartum depression (PPD) in adults vs. selective serotonin reuptake inhibitors (SSRIs) and combination therapies used for PPD in the United States. Materials and methods Randomized controlled trials (RCTs) for zuranolone and SSRIs, i...

Introduction Major depression (MD) is more common amongst women than men, and MD episodes have been associated with fluctuations in reproductive hormones amongst women. To investigate biological underpinnings of heterogeneity in MD, the associations between depression, stratified by sex and including perinatal depression (PND), and blood biomarkers...

Postpartum depression (PPD) affects nearly 20% of postpartum women in Sub-Saharan Africa (SSA), where HIV prevalence is high. Depression is associated with worse HIV outcomes in non-pregnant adults and mental health disorders may worsen HIV outcomes for postpartum women and their infants. PPD is effectively treated with psychosocial or pharmacologi...

Background Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers...

Objective: Postpartum depression (PPD) is a common subtype of major depressive disorder (MDD) that is more heritable, yet is understudied in psychiatric genetics. The authors conducted meta-analyses of genome-wide association studies (GWASs) to investigate the genetic architecture of PPD. Method: Meta-analyses were conducted on 18 cohorts of Eur...

Background Option B + offers lifelong ART to pregnant or breastfeeding mothers, but postpartum loss to HIV care, partially driven by perinatal depression (PND), threatens the impact of this policy. This study aims to understand women’s and providers’ preferences for developing a feasible intervention to address PND and support engagement in HIV car...

This article reviews novel neurosteroid therapeutics for post-partum depression, with a focus on their development, clinical trial data, current practices, and future directions in this exciting field. We discuss the clinical impact of brexanolone and several other neurosteroids, particularly as they relate to the treatment of postpartum depression...

Introduction: Sex steroid hormone fluctuations may underlie both reproductive disorders and sex differences in lifetime depression prevalence. Previous studies report high comorbidity among reproductive disorders and between reproductive disorders and depression. This study sought to assess the multivariate genetic architecture of reproductive dis...

Objective: Postpartum depression (PPD) is a common perinatal complication with adverse maternal and infant outcomes. This study investigated the efficacy and safety of zuranolone, a positive allosteric modulator of synaptic and extrasynaptic GABAA receptors and neuroactive steroid, as an oral, once-daily, 14-day treatment course for patients with...

Brexanolone, a formulation of the neurosteroid allopregnanolone (ALLO), is approved for treating postpartum depression (PPD) and is being investigated for therapeutic efficacy across numerous neuropsychiatric disorders. Given ALLO’s beneficial effects on mood in women with PPD compared to healthy control women, we sought to characterize and compare...

Perinatal depression (PND) is common and an important barrier to engagement in HIV care for women living with HIV (WLHIV). Accordingly, we adapted and enhanced The Friendship Bench, an evidence-based counseling intervention, for perinatal WLHIV. In a pilot randomized trial (NCT04143009), we evaluated the feasibility, acceptability, fidelity, and pr...

Objective: To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. Study design: We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the...

Objectives: To examine: (1) the psychometric properties of two therapist competence measures-multiple choice questionnaire (MCQ) and standardized role-plays; (2) whether therapist competence differed between non-specialist (NSPs) and specialist (SPs) providers; and (3) the relations between therapist competence and patient outcomes among perinatal...

Perinatal perceived stress can contribute to worse health outcomes for the parent–child dyad. Given the emerging relationship between the microbiota-gut-brain axis and stress, this study sought to elucidate connections between bowel symptoms and the gut microbiome in relation to perceived stress at three time points in the perinatal period: two dur...

Background: Brexanolone has rapid, long-lasting, and remarkable efficacy in the treatment of post-partum depression (PPD). We test the hypothesis that brexanolone inhibits proinflammatory modulators and macrophage activation in PPD patients, which may promote clinical recovery. Methods: PPD patients (N = 18) provided blood samples before and aft...

Postpartum depression (PPD) is a leading cause of morbidity and mortality among women. Clinically, the administration and withdrawal of supraphysiologic estradiol and progesterone (E2 + P) can cause affective symptom reoccurrence in women with a history of PPD, but not matched controls. To investigate the cellular basis underlying this differential...

Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota, reflecting environment and social interactions, alongside host immune responses have the potential to better understand perceived stress and identify when stress is excessive in pregnancy. Two U.S. cohorts of 84 pregnant individuals, comp...

Background Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity cl...

Background Postpartum depression (PPD) and postpartum psychosis (PPP) are linked to negative consequences for women and families. Virtual applications present a solution to the challenge of recruiting large samples for genetic PPD/PPP research. This study aimed to evaluate the feasibility of a protocol for enrolling Canadian women with PPD and PPP...

Purpose of Review Telemedicine has transformed our ability to access and offer mental healthcare. There remain key questions to facilitate scalable, patient-centered solutions for perinatal mental health. We critically evaluate the recent literature and propose potential future directions. Recent Findings The current literature highlights the prom...

Purpose Assess postpartum depression and psychotic symptoms from three continents. Methods Compare numbers of women with depression and psychotic symptoms, mania with or without psychotic features, or transient non-affective psychosis and medication choice. Results The prevalence of postpartum depression and psychosis and treatment choice differe...

The COVID-19 pandemic has been particularly difficult for mothers. Women with a history of peripartum depression (PPD) may be vulnerable to relapse. We sought to understand changes in depressive and anxious symptoms throughout the pandemic and which stressors increased symptoms in women with a history of PPD. In June 2020, all US participants with...

Background Brexanolone is currently the only treatment specifically approved for postpartum depression (PPD) in the United States, based on the results from one Phase 2 and two Phase 3 double-blind, randomized, controlled trials in the HUMMINGBIRD program. Methods Adults with PPD randomized to a 60-h infusion of brexanolone 90 μg/kg/h (BRX90) or p...

Objectives: This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women...

Background Hospitalists are physicians trained in internal medicine and play a critical role in delivering care in in-patient settings. They work across and interact with a variety of sub-systems of the hospital, collaborate with various specialties, and spend their time exclusively in hospitals. Research shows that hospitalists report burnout rate...

Introduction: Postpartum depression (PPD) is a prevalent and debilitating disease that may affect medication adherence and thus maternal health and vertical transmission among women with HIV. We assessed the feasibility of a trial of interpersonal psychotherapy (IPT) versus antidepressant medication (ADM) to treat PPD and/or anxiety among postpart...

Background Perinatal depression is a common and disabling mental health problem in Malawi and other Low- and middle-income countries. There is evidence for effective psychosocial interventions for perinatal depression, but no such intervention has been developed for use in Malawi. The broad aim of this study was to explore the cultural appropriaten...

Postpartum depression (PPD) affects 1 in 7 women and has negative mental health consequences for both mother and child. However, the precise biological mechanisms behind the disorder are unknown. Therefore, we performed the largest transcriptome-wide association study (TWAS) for PPD (482 cases, 859 controls) to date using RNA-sequencing in whole bl...

Background Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota reflects the environment, lifestyle, and the perinatal period. The gut microbiota, alongside host immune responses, has the potential to aid in identifying when stress is excessive. Methods Two U.S. cohorts, of 84 pregnant indi...

Context : Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being. Objective : To evaluate the impact on well-being of a self-compassion program modified for surgical residents. Design : This is a 3-year, mixed-methods study using pre-post surveys and focus groups to identify areas for pr...

During the COVID-19 pandemic, outpatient psychotherapy transitioned to telemedicine. This study aimed to examine barriers and facilitators to resuming in-person psychotherapy with perinatal patients as the pandemic abates. We conducted focus group and individual interviews with a sample of perinatal participants (n = 23), psychotherapy providers (n...

In the United States, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers. Although awareness of and action on perinatal mental health is increasing, significant gaps remain. Screening and treatment are widely recommended but unevenl...

Depression and anxiety during pregnancy and postpartum are common, but affected women differ in timing, trajectories, and extent of symptoms. The objective of this pilot, feasibility study is to analyze trajectories of serotonin and tryptophan-related metabolites, bile acid metabolites, and microbial composition, in relation to psychiatric history...

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical...

Background: Brexanolone (Zulresso) is the first Federal Drug Administration (FDA) approved drug for the treatment of postpartum depression (PPD). Brexanolone is a positive allosteric modulator of the GABAA receptor, and is given over 60 hours by infusion in a medical setting. This drug has been shown to be effective at significantly reducing Hamil...

Background Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. Methods This cross-sectional analysis included 179...

Background Genetic factors influence susceptibility to postpartum mood disorders (PPMDs). However, the genetic architecture of PPMDs remains poorly understood. This study explored the genetic architecture of depressive symptom severity in a transdiagnostic sample of Canadian women with self-report PPMDs. Methods Women with self-reported current or...

BACKGROUND: During the COVID-19 pandemic, essentially all outpatient psychotherapy with perinatal patients transitioned to telemedicine. The aim of this study was to examine how to resume in-person psychotherapy with perinatal patients within the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial as the pandemic...

Importance Postpartum depression (PPD) is one of the most common medical complications during and after pregnancy, negatively affecting both mother and child. Objective To demonstrate the efficacy and safety of zuranolone, a neuroactive steroid γ-aminobutyric acid receptor–positive allosteric modulator, in PPD. Design, Setting, and Participants T...

Treatment of perinatal mood and anxiety disorders (PMADs) requires an individualized approach that considers the health and well-being of the mother, the infant, and the mother-infant relationship. The known risks of untreated illness are weighed against the potential risks and benefits of treatment. There are important pharmacologic considerations...

The establishment of perinatal psychiatry as a specialty field can be traced to the 1980s and the inception of the Marcé Society in the United Kingdom. Inspired by the works of nineteenth-century French psychiatrist Louis-Victor Marcé, the Marcé Society launched 50 subsequent years of progress towards improving research, clinical treatment and educ...

This chapter provides a way of thinking about perinatal mood and anxiety disorders (PMADs) broadly: their definition and expression, as well as their similarities to and differences from depression and anxiety disorders outside of the perinatal period. We review the epidemiology and then describe our current understanding of the underlying pathogen...

Exploration of photoplethysmography (PPG), a technique that can be translated to the clinic, has the potential to assess the autonomic nervous system (ANS) through heart rate variable (HRV) in pregnant individuals. This novel study explores the complexity of mental health of individuals in a clinical sample responding to a task in late pregnancy; f...

Background History of psychiatric disorders, particularly depression, is the strongest risk factor for perinatal depression (PND). Yet many women without such history experience their first depression episode perinatally, whilst other women with depression history do not experience any episodes during the perinatal period. PND may itself be heterog...

Objectives Amongst women with a history of depression, this study sought to identify risk factors associated with reporting perinatal depression (PND)). Lifetime prevalence, length and severity of PND were evaluated, as well as the effect of PND onset either after previous depression episodes, or as the first episode of depression.SettingThe Austra...

Objective To evaluate the health-related quality of life (HRQoL) burden associated with postpartum depression (PPD), determine the extent to which clinical response impacts HRQoL, and estimate the impact of PPD and clinical response on healthcare resource utilization (HRU) and productivity. Methods Patient data (n = 127) from two multicenter, rand...

Maternal postpartum depression (PPD) is a significant public health concern due to the severe negative impact on maternal and child health and well-being. In this study, we aimed to identify genes associated with PPD. To do this, we investigated genome-wide gene expression profiles of pregnant women during their third trimester of pregnancy and tes...

BACKGROUND Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth but significant gaps in screening and treatment remain. OBJECTIVE We investigated the clinica...

Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study ai...

Women worldwide are two to three times more likely to suffer from depression in their lifetime than are men. Female risk for depressive symptoms is particularly high during the reproductive years between menarche and menopause. The term “Reproductive Mood Disorders” refers to depressive disorders triggered by hormonal fluctuations during reproducti...

Importance Screening for anxiety and depression is important but especially difficult during pregnancy. Identification and quantification of the variation of maternal biologic dimensions during the dynamic pregnancy period, e.g. immune and microbiome profiles, have the potential to greatly improve mental heath screening and patient stratification....

Background: Brexanolone (BRX) injection was approved by the United States Food and Drug Administration in 2019 for the treatment of adults with postpartum depression (PPD) based on two Phase 3 clinical trials. Materials and Methods: Data from the three trials were combined. PPD-specific 17-item Hamilton Rating Scale for Depression (HAMD-17) group-...

The objective of this study is to explore the associations between the patient-reported Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ)-9 and clinician-reported 17-item Hamilton Depression Rating Scale (HAMD-17) in order to facilitate clinical decision-making. An integrated efficacy dataset of three randomized pla...

BACKGROUND Postpartum depression (PPD) is linked to long-standing negative consequences for women and families. Virtual care applications present a solution to the challenge of recruiting large samples for genetic PPD research. OBJECTIVE This study evaluated the feasibility of using an iOS mobile application (PPD-ACT app) to collect genetic sample...

Background Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. Methods We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 wome...

Recent years have seen a surge of methylome-wide association studies (MWAS). We observed that many of these studies suffer from test statistic inflation that is most likely caused by commonly used quality control (QC) pipelines not going far enough to remove technical artefacts. To support this claim, we reanalysed GEO datasets with an improved QC...

INTRODUCTION One proposed etiology of postpartum depression (PPD) involves dysfunctional GABAergic signaling. Brexanolone injection (BRX) and SAGE-217, two neuroactive steroid GABAA receptor positive allosteric modulators, have been evaluated in a total of 4 double-blind, randomized, placebo-controlled trials (RCTs). METHODS Inclusion criteria: ad...

Background: Brexanolone injection (BRX) was approved by the FDA in 2019 for the treatment of adult patients with postpartum depression (PPD), but its cost-effectiveness has not yet been evaluated. Objective: To estimate the cost-effectiveness of BRX compared with treatment with selective serotonin reuptake inhibitors (SSRIs) for PPD. Methods:...

Postpartum depression (PPD) is a unique subtype of major depressive disorder and a substantial contributor to maternal morbidity and mortality. In addition to affecting the mother, PPD can have short- and long-term consequences for the infant and partner. The precise etiology of PPD is unknown, but proposed mechanisms include altered regulation of...

Background: Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. Methods: We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted interviews with 24 women experienc...

The Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium was created to increase our understanding of the heterogeneity of the perinatal period and to address the gaps in knowledge. This international research consortium subscribes to successful models of team science, whereby collaboration and sharing of clinical phenotypic...

Despite many prevailing societal beliefs, parents often experience mood and anxiety symptoms during the postpartum period, often referred to as postpartum distress (PPD). The aim of this study was to explicate whether aspects of role functioning during the postpartum period are associated with PPD, and whether this association may be partially expl...

La brexanolone (BRX) et SAGE-217 sont des stéroïdes neuroactifs modulateurs allostériques positifs du récepteur GABAA, évalués dans des essais randomisés, en double aveugle versus placebo (RCT) dans la dépression du post-partum (PPD) et le trouble dépressif majeur (MDD). Trois RCT ont évalué l’efficacité et la tolérance de la BRX : perfusion de 60...

Postpartum psychiatric disorders are heritable, but how genetic liability varies by other significant risk factors is unknown. We aimed to (1) estimate associations of genetic risk scores (GRS) for major depression (MD), bipolar disorder (BD), and schizophrenia (SCZ) with postpartum psychiatric disorders, (2) examine differences by prior psychiatri...

Background: Postpartum depression (PPD) is a common and gravely disabling health concern. Repetitive transcranial magnetic stimulation (rTMS) is an FDA approved treatment for major depression and may be a valuable tool in the treatment of PPD. The treatment effect of rTMS is rapid, generally well tolerated, without systemic effects, and without me...