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Anchor lead: One in five women may experience depression after giving birth, and a new drug may help, Elizabeth Tracey reports

Brexanolone, marketed as Zulresso, is a newly FDA approved drug for postpartum depression. Lauren Osborne, a postpartum depression expert at Johns Hopkins, describes how this drug is different.

Osborne: It’s operating by this completely novel mechanism for an antidepressant drug. It’s not related to the serotonin system, it’s related to this hormonal system, and it’s exciting to have a drug with a brand new mechanism be approved. The early studies with this drug showed that 70% of women went into remission. The later phase 3 trials not quite as different from placebo as the earlier ones. We don’t yet know a lot about the safety of breastfeeding, people have to stay inpatient for three days, it’s something like $34,000. The problem right now is going to be access.   :31

Osborne says studies to more completely assess the impact of the drug on breastfeeding infants are underway, as is an effort to develop an oral formulation, which should reduce both cost and improve convenience. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Understanding postpartum depression may help identify those at risk, Elizabeth Tracey reports

Having a new baby can be a time of joy, but for one in five women postpartum depression may interfere. Now the FDA has approved a new drug to treat the condition, and Lauren Osborne, a postpartum depression expert at Johns Hopkins, says a better understanding of how the condition develops is also emerging.

Osborne: The clear biological thing that happens is childbirth. When women go through pregnancy, their levels of reproductive hormones rise enormously across the course of their pregnancy, then within about 24 hours after childbirth those hormone levels crash down, about a thousand fold over that 24 hour period. We think it’s that hormone crash that in some women is triggering an episode of postpartum depression. There are some women who are particularly vulnerable to that transition, but we haven’t quite figured out what makes women vulnerable.  :31

Osborne welcomes the newly approved drug, called Zulresso, to help, and urges women who feel they may have the condition to see a clinician right away. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new drug for postpartum depression offers hope for a common condition, Elizabeth Tracey reports

Postpartum depression is surprisingly common, so it’s good news that the FDA has recently approved a new drug to treat the disorder. Lauren Osborne, a postpartum depression expert at Johns Hopkins, reviews what’s known about the condition.

Osborne: Postpartum depression is the only time in a human’s lifetime when we have a clear biological trigger that is related to a mood episode. The actual symptoms of postpartum depression aren’t so different from depression at other times of life but we know that there’s that biological trigger and it’s something like 15 to 20% of women will develop a postpartum depression. We actually know the rate is much higher in certain populations. Women who are of low income, low socioeconomic status, or have a lot of risk factors like a strong family history or their own prior history of depression, their rates are even higher.  :34

Osborne says any woman who feels she may be experiencing postpartum depression should seek help immediately. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What is the impact of psychosocial factors on outcomes after surgery? Elizabeth Tracey reports

How do psychosocial factors, such as reaction to stress, impact recovery after cancer surgery? According to a study by Ira Leeds, a surgical resident and postdoctoral fellow at Johns Hopkins, and colleagues, when taken along with the presence of other medical conditions, quite a lot. And the study indicates that accounting for psychosocial factors at the time of surgery may be important.

Leeds: Typically with surgery, you’re diagnosed with cancer and relatively quickly if you have a cancer that is surgically resectable you’re going to take as much as that out as fast as possible and then move on to the longer term modality of chemotherapy. People have really played down the importance of these psychosocial risk factors in that surgical paradigm. There’s been a much stronger push to say, get them to surgery as fast as possible then focus on these longer term risk factors in the longer term period following surgery. I think what this research is showing though is that in order to do the surgery effectively you do have to consider these psychosocial risk factors.  :32

Leeds says further research will explore interventions. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: New risk factors for poor surgical outcomes have been identified, Elizabeth Tracey reports

How well do you cope with stress? Do you have people in your life who will help if things go awry? Such factors, called ‘psychosocial risk factors,’ may have an impact on how well you recover from surgery if you also have other health conditions such as diabetes. That’s according to research by Ira Leeds, a postdoctoral fellow and surgical resident at Johns Hopkins.

Leeds: We found that the magic number is about two. So if someone has two psychosocial risk factors or more, and they have a medical comorbidity, the combination leads to patients having a higher risk for postoperative complications. And it’s not a small risk, it’s a real risk, it’s about a thirty percent increased risk. That’s on par with comparing a patient who has zero diabetes and a patient with uncontrolled diabetes. So in talking on the grand scheme of is this a clinically significant risk, the answer is it’s an significant as any of the things we think of as a risk factor before surgery.  :28

Leeds says evaluating psychosocial risk factors along with other known risk factors such as preexisting health conditions may help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why would someone with HIV donate a kidney? Elizabeth Tracey reports

Have you ever considered donating a kidney? People do so for a number of reasons, including helping a loved one and giving back. Dorry Segev, one of the transplant surgeons at Johns Hopkins involved in the recent historic kidney transplant between an HIV positive donor and recipient, also asked the donor that same question.

Segev: When you ask people with HIV if they would become living donors and why, you get solidarity with other HIV positive individuals, a feeling that not only did they control their disease but they conquered their disease. Years ago HIV was a death sentence. Even today HIV is associated with so much stigma and to destigmatize this by saying not only am I okay, but I can give a part of my body to somebody and save their lives as well, that’s really exciting.  :33

Segev hopes others with HIV will consider kidney donation. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Does having HIV make kidney transplantation more risky? Elizabeth Tracey reports

HIV infection today is a chronic, manageable condition, so much so that life expectancy for someone with HIV is essentially the same as someone without the virus. Dorry Segev, one of the transplant surgeons at Johns Hopkins who performed the recent kidney transplant between two HIV positive people, says the risks for both should be the same as if they weren’t infected.

Segev: The risk for an HIV positive kidney donor we don’t fully know because nobody has ever done this before but the science seems to suggest that it’s not much higher than the risk for anybody else without HIV to donate. On the recipient side the risk of getting transplanted with HIV is no higher than the risk of getting transplanted without HIV, and in fact, the benefit of the transplant is higher for patients with HIV because they don’t do as well on dialysis.  :30

Segev notes that medications used to keep HIV in check don’t interfere with those needed after kidney transplant. At Johns Hopkins, I’m Elizabeth Tracey.

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