Dr. Nasuh Malas, MC3 consulting psychiatrist and Emergency Services Clinical Lead, was recently quoted in an article by the Ann Arbor Family Press, “Spotting Depression in Adolescents: Signs Every Parent Should Know.” In the article, Nasuh Malas, M.D., MPH, provides expert advice on how parents can recognize and support teens with depression.
The following article was originally published as a guest column on Bridge Michigan by Dr. Maria Muzik.
Link to the original article on Bridge Michigan’s website
On August 28, U.S. Surgeon General Vivek Murthy issued an urgent public health advisory about a crisis that has been simmering for far too long: parental stress. As parents grapple with the demands of raising children in today’s fast-paced, high-pressure world, they are breaking under the weight of exhaustion, isolation, and mental health struggles.
As both a parent and a perinatal psychiatrist with Michigan Medicine’s Department of Psychiatry Zero to Thrive program, I see this crisis every day. The parents who come to our clinics are not just tired; they are at the breaking point and their exhaustion is not a passing phase — it’s a public health emergency. The surgeon general’s advisory makes clear: Parental stress impacts entire families and communities.
But acknowledging the problem is not enough. For Michigan families, the answer must be a renewed commitment to supporting parents — because when parents thrive, so do their children.
Decades of research show that parental stress and subsequent mental health problems can negatively impact children, leading to increased anxiety, behavioral issues, and developmental delays. But we also know that with the right support, families can thrive.
Right here in Michigan, research done in my lab has proven that targeted interventions can make a profound difference. By combining mental health care, parenting education, and peer support, interventions like Mom Power or Fraternity of Fathers (FOF) groups help parents manage stress, foster resilience, and build stronger families. This evidence-based group program, along with state funded programs like the Michigan Clinical Consultation and Care (MC3) initiative, which connects families to mental health specialists, offer a comprehensive solution to Michigan’s parental stress crisis.
However, access to group-based mental health programs like Mom Power/FOF and individual psychotherapy for parents is inconsistent. While Medicaid and some commercial health plans cover individual components of programs like Mom Power/FOF, there is no explicit requirement for comprehensive coverage of specialized programs that integrate mental health care, parenting education, and peer support. This gap in standardized coverage means many families miss out on vital services.
Additionally, coverage for mental health prevention programs varies greatly depending on the insurance plan. This variability leads to inconsistencies in parental mental health services across regions, leaving some families without the necessary resources to manage parental stress.
Michigan policymakers must take bold steps to address these challenges:
In the words of the surgeon general, “The health of our nation’s families is at stake.” This isn’t hyperbole; it’s reality. If we fail to act, the costs will be staggering — not just for individual families but for our entire society. Parents are the foundation of strong, healthy communities, and their well-being is critical to the success of future generations.
The surgeon general’s report is a wake-up call. Let’s not hit the snooze button. Together, we can create a future where every Michigan family has the opportunity to thrive.
Dr. Nasuh Malas, MC3 consulting psychiatrist and Emergency Services Clinical Lead, was recently quoted in an article by the U-M Department of Psychiatry, “Suicide prevention efforts underway at Michigan Medicine,” discussing the Zero Suicide initiative at C.S. Mott Children’s Hospital.
“Zero Suicide offers the aspirational goal of minimizing suicide risk through comprehensive review of all care pathways, workflows and resources that interface with individuals and families at-risk, as well as provides an evidence-based and practical guide to the holistic transformation of health systems towards safer suicide care,” said Nasuh Malas, M.D., MPH.
The article also includes a 30-minute podcast by The Wrap, where Dr. Malas is joined by Dr. Corrie Ziegman from Mott.
Dr. Nasuh Malas, an MC3 Consulting Psychiatrist, was quoted in The Blade article, “State of mind: Mental health remains a high priority following pandemic.”
“A lot of times with younger folks, we forget that they need to have some voice in their care,” said Dr. Nasuh Malas, director of child psychiatry at the University of Michigan. He added that such interaction improves patient engagement in treatments and lends to further customization in dealing with each person’s unique situation.
MC3 Consulting Psychiatrist, Dr. Nasuh Malas, was quoted in a Relias Media article, “Clinical Pathways Combat Mental Health Stigma in EDs.”
Standardized, evidence-based clinical pathways are an effective approach to combat stigma toward individuals with mental illness in the ED setting, reports Nasuh Malas, MD, MPH, division director and service chief of Child and Adolescent Psychiatry at University of Michigan Health System.
“It is important for EDs to combat this stigma,” stresses Malas. “Everyone inherently has stigma and bias. Our job is not necessarily to eradicate stigma and bias, but to recognize it, and minimize its impact on care,” Malas says.
MC3’s perinatal medical director, Dr. Maria Muzik, was featured on a YOUR NEWS NOW segment and quoted in an accompanying article about the new postpartum depression pill, zuranolone.
“We are very excited about this new medicine because it’s the first time that we specifically target the mechanism for depression after childbirth is a very different mechanism than depression at any other time in a person’s life. Or in men,” says Dr. Maria Muzik, a perinatal psychiatrist at UM Health. “This is very specific to childbirth. And it’s very promising to go down this route because we might develop ” even better, more promising medicines following this route.”
The following story, written by Patricia DeLacey, extensively quotes Dr. Maria Muzik, MC3’s perinatal medical director.
Link to the original article on Michigan Health Lab’s website
The first oral medication to treat postpartum depression, zuranolone (branded Zurzuvae), received approval from the Food and Drug Administration in August 2023.
Taken orally once a day for 14 days, the pill starts relieving depressive symptoms after about three days and the effects last up to 45 days.
Zuranolone supplies a mimic of allopregnanolone – a neurohormone that decreases rapidly after pregnancy – that acts on receptors to reverse the withdrawal effects that impact mood.
This mechanism differs from most anti-depressants, which target neurotransmitters and take up to six to eight weeks to take effect.
The fast-acting pill offers more convenience than the postpartum depression infusion treatment, brexanolone (branded Zulresso), which has been available since 2019, but cost concerns remain.
As with all mental health medications, zuranolone should be paired with psychosocial treatment to treat all factors contributing to the disease.
“We get excited about new medicines – which are wonderful – but we put a lot of resources towards developing medicines when known psychosocial risks need our attention as well. These risks often get forgotten and stay unaddressed,” said Maria Muzik, M.D., M.Sc., a professor in the Michigan Medicine departments of psychiatry and obstetrics and gynecology.
A ‘multifactorial origin’
Like during depressive periods at any other time in life, postpartum depression is characterized by symptoms such as low energy, sad or irritable mood, sleeping/eating too much or too little, or not feeling joy in expected activities, including caring for the baby. In severe cases, postpartum depression can be life-threatening as mothers may experience thoughts of harming themselves or their child.
Both biological factors, like the shift in the hormonal landscape after birth, and psychosocial factors contribute to the development of postpartum depression, says Muzik.
“Because postpartum depression has a multifactorial origin, we also need multilevel treatments. In clinical practice, we first address psychosocial factors with a wide range of evidence-based psychotherapies and support and then address biological factors with medications,” said Muzik.
Treating postpartum depression
Psychoeducation should come first, says Muzik. Women often don’t realize they are depressed or downplay their symptoms.
“Many women feel guilty for their depressive symptoms, and we must educate them that their symptoms are part of a treatable illness. They are not weak.”
Peer-to-peer support groups, where moms support other moms, are enormously helpful. Psychotherapy, like cognitive behavioral therapy, interpersonal therapy, or parent-infant psychotherapy can help women work through their anxious or depressive feelings and support their parenting confidence while also developing strategies to avert future flare ups.
Until now, the mainstay of biological treatment for postpartum depression were anti-depressants or anti-anxiety medications that increased serotonin levels in the brain called selective serotonin reuptake inhibitors or SSRIs.
The newly approved zuranalone will offer another, mechanistically totally different, option for treating the biological underpinnings of postpartum depression.
“Postpartum depression co-occurs with anxiety even more so than major depressive disorder,” said Muzik.
“Zuranolone works on allopregnanolone receptors to decrease anxiety, insomnia, and depression associated with postpartum depression.”
Side effects of the medication include dizziness and sedation which prohibits patients from driving or operating machinery while taking the medication.
Patients cannot take the medication while pregnant and cannot breastfeed while taking the medication and for a week afterwards.
Importantly, zuranolone has an addictive potential and should be avoided in individuals with a history of addiction.
Cost concerns
It is not yet clear whether zuranolone will remain as costly as its intravenous predecessor, brexanalone.
Currently, zuranolone is FDA approved only for the treatment of postpartum depression and not for major depressive disorder.
Sage Therapeutics, the drug manufacturer, originally projected the price for zuranolone to stay under $10,000 if it was also approved for major depressive disorder. Now that the market is smaller, the price will likely increase.
If it’s not fully subsidized by Medicare or insurance companies, this medication will heighten health care inequities, says Muzik.
Those who can afford the medication or have insurance that covers it will have access and those who do not will not have access.
“I am very excited, but I also wonder what the ramifications are,” continued Muzik.
“My biggest concern is how will those who have the greatest risk and need get access to the medication?”
Resources
If you or someone you’re with is having a life-threatening psychiatric emergency, please call 911.
For mental health crises and urgent concerns, dial 988 for the National Suicide and Crisis Lifeline.
Nasuh Malas, M.D., M.P.H., a consulting psychiatrist for MC3, wrote an article for Psychiatric Times along with colleagues about the National Pediatric Boarding Consensus Panel Recommendations.
“Horror stories of patients and their families sitting in emergency departments (EDs) and medical units for days, weeks, and even months are palpable reminders of the challenges of psychiatric boarding and its impacts on patients, families, and health systems,” they write.
Dr. Joanna Quigley, an MC3 consulting psychiatrist, was quoted extensively in an article from Everyday Health, “How to talk to kids about suicide.”
“If they are thinking about it or considering it already, naming it likely offers relief that this is something that you can say out loud or talk about — and that may open doors for them to say or ask more,” Quigley says.
Dr. Nasuh Malas, an MC3 consulting psychiatrist, provided guidance about how to ease stress as students return to school in a CBS News Detroit story.
“One thing you can do is speak in a very loving and empathic tone because that shows the child that they’re cared for, and it gives them a sense of stability when you’re engaging them,” said Malas. “You also want to really provide them some structures throughout their day.”
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