I heard there is a new medication for postpartum depression. What is it?
Last week, the FDA approved Zuranolone (Zurzuvae) for Postpartum Depression (PPD). This is the second medication to be approved for PPD (after Brexanolone (Zulresso) and the first one to come in pill form. Zuranolone, like Brexanolone, is a neuroactive steroid (hormone with ability to act in the brain) that increases the activity of the GABA-A receptors. GABA is an inhibitory neurotransmitter and can decrease the activity of a cell. It is known for its calming effects. Zuranolone works on GABA a little differently than traditional antidepressants and is thought to decrease the body’s stress response through GABA-A rather than increase neurotransmitters like serotonin, dopamine, or norepinephrine directly. Zuranolone itself is a synthetic version of allopregnanolone, which comes from the breakdown of progesterone and drops significantly in the body after the birth of a baby.
How is it different?
Zuranolone is a pill given once a day at night with a meal for 14 days. People in the two clinical trials completed started to show improvement in their depressive symptoms early in the two weeks of treatment and the majority showed an improvement in their self-reported depression symptoms (measured by the Hamilton-D scale) by day 15. Traditional antidepressant therapy can take up to 6 weeks to see initial effects of the medication, so the fact that this works quickly is unique. This is also different because the previously approved medication for postpartum depression, Brexanolone, is only delivered intravenously and under certain programs monitored for safety events. It is also costly to give. While the cost is not yet known for Zuranolone, it is hoped that it will be lower cost and more widely available to people experiencing postpartum depression.
Are there any downsides?
Zuranolone has relatively few side effects in people who received the medication. These included sleepiness, fatigue, dizziness, diarrhea, runny nose, and urinary tract infection. It is recommended that people do not drive or participate in potentially dangerous activities for 12 hours after the dose is taken because of its sedative effects. Zuranolone also has the potential for misuse and dependence and will be a controlled substance. Finally, there is potential for harm to the developing fetus if a person were to become pregnant while on Zuranolone. For this reason, it is recommended that people use contraception while being treated with Zuranolone. More data is needed to understand if there are risks associated with lactation. This is not to say that a person should not breastfeed, but that risks and benefits should be weighed while more data is gathered.
Is this something that might be good for someone I know experiencing postpartum depression?
We don’t know yet who will benefit the most from Zuranolone. It may be appropriate for people experiencing severe depressive symptoms, including suicidality, and/or people who will benefit from rapid treatment. Given that it is a 14 day treatment, it may also be appropriate for people who are unlikely to stay in care after 14 days. Finally, it is possible that this could be effective for people who have treatment resistant depression or have previously tried many medications without success.
Why is this so important?
Postpartum depression affects up to 20% of people globally. It is one of the most common complications in the postpartum period and can have negative effects on the birthing person and the baby. Approving medications specifically for postpartum depression increases awareness of this serious condition and hopefully decreases stigma around its treatment.
What do we not know about Zuranolone yet?
We don’t know how much it will cost and if people may need additional treatments after the initial 14 days. We don’t have long term data for Zuranolone, but this information will come after more people receive the medication. It is also unknown what the widespread access to this medication will be, which is important to consider.
What else do I need to know?
There ARE effective treatments for postpartum depression including antidepressants like selective serotonin reuptake inhibitors (SSRIs), therapy (like cognitive behavioral therapy), peer support, and social support. Medication alone is not the only treatment for postpartum depression and a holistic approach is needed to support people in the postpartum period. As Zuranolone and other treatments become widely available, it is important to consider access to this medication as people with the least access likely also have the least support for childcare, access to therapy, and access to other social supports.
The bottom line: Zuranolone is a new and exciting medication for the treatment of postpartum depression with relatively few side effects. It is not known who will benefit most but it is significant because it is a fast acting and effective treatment for postpartum depression. More data about how people do over time will be gathered as Zuranolone becomes more widely available.
Stay safe. Stay well.
Those Nerdy Girls
*If you or a loved one need urgent mental health help, please call 988*
If you are experiencing symptoms of postpartum depression, it is important to tell someone. If you can’t talk to a loved one or a family member, there are many resources at Postpartum Support International (www.postpartum.net). You can also call or text “Help” to 1-800-944-4773 (#2 for Spanish) to talk to someone and get help (In Spanish, Text “Help” to 1-971-203-7773. The maternal mental health hotline is also available in English and Spanish 24/7 at 1-833-852-6262 (TTY users can use a preferred relay service or dial 711 and then 1-833-852-6262.) Support groups, talking to people one on one, seeking community support (like from a faith group or community organization), and/or talking to a professional can all be helpful.
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Additional References:
MGH Women’s Mental Health Summary
NYT Article on Postpartum Depression Pill
