The FDA Approved the First Pill for Postpartum Depression—Here’s How It’s Different From Other Antidepressants
Approximately one in seven women experience postpartum depression (PPD) after giving birth. This goes beyond the typical exhaustion that comes from new parenthood. With PPD, even basic functioning is difficult and, for many, it impacts the budding relationship between mom and baby. But a new sense of hope is on the horizon.
Earlier this month, the Food and Drug Administration approved the very first pill specifically made to treat PPD, Zurzuvae (zuranolone). Psychiatrists specializing in maternal mental health are excited about this new advancement, but there are some important facts they want anyone thinking about taking it to know.
How Zurzuvae Works and What Makes It Different From Other Antidepressants
“The approval of Zuranolone is a significant step forward in the treatment of postpartum depression, a type of depression that is often both underdiagnosed and challenging to treat,” says Dr. M Rameen Ghorieshi, MD, MPH, a psychiatrist and founder of Palo Alto Mind Body as well as an adjunct clinical assistant professor at the Sanford University School of Medicine. Dr. Katie Unverferth, MD, a psychiatrist specializing in reproductive psychiatry and women’s mental health, agrees, saying that it’s an extremely important new medical option for treating PPD. “It’s very exciting and I think it will help people so much faster than [existing] antidepressants,” she says.
Zuranalone works completely differently from selective serotonin reuptake inhibitors (SSRIs) and the psychiatrists say that this is because PPD is different from major depressive disorder. Dr. Unverferth explains that during pregnancy, the hormones estrogen, progesterone and allopregnanolone increase to high levels. After birth, these hormones drop drastically. “Zuranalone is treating this hormonal component of PPD,” she explains, adding that, in contrast, SSRIs block the reuptake of serotonin.
“Antidepressants like Prozac and Zoloft mainly block the reuptake of the neurotransmitter serotonin, so it can remain active between nerve cells—a process that takes a few days,” Dr. Ghorieshi says. He explains that the reason why it typically takes longer than a few days to notice a difference is that the increased serotonin level itself does not improve depression.
“Rather, it acts as a signal for your brain and body to carry out other actions—a ‘downstream chain of events’ we call it—that includes the production of new proteins, a process that can take weeks, so we see someone’s depression improve in the two to six, or even eight, week range,” he says. In contrast to SSRIs, Dr. Ghorieshi says that Zuranalone reports that women notice a difference in their mood as soon as three days.
Related: Why It's So Important That Chrissy Teigen Continues the Conversation on Postpartum Depression
Dr. Nicole Derish, MD, a psychiatrist and voluntary assistant professor of psychiatry at the University of Miami Miller School of Medicine, explains that while Zuranalone is the first pill for PPD, a version of the medication existed in IV form. Called brexacolone and marketed under the brand name Zulresso), Dr. Ghorieshi explains that this drug was given over 60 hours in a clinical setting but it has been very underutilized and hard to find. “With brexacolone, you had to be in a clinical or hospital setting the whole time and stay in bed. It was also quite expensive,” Dr. Unverferth says.
With Zuranaolone, Dr. Unverferth says women can take the pill in the comfort of their own homes. The other big selling point: It only needs to be taken for two weeks, unlike SSRIs and other antidepressants which work slower and people are on for more extended periods of time.
What To Know Before Taking It
How can you know if Zuranalone is a good fit for you? All three experts say that it’s best to talk to your doctor about it. They say that something important to consider is that, currently, it’s not considered safe to breastfeed while taking Zuranalone. Dr. Unverferth explains that this is because the drug is still so new and there is limited information available about how it could affect breast milk.
Dr. Ghorieshi adds to this, saying, “A human lactation study showed that Zuranolone is present in breastmilk at low levels, but we don’t have enough research to know if those levels are harmful to an infant.” He adds that breastfeeding has significant benefits for both mother and baby, and those considering Zuranolone will need to weigh those known benefits against the unknown risks of Zuranolone in breast milk.
“For brexanolone, which is considered to have much lower oral bioavailability than Zuranolone, most treatment centers, and some insurance companies, require that patients pump and dump breast milk while receiving treatment. I suspect most prescribers of Zuranolone will recommend the same for the two weeks or so that a patient is taking it,” he says.
In terms of side effects to be aware of, Dr. Unverferth says Zuranolone is typically well-tolerated. “The common side effects [are] tiredness and a little bit of dizziness,” she says.
As the experts have explained, one of the major benefits of the drug is that it’s quick-working; women with PPD should feel a difference in just a few days. So what if the depression continues? Dr. Unverferth says that this is when it’s appropriate to talk to a healthcare provider about taking another type of antidepressant, such as an SSRI. It should also be noted that SSRIs are considered safe to take while breastfeeding.
Since Zuranolone is still so new, the jury is still out on whether insurance companies will carry it. But Dr. Unverferth and Dr. Ghorieshi are hopeful. “I’m optimistic that insurance will cover it because of the recent FDA approval,” Dr. Ghorieshi says. “Once a medication receives a specific FDA-approved indication, the likelihood that insurance companies approve the drug for that indication increases substantially. However, like many newer treatments, it may require a prior authorization process.”
The FDA approval of Zuranolone is an exciting new step in PPD treatment. But if you try it and it doesn’t work for you, Dr. Ghorieshi says not to give up hope. “There are always more options to try, such as different medications and psychotherapy,” he says. “Don’t give up. Reach out for help.”
Next up, check out these seven science-backed ways to manage depression.
Sources
Dr. M Rameen Ghorieshi, MD, MPH, interventional psychiatrist and addiction medicine specialist who is the founder of Palo Alto Mind Body and an adjunct clinical assistant professor at the Stanford University School of Medicine
Dr. Katie Unverferth, MD, a psychiatrist specializing in reproductive psychiatry and women’s mental health
Dr. Nicole Derish, MD, psychiatrist and voluntary assistant professor of psychiatry at the University of Miami Miller School of Medicine