Last Friday, a breaking news alert lit up phone screens: the US Food and Drug Administration had approved zuranolone (sold under the brand name Zurzuvae), the first oral medication created specifically to target postpartum depression. Considering that the news cycle more commonly focuses on the tragic consequences of the rarest and most extreme circumstances of postpartum mental health issues (as it would for many New Yorkers the very next day), the announcement felt like a dramatic shift. And a necessary one: one in five mothers will experience a mood or anxiety disorder (or PMAD) during pregnancy or postpartum, around one in seven women may develop postpartum depression, and women of color are at a notably higher risk of both.
But can zuranolone be a fix for these wide-ranging issues? First, though it’s being touted as a first for postpartum depression (which, admittedly, makes for a very compelling headline), that’s not exactly true. In 2019, the FDA approved brexanolone, which works in a very similar way but is administered via IV instead of orally. “You can imagine all of the procedural as well as logistical complications involved in going in for an IV when you’re in the postpartum period,” says New York-based reproductive psychiatrist Lucy Hutner, MD. “It’s just not the most feasible thing to do postpartum.”
Zuranolone, on the other hand, appears to be a far more practical option. The pill works by controlling the brain’s GABA neurotransmitters, acting, Hutner points out, in the same way as our reproductive hormones. The fact that the pill works very rapidly—zuranolone is administered over the course of 14 days and in the study, results were seen after only three days—and that it’s effective on the most severe symptoms are the biggest positive takeaways, says Hutner, who sees it as a precision medicine for postpartum depression. One challenge will be determining which people will benefit from it the most. For Hutner, they will be her patients whose moods tend to fall off a cliff after giving birth in a manner that’s clinically distinct from others with PPD. “There is a subgroup of people who are particularly sensitive to reproductive hormone transitions, and giving birth is one of the biggest ones—because the levels of hormones in our brains go from sky high at the end of pregnancy, down to almost menopausal levels within 24 hours,” Hutner explains.
The scientists conducting the study measured the depression scores of participants (women with children under a year who were all suffering from severe PPD) at various points, starting at three days when they first saw positive results (impressive considering most antidepressants take two weeks to have an impact), and after they had ceased taking the medication at 15 and then 45 days. The improvements, even at day 45, were significant.