New mothers often suffer from profound and even life-threatening depression after giving birth. This can interfere with the care of the new baby, and lead to self-harm or even harm to the infant. The CDC estimates that 11-20% of women experience post-partum depression (PPD). Antidepressants like SSRIs have been used to treat PPD with some success, but the pathophysiology of PPD is different and a different type of medication may prove to be more effective.
A new medication called brexanolone (Zulresso) was recently approved by the FDA specifically for PPD. This new drug works in a different way than antidepressants. Brexanolone is chemically identical to a naturally occurring hormone called allopregnanolone. After childbirth, levels of allopregnanolone decrease sharply and this leads to depression. Brexanolone binds to GABA receptors which play a role in several brain functions. Other drugs like benzodiazepines also bind to GABA receptors, but it is a different receptor subtype, so the effects are not the same.
Brexanolone is administered as a 60 hour infusion and can only be given at a healthcare facility with continuous monitoring, so it requires hospitalization. Additionally, the healthcare facility and the patient both must be enrolled in a Risk Evaluation and Mitigation Strategy (REMS) program to monitor for excessive sedation and sudden loss of consciousness during the administration of the drug.
Although the administration of the drug is complicated, and the cost is expected to be high (around $34,000), the medication works much faster than antidepressants. Patients in the clinical trials of the drug had significant improvements even before the 60 hour infusion was completed. Most other antidepressants on the market require several weeks of use to get the full benefits. The manufacturer of Zulresso is also developing a PPD treatment in tablet form.
Read more about postpartum depression