On March 19th 2019 FDA announced approval of the very first treatment targeting postpartum depression (PPD). Given that PPD is not that uncommon, or unknown, it might have come to you as a surprise that this is the FIRST treatment specifically tailored for PPD. Almost 1 in 9 women experience some form of PPD, and many more suffer in silence.
How does it work?
The proposed mechanism for Zulresso (brexanolone) is very interesting. Allopregnanolone levels (progesterone metabolite) rise together with progesterone during pregnancy. Given that allopregnanolone is a positive modulator of GABA receptor, the effects of this chemical are quite pleasant for the expecting mother. The trouble happens about a month before due date. The levels of allopregnanolone start dropping, leaving the mother with some unhappy GABA receptors. Depression slowly sets in. Baby is born. Sleepless nights and society induced stress push already vulnerable mother over the edge and…..postpartum depression is born.
In order to correct this Allopregnanolone depletion, the most reasonable thing would be to replace lost Allopregnanolone. The issue is poor oral bioavailability, so IV route was chosen. In order to effectively administer this medication proprietary compound brexanolone was developed. This is the proposed mechanism. Research around PPD continues.
Anything special I need to know?
Zulresso is very unique in respect to administration and monitoring.
BLACK BOX WARNING: Excessive sedation
Method of administration and dosing: Continuous IV infusion over 60 hours. Dose tapers up and down throughout the 60hr infusion.
Availability: Only available trough REMS program. Administered in certified healthcare facilities under supervision of a qualified healthcare provider.
Efficacy: Effects are seen almost immediately, with peak efficacy occurring after about 2 days. Effects of the treatment have persisted up to 30 days. The effects may be longer.
Side effects: excessive sedation, dry mouth, hot flashes
Price: $34,000 per treatment. High price may not allow many mothers access to this treatment.