You’ve just given birth, you’re holding your beautiful newborn in your arms, and yet you can’t enjoy this moment you’ve been dreaming of for nine long months because your world feels like it’s crashing down around you. This is the feeling of postpartum depression, and until recently, the only option was to take standard antidepressants—which can take weeks to start working—and miss out on critical early bonding time with your newborn. A new prescription antidepressent specifically for postpartum depression may change all that. Zulresso (generic name: brexanolone) is designed to start working within a day.
“This approval is a big deal because brexanolone acts differently than all other antidepressants and it starts to work quickly,” explains Samantha Meltzer-Brody, MD, MPH, director of perinatal psychiatry at the University of North Carolina School of Medicine in Chapel Hill and a lead author on the trials that led to the drug’s approval.
Time is of the essence
Different than the baby blues, postpartum depression is a serious and potentially life-threatening condition that can last for weeks or even months. Symptoms such as extreme sadness, debilitating anxiety, and exhaustion make it difficult for a new mom to care for herself and her newborn. Untreated, postpartum depression can hamper a new mother’s ability to bond with her baby—and this can have lasting consequences. That’s just one of the things about postpartum depression that your OB/GYN wishes you knew.
Doctors deliver the new drug via a 60-hour infusion, and that one dose can last at least 30 days—which is often enough time to get new moms through the critical period. Other antidepressants take weeks or even months to start working and they don’t work for everyone, explains Dr. Meltzer-Brody. During this early infusion, mothers are attended in a medically supervised setting—generally the hospital where they gave birth—and monitored for risks, such as dizziness and fainting. Meanwhile, baby is likely be able to visit mom during treatment.
So, how does brexanolone work differently than other antidepressants? During pregnancy, levels of the female sex hormones estrogen and progesterone climb sky-high, then dramatically plummet after birth. It is this striking hormonal shift that can trigger symptoms of postpartum depression in vulnerable women. Where traditional antidepressants target the mood chemical serotonin, brexanolone is a hormonal fix that boosts levels of a key progesterone byproduct that activates mood receptors in the brain. This helps explain why it so swiftly reverses mood and other symptoms of postpartum depression in postpartum moms. Researchers are studying whether administering brexanolone earlier to women who are susceptible could prevent postpartum depression altogether.
Unfortunately, the drug may be out of reach for many women: Media reports suggest the cost will average $34,000—not including the costs of labor, delivery, and stay in a medical center—making the new drug a prime candidate for our most expensive prescription drugs in America list. Insurers may cover some of the expense.