Zuranolone (Zurzuvae) - A Neurosteroid for Postpartum Depression

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The most likely time in a woman’s life to become depressed is in the weeks after delivery, so-called postpartum depression (PPD). Postpartum depression is more common than any other medical complication of delivering a baby. But despite the frequency of occurrence, and improvements in screening and detecting postpartum depression, the majority of cases go untreated.

Two years ago, brexanolone, a neuroactive steroid, was approved for treating PPD, but it requires a clinic or hospital visit for the 60 hour continuous i.v. infusion, and carries a $34,000 price tag. In contrast, zuranolone (Zurzuvae) is an oral pill, taken daily for two weeks. Response to either treatment starts within three days, and benefits last for at least a month after the end of treatment. Zuranolone appears effective in general depression as well, but the FDA has required at least one additional study before it approves it for that indication.

Zuranolone appears to act by binding to, and altering the shape of, the GABA-A receptor, thereby affecting how readily the neurotransmitter GABA can bind to the receptor. Although less well known than serotonin, dopamine, or norepinephrine, GABA is the most common inhibitory neurotransmitter in the brain. Most steroids also have the ability to enter the nucleus of neurons, and either activate or silence specific genes.

We may be witnessing the start of a new age in treating PPD, and depression in general.

Levels of the body’s own neurosteroid allopregnanolone, are low in children with ADHD, but are boosted by treatment with methylphenidate (Ritalin).

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References:

Zuranolone for the Treatment of Postpartum Depression (2023)

Zuranolone for the Treatment of Adults With Major Depressive Disorder: A Randomized, Placebo‐Controlled Phase 3 Trial (2023)

Brexanolone - National Institute of Health (2023 update)

Low serum allopregnanolone levels in children with attention deficit hyperactivity disorder (2022)

Differential responses of two related neurosteroids to methylphenidate based on ADHD subtype and the presence of depressive symptomatology

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Streamed live October 11, 2023

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Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions.

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