What you need to know about the first FDA-approved treatment for postpartum depression

Childbirth and the months that follow often involve balancing recovery, learning how to feed and care for a newborn, and trying to make time for sleep and other forms of self-care. It can take time to adapt to such a life-changing event, and the transition is easier for some than others. But beyond the anticipated challenges, many pregnant people and those who have recently given birth struggle with intense sadness, feeling overwhelmed, and disinterest in their newborn—a condition called postpartum depression (PPD).

PPD affects an estimated one in eight women in the United States. If you have PPD, it means your depression lasts more than two weeks after childbirth and it affects both your daily activities and your ability to care for your infant.

In the past, many people with PPD who didn’t respond to lifestyle adjustments and talk therapy relied on oral antidepressant medications, which can take weeks to provide relief. In 2019, the U.S. Food and Drug Administration (FDA) approved Zulresso (brexanolone), the first drug specifically for the treatment of PPD. It’s an intravenous (IV) treatment, which means it’s delivered to patients directly through a vein. (In 2023 the FDA approved Zurzuvae (zuranolone), the first oral medication to treat PPD.)

Here’s what you should know about Zulresso and whether it may be a good treatment option for you.”

The basics of Zulresso for PPD

Zulresso takes effect quickly—in some cases, within 24 hours—and maintains its effectiveness for up to 30 days after it is administered. While it’s not entirely clear how Zulresso works, one theory is it reduces symptoms by helping the brain adjust to hormonal changes, such as the sudden drop in progesterone levels people experience right after giving birth.

Zulresso is given through a 60-hour IV infusion, which administers the medication directly into your blood through a vein. The drug is only available through a restricted program, known as the Zulresso Risk Evaluation and Mitigation Strategy (REMS). It must be administered by a healthcare provider (HCP) in a certified healthcare facility, specifically, a hospital or infusion clinic. During this time, you will be monitored for side effects, such as sudden loss of consciousness and excessive sleepiness. You will be able to see your baby during this time, but the newborn must be accompanied by another adult.

Zulresso is not for everyone

Most nonpregnant people with PPD are eligible for this treatment, but you should talk to your doctor about the risks and benefits if you:

• Are breastfeeding or are planning to breastfeed
• Drink alcohol
• Have kidney problems or end-stage kidney disease

It’s important to tell your HCP about any prescriptions (particularly other antidepressants), over-the-counter medications, vitamins, or supplements you’re taking prior to treatment. Also tell your HCP if you become pregnant again before receiving the drug, as it’s not known whether it will harm your fetus.

The high price of the drug may also be an issue. Insurance may cover some, or most, of the costs, and Zulresso’s maker, Sage Therapeutics, offers co-pay assistance programs if you have health insurance. If you have questions about your insurance and the cost of Zulresso, ask your HCP.

How to recognize PPD

It’s important to be aware of your individual risk factors for PPD. This could help you recognize the difference between PPD warning signs and typical postpartum anxiety linked to hormonal fluctuations and major life changes, also known as the “baby blues” or “postpartum blues.”

Some people are more susceptible than others to having PPD, including those who had a hard time getting pregnant, have a personal or family history of depression, experienced pregnancy or birth complications, or have a child who was hospitalized after birth. People who lack support from family and friends or experience a stressful life event, like a family illness or the recent loss of a loved one, are also at greater risk.

While PPD is different for everyone, signs of the condition are similar to those associated with major depressive disorder. If you have PPD, you are likely to experience a variety of symptoms, like:

• Feeling sad, hopeless, empty, or overwhelmed
• Crying more often than usual
• Feeling angry
• Withdrawing from family and friends
• Feeling disconnected from the baby
• Worrying that you may hurt your baby
• Feeling guilty about not being a good parent
• Experiencing suicidal thoughts

Seeking help for PPD is essential

Symptoms of PPD usually occur one to three weeks after delivery, but they may arise up to a year after giving birth. If you think you may suffer from PPD or if you develop any of the warning signs associated with the condition, it’s important to talk to your HCP right away. Untreated PPD can make it harder to properly care for your child and, in more extreme cases, cause thoughts of suicide or harming your baby. If you’re feeling like you want to hurt yourself or your baby, call 911 immediately.

Whether your HCP recommends Zulresso, other medications, talk therapy, or something else, there are many effective ways to treat your symptoms. Your HCP will work with you to determine what course of action is right for you.