Zuranolone shines a spotlight on peripartum depression

min read

Postpartum depression is a serious concern for many new parents, experienced by up to 1 in 7 people after giving birth. Mental health conditions are the leading cause of pregnancy-related death, responsible for 23% of deaths. Postpartum depression, now recognized as peripartum depression (PPD), can have a devastating long-term impact on patients and their families. A new, fast-acting, short-duration antidepressant called zuranolone could transform a challenging postpartum period for new moms and their families. While this is an exciting development, this new drug is only one piece of the puzzle: we have work to do during pregnancy, and even preconception, to set new parents up for the most positive experiences and outcomes. 

Zuranolone is the first available oral antidepressant formulated specifically for peripartum depression, with FDA approval announced last week. This development is significant for both obstetrics and psychiatry. I recently connected with experts in both fields to better understand the impact we anticipate for our patients. Dr. Nirmaljit Dhami, a maternal mental health specialist on our Medical Advisory Board, reaffirms the importance of the development of zuranolone. “This lends legitimacy to this diagnosis. Postpartum depression, postpartum psychosis are not their own diagnoses in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). We need to use specifiers for these conditions despite the fact that we know that they happen during a certain time in life.” 

Our Chief Medical Officer Dr. Bonnie Zell, an OBGYN physician, agrees: the development of zuranolone is an acknowledgment of the “impact of this issue on the lives of so many and the need for it to be addressed.” 

Zuranolone’s relatively rapid action is crucial to its unique potential efficacy for PPD. The most commonly prescribed antidepressants generally take weeks to take effect, and there are certain medications for depression that are not indicated for breastfeeding mothers. This is a significant disruption: breast milk is the best nutrition for newborns, helping them to grow and protecting them from illness. Breastfeeding also helps new parents bond with their babies, but many patients struggle to exclusively breastfeed. Taking zuranolone, a new mom may only need to take a few weeks away from breastfeeding her infant.

However, both Dr. Dhami and Dr. Zell agree that these potential benefits come with multiple caveats. Dr. Zell explains that “there’s nuance, and we still have a lot to figure out. We know how important breastfeeding is for health as well as bonding, and we don’t want to disrupt it without more evidence of the effectiveness of the drug.” 

Dr. Dhami agrees. “Some people are calling zuranolone a game-changer—I think that we as a field need to be cautious, and see if the beneficial effects from the early studies are seen in a larger, diverse population.”

In addition to a drug like zuranolone, the treatment of PPD may require psychotherapy, sleep regulation and other interventions during—and even before—pregnancy. Though PPD sometimes manifests unexpectedly, there are factors that predictably contribute to its development. Social determinants of health, factors like societal expectations of mothers, housing or food insecurity, substance use, and other systemic inequalities affect a pregnant person’s overall health, particularly their risk of developing mental health conditions like PPD. While zuranolone may treat the specific chemical changes in the brain that can cause PPD, it does not address all the underlying factors that might be contributing to a mother’s mental health.


Dr. Zell is adamant that prenatal support and early screenings for PPD are central to handling this illness. “We treat this as a discrete time-limited issue, we don’t pay attention to the fact that sometimes the mother is depressed and anxious coming into the pregnancy. We just pay attention when moms develop moderate to severe symptoms because of hormonal fluctuations—[PPD] is an accumulation of experiences, sometimes throughout the entire course of the pregnancy, that manifests as postpartum depression.”

Dr. Dhami agrees that even if proven effective, zuranolone cannot be a cure-all for postpartum depression. “Let’s focus on a composite picture of a woman’s mental health prior to and during pregnancy so that postnatally she doesn’t have to struggle with it. We can prevent postpartum depression on multiple levels like building social support, supporting adequate sleep, ensuring good nutrition, coming up with a birth plan, and addressing past trauma and complications of childbirth like pain.” Zuranalone can likely make a positive difference in our patients’ lives, but it will be most effective in conjunction with additional therapeutic modalities.

While we are excited to see the emerging literature on zuranolone and how it functions in pregnancy, we at Delfina will remain focused on supporting and counseling pregnant patients. With our unique data analysis on mood progression and social determinants, easy referrals to mental health clinicians, interpersonal non-clinical support from our team of Delfina Guides, and clinically-curated educational resources, we are laying the next-generation framework for effective maternal mental health interventions.

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