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How does Zulresso (brexanolone) for postpartum depression work?

Answered by Rebecca Feldman, CNM, PMHNP, RN | Posted June 19, 2019

In March 2019, the FDA approved Zulresso (brexanolone), which is an intravenous (IV) infusion for treating postpartum depression (PPD). Zulresso is the first drug approved by the FDA that is specifically for PPD.

Brexanolone represents a novel approach to the treatment of depression. Traditional antidepressants, or Selective Serotonin Reuptake Inhibitors (SSRIs) like Zoloft (sertraline) and Lexapro (escitalopram), typically take 2 - 4 weeks to yield initial results, whereas Zulresso (brexanolone) only takes a couple of days to work. That is cause for excitement.

While brexanolone is only approved as a treatment for PPD, it may prove effective for both women and men with moderate to severe depression.

The approved treatment, one single IV drip infusion, costs $34,000. Zulresso is not a drug taken at home. It will be prescribed and administered at the hospital or other clinical setting. Current trials include investigations of an oral compound similar to brexanalone that will be able to be taken at home.

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What is postpartum depression (PPD)?

Postpartum depression is depression that occurs after giving birth. Women who experience PPD have feelings that are more severe than what some refer to as “baby blues” symptoms. “Baby blues” symptoms, occur in about 80% of new mothers, and include fatigue, worry, and sadness that often go away within a few days without need for treatment.

There is absolutely no shame in feeling that your baby blues are verging on postpartum depression. A new baby at home is a huge change and it certainly isn’t as easy as Instagram and Facebook make it look! If you even think that you have PPD, or are exhibiting any symptoms, don’t hesitate to consult your health care provider to seek help.

Symptoms of Postpartum Depression may include:

•    Excessive guilt
•    Feeling hopeless and/or helpless
•    Being distant from loved ones
•    Excessive crying
•    Irritability
•    Poor sleep and/or appetite
•    Poor bonding with baby
•    Thoughts of suicide

Resources for help for depression during and after pregnancy can be found through Postpartum Support International: postpartum.net

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How does Zulresso (brexanolone) work?

How Zulresso works is not fully known, but it is related to the GABA agonist class that works by reducing brain activity and relaxing muscles. It is administered as a single IV drip given over 60 hours continuously.

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What are the side effects of Zulresso?

The most common side effects associated with Zulresso include dry mouth, flushing, sleepiness, and the most severe being loss of consciousness. As a result, patients must be strictly monitored while taking this medication.

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How can I get Zulresso?

Zulresso is not a drug that you buy at a regular retail pharmacy. Zulresso is only available through the Zulresso Risk Evaluation and Mitigation Strategy (REMS) Program, which is a restricted program that requires the medication to be administered by a health care provider in a certified health care facility. Only certified pharmacies enrolled in the program will be able to dispense Zulresso.

Some requirements of the REMS program:

•    Patients must be enrolled to the program prior to administration of Zulresso
•    Zulresso must be given to patients as a single IV drip given over 60 hours or 2.5 days continuously
•    Patients must be monitored for over-sedation and sudden loss of consciousness
•    Oxygen levels in the blood must be monitored
•    During the infusion, patients must be accompanied if interacting with their children

Patients can learn more here:

Zulresso REMS Program

According to the manufacturer of Zulresso, the Drug Enforcement Agency (DEA) has issued a final rule designating Zulresso as a Schedule IV controlled drug. This last step has cleared the way for the company to finalize the drug label for market launch.

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How can I save money on a Zulresso prescription?

Unfortunately, when a drug is the first and only medication for treating a condition, it’s often expensive. And specialty medications usually mean even higher prices. Zulresso is no exception. As stated above, one single IV drip infusion costs $34,000.

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Can I use other antidepressant medications for postpartum depression?

The answer is yes. Some more common antidepressants like Zoloft (sertraline) , Lexapro (escitalopram), Prozac (fluoxetine), or Remeron (mirtazapine) can be used to treat PPD. However, you must be under the care of a qualified medical professional, such as a psychiatrist or psychiatric nurse practitioner, to prescribe the best medication to treat you.  

Additional outside sources: https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617

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Updated November 18, 2019

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