Dr Rachel Dalthorp Discusses the Difference Between Depression and Postpartum Depression

In this interview, Rachel Dalthorp, MD, executive medical director of Specialty Services at LifeStance Health, discusses how the only approved oral treatment for postpartum depression (PPD), zuranolone (Zurzuvae; Sage Therapeutics/Biogen), provides improved treatment for this population compared with typical antidepressants.

This transcript has been lightly edited.

Transcript

You mentioned antidepressants have often been used to treat PPD. Can you explain why the introduction of zuranolone is so impactful for this population?

Zuranolone is a neuro steroid. It is related to the hormone progesterone, and so when we think about pregnancy, we think about hormonal changes, which definitely happen after birth; we had this dramatic drop in estrogen and progesterone and other hormones. And so what we've recognized is that in certain women, their brains are sensitive to this fluctuation, and it's allopregnanolone, this metabolite of progesterone, certain women are genetically predisposed to not have a rebound in their own production of fat hormone, and it's implicated in depressive disorders.

One of the things that I think is really exciting about neurosteroids—and we're learning more about this, it's not completely known yet—but we think that there is an ability of neuro steroids to protect the brain from the longer-term effects of stress. And so when I think about this medicine, and I think about how stressful the postpartum period is, that first year of having a new baby, and all the things that come along with that—sleep deprivation, life changes. I think about wanting to protect moms from the effects of that stress, and I feel like this medication can do that, and it's really exciting.

A traditional antidepressant is going to be working on neurotransmitter levels in between the synaptic cleft of the neuron. And it's not that they don't work. The biggest drawback is that they take a long time to work, a patient has to take them every day, and they often have weight gain or sexual side effects, things that we shouldn't ask our patients to accept to have their depression treated.

Can you share any adverse effects or related concerns that may be associated with zuranolone?

So sedation is not uncommon. We had one patient that maybe had a little bit of restless leg [syndrome], but it wasn't anything significant. When you think about antidepressants as a class, there are a lot of side effects that come along with them, and patients are often asked to accept those side effects as a long-term part of their treatment, right? The great thing about zuranolone is it's just a 14-day course, right? So, a woman isn't necessarily going to be on a medication with any side effects long term. This medication is just a short-term [treatment], and so those side effects are manageable. And I think when you explain to a mom that this treatment will help her feel like herself again, will help her take care of her baby and get back to life, it's definitely worth the worth the minimal side effects that come along with treatment.