Dr Rachel Dalthorp: Zuranolone, the First Line of Treatment for Postpartum Depression

Public policy changes and a growing emphasis on maternal health have contributed to the awareness of zuranolone (Zurzuvae; Sage Therapeutics/Biogen) as the only oral treatment for postpartum depression (PPD), highlighting the importance of addressing maternal mental health. In this interview, Rachel Dalthorp, MD, executive medical director of Specialty Services, LifeStance Health, explained to The American Journal of Managed Care® that if untreated, PPD can have lasting negative effects on both mothers and their children, potentially leading to generational mental health issues. Additionally, zuranolone is recommended as the first line of medication, alongside psychotherapy, to effectively manage PPD and mitigate long-term impacts.

This transcript has been lightly edited for clarity.

Transcript

Has the awareness of zuranolone as a treatment option for postpartum depression increased since becoming available on the market?

I think one of the things that I've seen in the last few years—and I increasingly see things pop up on LinkedIn or Facebook—is this public policy change. There's a lot of emphasis on maternal health in general, we realize that we have a lot of work to do there and maternal mental health. So, we know that in the postpartum period, suicide in combination with drug overdose is the number one cause of death. We know that perinatal mood and anxiety disorders are more common than gestational diabetes and we do a great job of screening for that. So, I think that we have an increasing awareness out there. And the next step is to help moms understand that getting treatment is the way to go.

We know that untreated or undertreated postpartum depression impacts her but also her baby and what we're learning is that that impact is long-lasting for children and families. And so we think about PPD, we know that there's a genetic component to that. But what I think isn't realized is there's an epigenetic component to it. So what that means is when you have a baby with a mom who's depressed, the baby actually has epigenetic changes in terms of their ability to handle stress, their ability to have resilience and manage life. And so those children are going to grow up and they're going to be more susceptible to mental health issues themselves. And in that way, it's generational. So this medicine represents an opportunity to stop that so that children of mothers who are depressed don't grow up and have children themselves and perpetuate the impact.

How does zuranolone compare to other treatment options available for postpartum depression?

Yes, I think that there are some misconceptions out there with health care providers. So zuranolone is the only FDA-approved oral antidepressant for PPD. And fortunately, our payers do not require step therapy for a woman to access that medication, right? In psychiatry and in health care in general, we have these treatment algorithms and we think: step 1, step 2, step 3. Step 1 for medication is going to be zuranolone; why go to an SSRI that isn't FDA-approved for PPD and why put a mom through 6, 8 weeks of waiting to see if it's going to benefit.

So, first of all, zuranolone needs to be the step 1, the first medication step that is prescribed. I always encourage psychotherapy as well because we can all benefit from that. But I think if we are really watching our patients closely if we are aware of the risks that are associated with developing PPD and keep a really close eye on these moms, we need to make sure we see them postpartum if they have risk factors, and then get them treated quickly to minimize the long term impact of untreated PPD.