Postpartum depression (PPD) is one of the most common complications of childbirth, affecting about 1 in 7 new moms, but a new treatment is giving families and experts hope. Zurzuvae is the first pill that the Food & Drug Administration (FDA) has approved specifically for PPD.[1] This drug could radically change care in that it works fast and at home — two important aspects when you're caring for a newborn — but some questions remain about its affordability and impact on breastfeeding.
Wondering if this new pill is right for you? Here’s what new moms need to know about Zurzuvae, according to experts.
What is Zurzuvae and how does it work?
Developed by Sage Therapeutics and Biogen, Zurzuvae is the brand name for a new PPD medication also called zuranolone.[2] It's a neuroactive steroid designed to rebalance brain signals tied to mood, behavior and thinking.
"Zurzuvae works by targeting certain neurotransmitter systems in the brain, aiming to alleviate the symptoms of depression that occur after childbirth," says Sipra Laddha, M.D, a psychiatrist and specialist in maternal mental health and a member of the What to Expect Advisory Board. "While the exact mechanisms are complex, Zurzuvae's goal is to restore mood in the postpartum period."
How is Zurzuvae different from other available treatments?
Zurzuvae differs from other treatment options in a number of ways, including how it’s administered and how it works. The medication is prescribed as a once daily, 50-milligram oral tablet for a 14-day treatment course, says Shannon Smith, M.D., a board-certified OB/GYN and a member of the What to Expect Medical Review Board.
The only other PPD-specific drug treatment on the market is an intravenous drug called Zulresso (brexanolone), also developed by Sage Therapeutics. It's fairly fast-acting, but intense and expensive. You can only receive the drug via an IV drip over a multi-day hospital stay — and the price tag reflects that.
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Other depression treatments, like selective serotonin reuptake inhibitors (SSRIs), cost less than Zulresso, but these pills don't work as fast or target PPD specifically. In fact, they operate using a different mechanism altogether. Patients typically take them for longer courses of time — usually months, not weeks — in order to achieve adequate and more prolonged mood improvement.
Ultimately, your doctor may recommend multiple PPD treatments based on your unique circumstances.
"Typically, in any depressive episode, best results are achieved with a combination of therapy and medication if needed," Dr. Laddha says. "It is best to consult with a health care professional to tailor the treatment plan."
How long does Zurzuvae take to work?
Zurzuvae only takes about two weeks to work. The reason it works so much faster than other drugs like SSRIs is that it affects different pathways in the brain, Dr. Laddha says. According to the drug trials reviewed by the FDA, participants’ depressive symptoms significantly improved after two weeks, and the effects remained after 45 days.
"Some results indicate that patients can see effects in just three days," Dr. Laddha adds. That said, the time it takes for Zurzuvae to work can vary from person to person.
Plus, some questions remain about how long the effects last given that the studies only followed women for a month and a half. It's possible that doctors may prescribe Zurzuvae for immediate relief and then another antidepressant for longer-term management.
Can you breastfeed while taking Zurzuvae?
Because some medications can pass into breast milk and there's not enough data (yet) to determine whether Zurzuvae is one of them, moms should not breastfeed while taking Zurzuvae, Dr. Laddha says.
Work with a lactation consultant and your doctor to come up with a plan if you're dealing with PPD but would like to breastfeed. Other drugs, such as some SSRIs, could help alleviate symptoms while allowing you to breastfeed safely.
Why can't you drive while taking Zurzuvae?
One of the side effects of Zurzuvae is drowsiness, so people should not drive or operate heavy machinery for at least 12 hours after taking a dose. Other common side effects include nausea, dizziness and changes in sleep patterns, Dr. Laddha says.
How much will Zurzuvae cost?
This is the million dollar question, so to speak, since Sage Therapeutics has not set prices for Zurzuvae yet. It may depend on your insurance — whether or not you have any, and if so, which kind.
"Whether Zurzuvae is covered by insurance will depend on the specific policies of each insurance provider," Dr. Laddha says. "As it's a newer medication, coverage might vary."
When will Zurzuvae become available?
Manufacturers say Zurzuvae will become commercially available by the end of the year, pending review from the U.S. Drug Enforcement Administration.
While some unknowns remain, Zurzuvae has a lot of potential to help moms and babies quickly. "It is important to recognize and offer support as early, and as quickly as possible, to our postpartum mothers, as PPD is a condition that disrupts not only the health of a mother, but also the maternal-infant bond," Dr. Smith says. "Zurzuvae appears to have the potential to be a great treatment option for these moms."
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