• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Brexanolone: A New Treatment for Postpartum Depression

Brexanolone: A New Treatment for Postpartum Depression

January 1, 2019
Chris Aiken, MD
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Chris Aiken, MD Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC. Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

There is a need for rapid treatment in postpartum depression, as each month of this potentially severe condition can take a toll on infant development. That is why brexanolone (Zulresso), which was recently fast-tracked for approval by the FDA, is causing such a splash.

Brexanolone is a neurosteroid that activates GABAA receptors. It was originally developed as an anticonvulsant before its antidepressant properties were discovered. The pending approval is based on three randomized, double-blind, placebo-controlled trials involving 267 women with moderate or severe postpartum depression (Meltzer-Brody S et al, Lancet 2018;392:1058–1070). Most were not taking antidepressants. Patients randomized to brexanolone surpassed those on placebo by 2–5 points on the Hamilton Depression Rating Scale. Furthermore, most of the responders (94%) maintained their improvement for 30 days after administration of the medication, which is given as an injection. Women with severe depression saw the greatest improvements. Longer follow-up data are not available, but an oral version of the drug is being developed that could play a role in prevention. The treatment was well-tolerated, with mild increases in headache, dizziness, and somnolence.

Is it just for postpartum depression?
Brexanolone’s mechanism is particularly relevant to the postpartum period, but it plays a role in other psychiatric disorders as well. It is actually a prescription form of allopregnanolone, a neuroactive steroid with known effects in anxiety, depression, aggression, and negative symptoms of schizophrenia in both women and men (Schüle C et al, Prog Neurobio 2014;113:79–87). Basically, brexanolone is to allopregnanolone as levothyroxine is to thyroxine (T4).

Allopregnanolone activates GABAA receptors, the same ones responsible for the anxiolytic effects of benzodiazepines. Its levels rise during pregnancy and then fall abruptly after childbirth. Some women are particularly sensitive to that fall, and the state of GABAergic withdrawal it creates is thought to be one of the pathways to postpartum depression. Allopregnanolone levels also rise and fall during the menstrual cycle, though to a lesser degree, and those fluctuations are thought to contribute to premenstrual dysphoric disorder (PMDD).

In other psychiatric disorders, it is low levels of allopregnanolone rather than fluctuations that appear to play a role. Allopregnanolone is persistently low in major depression, post-traumatic stress disorder, and chronic stress. Several antidepressants raise allopregnanolone levels (SSRIs, tricyclics, and mirtazapine). However, as with most hormones, balance is the issue. Too much allopregnanolone can cause anxiety, depression, and irritability (Bäckström T et al, Prog Neurobiol 2014;113:88–94).

What’s next?
The FDA is expected to make a final decision on brexanolone in early 2019. If approved, there will still be hurdles to overcome because brexanolone must be delivered as an IV infusion over 60 hours. Unless overnight clinics step in to supervise the treatment, hospitalization will be required.

An oral version is expected in the future, and that may broaden its indications. Oral brexanolone (SAGE-217) has a positive randomized controlled trial in major depression and is currently undergoing phase III clinical trials for that condition.
General Psychiatry
KEYWORDS news_of_note
    Aiken eic 150x150
    Chris Aiken, MD

    Ketamine Assisted Therapy Part I

    More from this author
    www.thecarlatreport.com
    Issue Date: January 1, 2019
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Deprescribing, TCPR, January 2019
    Brexanolone: A New Treatment for Postpartum Depression
    Is Ketamine Just Another Opiate?
    Cannabidiol for Schizophrenia
    Wellbutrin Augmentation: When Does It Work?
    Deprescribing Medication
    Prescription CBD Is Available, But Are We Ready to Use It?
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.