What’s the New Treatment for Postpartum Depression?

The FDA recently approved the first oral medication for postpartum depression. Here’s what this medical breakthrough means and how the new pill compares to the IV treatment already available.

During pregnancy, your body and brain go through extreme physical and hormonal changes. Alongside the physical toll, growing and birthing a baby also requires an incredible amount of emotional work.

To put it very mildly, pregnancy, childbirth, and the postpartum period (the period following birth) are difficult and draining. And some people experience the difficult sides more than others.

In the weeks leading up to or following childbirth, it’s fairly common to develop a mental health condition called postpartum depression (PPD).

While historically, this condition has been downplayed, increased attention and advocacy around PPD in recent decades has now resulted in the development of the second FDA-approved PPD pharmaceutical treatment in less than 5 years.

We take a look at the two available treatments and what they can mean to anyone experiencing PPD.

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What is postpartum depression?

Postpartum depression, or PPD, is a serious and relatively common condition. PPD can be dangerous and even life threatening in certain cases.

An estimated 1 in 7 people develop PPD. Older research, however, suggests that as many as half of all potential PPD cases go undiagnosed due to the stigma around the condition. This means that the number of people silently living with PPD may well be higher.

PPD generally develops after giving birth, during the period that’s sometimes called the “fourth trimester.” In these cases, most people will develop the condition within 6 weeks after delivery. It’s also possible to develop PPD during the third trimester of pregnancy, before giving birth. (During pregnancy, PPD is called perinatal depression.)

PPD can have debilitating effects on the mental and physical health of anyone living through it. It can also impact their relationship with their new baby.

Many symptoms overlap with general depression symptoms.

What are the treatment options for postpartum depression?

The FDA recently announced approval for the second PPD-specific treatment. There are now two pharmaceutical treatments for PPD:

• Zulresso (brexanolone): This is an injectable medication administered through IV in healthcare facilities and hospitals to provide near-immediate relief.
• Zurzuvae (zuranolone): This is an oral medication taken in pill form for relief from depression symptoms.

Zulresso, the first medication aimed specifically at treating PPD, was approved by the FDA back in 2019. In August 2023, the FDA approved Zurzuvae, the first oral medication for PPD treatment.

Zulresso is currently available. Zurzuvae is expected to be available sometime at the end of the year.

Prior to these PPD-specific medications, people experiencing PPD could turn to talk therapy and traditional antidepressants for help. While traditional antidepressants are effective at treating depression, symptom improvement can take up to 6–8 weeks. For people experiencing an onset of PPD, this timeline is a long wait. 

Doctors continue to recommend talk therapy for PPD in addition to any pharmaceutical treatment, whether Zulresso (IV injection), Zurzuvae (pill), or traditional antidepressants.

IV vs. pill: Which PPD treatment is right for me?

If you or someone you know is dealing with PPD, it’s critical to get help. In addition to talk therapy, these new pharmaceutical treatments can be an incredibly important, effective, and safe source of treatment.

Any treatment decisions should be made with the help of a doctor. They can help you figure out which course of action is right for you.

In the meantime, here’s a breakdown comparing Zulresso and Zurzuvae:

How do you take them?

Zulresso

Zulresso is an injectable medication administered through an IV. During treatment, Zulresso is delivered continuously for 60 hours. The dosage in the IV infusion varies depending on the treatment timeline. Patients stay in bed for the entire treatment.

Due to the risk of potentially serious side effects — most notably loss of consciousness — Zulresso treatment is only available in a medical facility under the supervision of a professional.

Not all medical facilities can administer Zulresso. Both facility and patient need to be enrolled in a special program prior to treatment.

Zurzuvae

Zurzuvae is a pill taken once daily for 14 days. The pill should be taken in the evening alongside a meal high in fat. The daily recommended dose is 50 milligrams (mg).

Constant medical supervision is not required. Zurzuvae can be taken from anywhere, paving the way for at-home PPD treatment.

What are the side effects?

Potential side effects of Zulresso include:

• excessive sedation or excessive sleeping
• sudden loss of consciousness
• drowsiness
• dry mouth
• hot flushing of the face or body

You’ll have to avoid driving or operating heavy machinery after Zulresso treatment until all sedating or drowsy effects have worn off.

Potential side effects of Zurzuvae include:

• drowsiness
• dizziness
• diarrhea
• nasopharyngitis (common cold symptoms)
• urinary tract infection

You’ll need to avoid driving or operating heavy machinery for at least 12 hours after taking your daily dose of Zurzuvae, as it can make you drowsy.

Can you take them while nursing?

For both Zulresso and Zurzuvae, current data is limited concerning breastfeeding.

Available data suggests that both medications are present in low levels in breast milk. Lactation studies found the following calculated maximum relative infant doses:

• Zulresso: 1–2% during infusion
• Zurzuvae: Less than 1% over 5 days of treatment

There is no data on the effects of either medication on a breastfed infant.

People who need medication to treat their PPD should speak with a healthcare professional to determine if they should breastfeed during treatment.

How much do they cost?

When Zulresso was released in 2019, it cost $7,450 per vial. With multiple vials needed for one course of treatment, the total cost can hit over $30,000. This fee does not include the cost of staying in a healthcare facility while the medication is administered.

Out-of-pocket expenses for Zulresso vary depending on insurance coverage.

The cost of Zurzuvae is not yet known. Sage Therapeutics, the manufacturer of both PPD medications, has said they will announce the Zurzuvae price tag closer to the medication’s release. Biotech and financial analysts estimate a cost of several thousand dollars for a treatment cycle.

Insurance coverage for Zurzuvae remains a question until more information is known about the cost.

As medical communities and new parents wait for news about the price of Zurzuvae, the hope is that fees won’t be a barrier to getting treatment.

PPD can affect anyone — from the most vulnerable to the most privileged — and financial resources should not determine who can and can’t get help.

How effective are they?

Prior to the release of both Zulresso and Zurzuvae, research was conducted for each medication. The results of these studies show that both medications are effective forms of treatment for PPD.

In both studies involving Zulresso, depressive symptoms improved for participants immediately after the 60-hour IV infusion. Participants continued to show improvements at the end of the 30-day follow-up period.

During the Zurzuvae studies, PPD symptoms improved for participants by day 15, the last day of their treatment courses. These positive effects were still present at the end of the follow-up period, 4 weeks after the participants’ last dose of Zurzuvae.

Medical treatment: A new way of thinking about PPD

People dealing with PPD often experience feelings of shame and inadequacy, both because of the very real medical condition they’re going through and because of the way society views parenthood.

The stigma around PPD is so strong that if and when a new parent feels anything other than joy and happiness with their newborn, some assume they have “failed.”

Inevitably, this means that countless people have hidden their PPD from medical professionals, family, and friends — whether consciously or unconsciously. Many with PPD symptoms may not have the vocabulary to recognize what’s happening to them. Others may not know how or be able to reach out for help.

It’s incredibly important to recognize — and say out loud — that there’s nothing shameful about PPD.

There’s nothing inherently or morally wrong with you if you experience depression after giving birth (or at any point in your life). Nothing about PPD is your fault, and you’re not a bad parent or a bad person if PPD happens to you.

Postpartum depression is a medical condition. As such, it should be given the same clinical attention and societal grace as any other medical condition.

That’s partly why the recent FDA approval of a new oral pill for PPD is so significant. Recognition of the disease is pushing pharmaceutical companies to develop effective and convenient treatment options.

With two medications now available specifically for PPD treatment, we’re on the road to reshaping how we view PPD, and we’re that much closer to making help available to those who need it.

The bottom line

Postpartum depression is a serious mental health condition that can develop as someone reaches the end of their pregnancy or soon after giving birth. We now have two forms of medication specifically for PPD treatment.

Both medications have been found to effectively treat PPD, providing relief from symptoms and remission from the condition.

No one should have to go through postpartum depression alone. Reaching out to the people around you or to your doctor can be the first step toward getting better.

The course of treatment that’s right for you will depend on your unique circumstances. Your doctor can talk you through your options and help develop the best treatment plan for your needs.