Dr Rachel Dalthorp: Zuranolone Improves Access to Postpartum Depression Treatment


"As a health care provider and as a psychiatrist, it's something that I think about first—instead of step therapy, when I have a patient with postpartum depression, this is what they need to be on," Rachel Dalthorp, MD, explains.

About a year ago, the FDA approved the first oral treatment indicated for postpartum depression (PPD): zuranolone (Zurzuvae; Sage Therapeutics/Biogen). In an interview with The American Journal of Managed Care®, Rachel Dalthorp, MD, executive medical director of Specialty Services, LifeStance Health, discusses how the new treatment option offers better care access for patients with PPD and her experience prescribing it in her psychiatry practice.


Can you share some background on zuranolone and its impact on postpartum depression treatment?

When we think about postpartum depression and treatments, it's really taken, gosh, 20 years to see the medicines that are out now. So we've got 2 options. The first that was available for patients to be treated with, brexanolone, was a 60-hour IV [intravenous] infusion; it really represented a new way to treat postpartum depression using a neurosteroid, where traditionally we have used antidepressants that are effective for depression and anxiety, but not necessarily specifically for PPD. This was an innovative medicine with a differentiated mechanism of action and, most importantly, a very rapid onset.

In my practice, when brexanolone became available, we couldn't find a place to send our patients for treatment because it has to be provided in a monitored setting; it's a little bit more difficult for patients to access. But we successfully treated 154 moms, and it's a transformative medicine, right? So we see women coming in who are incredibly depressed, unable to take care of themselves and their babies, and then in just 3 days, we could see them transform in front of us. Seeing that in a patient, knowing the impact of untreated postpartum depression, it's something that really has motivated us to keep along this path. But the access-to-care issues really kept a lot of moms from getting treatment.

So, with zuranolone, what we see is an equal efficacy for treating moms with PPD and an equally rapid onset, but we've removed some of the barriers to getting that care, so mom doesn't have to leave home and potentially be separated from her baby or her family. She can take the medication at home for 14 days. And it's just opened up this easy-to-access medication that's so effective. We're not where we need to be in terms of getting moms into treatment, and there are a lot of reasons for that, but it really is a huge change in the field. As a health care provider and as a psychiatrist, it's something that I think about first—instead of step therapy, when I have a patient with PPD, this is what they need to be on.


FDA approves first oral treatment for postpartum depression. News release. FDA. August 4, 2023. Accessed June 19, 2024.

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