A pill to treat postpartum depression? It’s here

The fast-acting pill, paired with psychosocial treatment, offers a comprehensive treatment plan, but price concerns remain

5:00 AM

Author | Patricia DeLacey

woman sitting and using cell pill crib teddy bear blue pink
Justine Ross, Michigan Medicine

The first oral medication to treat postpartum depression, zuranolone (branded Zurzuvae), received approval from the Food and Drug Administration in August 2023.

Taken orally once a day for 14 days, the pill starts relieving depressive symptoms after about three days and the effects last up to 45 days.

Zuranolone supplies a mimic of allopregnanolone – a neurohormone that decreases rapidly after pregnancy – that acts on receptors to reverse the withdrawal effects that impact mood.

This mechanism differs from most anti-depressants, which target neurotransmitters and take up to six to eight weeks to take effect.

The fast-acting pill offers more convenience than the postpartum depression infusion treatment, brexanolone (branded Zulresso), which has been available since 2019, but cost concerns remain.

As with all mental health medications, zuranolone should be paired with psychosocial treatment to treat all factors contributing to the disease.

SEE ALSO: A $34,000 Drug for Postpartum Depression Brings Praise, Price Concerns

“We get excited about new medicines – which are wonderful – but we put a lot of resources towards developing medicines when known psychosocial risks need our attention as well. These risks often get forgotten and stay unaddressed,” said Maria Muzik, M.D., M.Sc., a professor in the Michigan Medicine departments of psychiatry and obstetrics and gynecology.

A ‘multifactorial origin’

Like during depressive periods at any other time in life, postpartum depression is characterized by symptoms such as low energy, sad or irritable mood, sleeping/eating too much or too little, or not feeling joy in expected activities, including caring for the baby. In severe cases, postpartum depression can be life-threatening as mothers may experience thoughts of harming themselves or their child.

SEE ALSO: Insomnia and Postpartum Depression: When a New Mom’s Sleep Loss Turns Perilous

Both biological factors, like the shift in the hormonal landscape after birth, and psychosocial factors contribute to the development of postpartum depression, says Muzik.

“Because postpartum depression has a multifactorial origin, we also need multilevel treatments. In clinical practice, we first address psychosocial factors with a wide range of evidence-based psychotherapies and support and then address biological factors with medications,” said Muzik.

Treating postpartum depression

Psychoeducation should come first, says Muzik. Women often don’t realize they are depressed or downplay their symptoms.

“Many women feel guilty for their depressive symptoms, and we must educate them that their symptoms are part of a treatable illness. They are not weak.”

SEE ALSO: A Third of New Moms Had Postpartum Depression During Early Covid

Peer-to-peer support groups, where moms support other moms, are enormously helpful. Psychotherapy, like cognitive behavioral therapy, interpersonal therapy, or parent-infant psychotherapy can help women work through their anxious or depressive feelings and support their parenting confidence while also developing strategies to avert future flare ups.

Until now, the mainstay of biological treatment for postpartum depression were anti-depressants or anti-anxiety medications that increased serotonin levels in the brain called selective serotonin reuptake inhibitors or SSRIs.

The newly approved zuranalone will offer another, mechanistically totally different, option for treating the biological underpinnings of postpartum depression.

“Postpartum depression co-occurs with anxiety even more so than major depressive disorder,” said Muzik.

“Zuranolone works on allopregnanolone receptors to decrease anxiety, insomnia, and depression associated with postpartum depression.”

Side effects of the medication include dizziness and sedation which prohibits patients from driving or operating machinery while taking the medication.

Patients cannot take the medication while pregnant and cannot breastfeed while taking the medication and for a week afterwards.

Importantly, zuranolone has an addictive potential and should be avoided in individuals with a history of addiction.

Cost concerns

It is not yet clear whether zuranolone will remain as costly as its intravenous predecessor, brexanalone.

Currently, zuranolone is FDA approved only for the treatment of postpartum depression and not for major depressive disorder.

Sage Therapeutics, the drug manufacturer, originally projected the price for zuranolone to stay under $10,000 if it was also approved for major depressive disorder. Now that the market is smaller, the price will likely increase.

If it’s not fully subsidized by Medicare or insurance companies, this medication will heighten health care inequities, says Muzik.

Those who can afford the medication or have insurance that covers it will have access and those who do not will not have access.

“I am very excited, but I also wonder what the ramifications are,” continued Muzik.

“My biggest concern is how will those who have the greatest risk and need get access to the medication?"


If you or someone you’re with is having a life-threatening psychiatric emergency, please call 911.

For mental health crises and urgent concerns, dial 988 for the National Suicide and Crisis Lifeline.

More Articles About: Gynecology obstetrics and gynecology Postpartum Depression Adult Psychiatric Treatment Mental Health Mental Health Assessment Women's Health
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories patient giving paperwork and person saying no with hand graphic moving teal white grey navy orange
Health Lab
Why new patient paperwork isn’t just busy work
While it’s easy to overlook doctor's office questionnaires, that paperwork actually serves a vital role in better understanding how to treat you. Called patient reported outcomes, this information gives medical specialists insight into how treatments truly impact you as a patient.
Health Lab Podcast in brackets with a background with a dark blue translucent layers over cells
Health Lab Podcast
A new pill for postpartum depression?
The fast-acting pill, paired with psychosocial treatment, offers a comprehensive treatment plan, but price concerns remain. Visit Health Lab to read the full story.
pink blue orange coloring woman looking at toilet, a calendar, a woman drinking purple drink, pink pills
Health Lab
Do your UTIs keep returning?
A Michigan Medicine urogynecologist discusses what urinary tract infections are, how they are treated and what new research is on the horizon.
physician talking to patient with lab researcher in background
Health Lab
Older adults left out of clinical research trials
Including older adults in research can be beneficial, explains a Michigan Medicine research, who says more should, and can be, done to have their insights.
older woman on phone with credit card in hand
Health Lab
Health plays a role in older adults' vulnerability to scams
Most older adults have faced an attempted scam, and some have been defrauded, but rates were higher among those with health problems or disabilities.
Michigan Medicine neuroscientist Huda Akil, Ph.D., accepts National Medal of Science from President Joe Biden.
News Release
U-M neuroscientist Huda Akil, Ph.D., wins National Medal of Science
Distinguished U-M neuroscientist Huda Akil, Ph.D., has received the nation’s highest scientific honor – the National Medal of Science -- for her contributions to science and their impact on humankind’s understanding of depression, anxiety, addiction and more.