Affiliation: School of Medicine, Department of Allied Health Sciences, Physician Assistant Program
Postpartum depression (PPD) is a serious and common public health issue that often goes undiagnosed and untreated. The treatment options for PPD, including antidepressants, are the same interventions used to treat major depressive disorder outside of the peripartum period; thus, they are not targeted to PPD. Novel studies of the pathophysiology of PPD implicate the role of neuroactive steroids in the regulation of Gamma-Aminobutyric Acid (GABA) A receptors. This new evidence led to the recent clinical trials which evaluate the efficacy of Brexanolone, a synthetic neuroactive steroid, for the treatment of PPD. Brexanolone is an intravenous synthetic version of allopregnanolone, which is a positive modulator of the GABA A receptor. The drug, which is administered as a continuous infusion over a period of 60 hours, was recently tested in both open-label and placebo- controlled randomized clinical trials. The results of these trials reveal an overall rapid diminishment of depressive symptoms in those with moderate to severe PPD. This impressive positive response to Brexanolone led to the US Food and Drug Administration approval of the drug in March of 2019. Brexanolone is the first targeted pharmacotherapy for this condition and marks an important turning-point for future research in the pathophysiology and treatment of PPD.