Delivery 7–10 daysZurzuvae (zuranolone) 25 mg capsules
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Description
💊 Prescription neurosteroid — the first oral drug approved specifically for postpartum depression.
▪︎ Zuranolone 25 mg capsules, a 14-day blister pack of 28 capsules (50 mg daily dose)
▪︎ Manufacturer: Sage Therapeutics and Biogen
▪︎ FDA approval: August 2023
🔬 How it works: through pregnancy the level of allopregnanolone — the calming metabolite of progesterone — rises many-fold, and the brain's inhibitory system adjusts to that background. After birth it collapses within hours, and in some women the receptors cannot readjust in time. Zuranolone reproduces allopregnanolone, strengthening the inhibitory GABA receptors. It does not act on serotonin, which is why separation from placebo appears within days rather than weeks. 📊 Evidence: SKYLARK (Am J Psychiatry 2023) in 196 patients — HAM-D fell 15.6 points versus 11.6 on placebo by day 15, with separation from day 3; ROBIN (JAMA Psychiatry 2021) in 153 patients — −17.8 versus −13.6 points (p=0.003), holding to day 45.
⚠️ Prescription-only and a controlled substance. The label carries a boxed warning for impaired driving: no driving for at least 12 hours after a dose, which is why it is taken in the evening with a fatty meal. Somnolence and sedation are common, so someone must be available to help with the baby across the 14-day course. There is no approval for major depressive disorder outside the postpartum period — that application was declined.
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