Postpartum depression: the first specific oral treatment

Postpartum depression occurs in the context of physiological hormonal changes in the perinatal period, especially allopregnanolone, a neurohormone that acts on GABA (gamma-aminobutyric acid) receptors in the brain. It is produced from progesterone, one of the most important pregnancy hormones. During pregnancy, progesterone gradually rises until it reaches its peak during the third trimester, then declines quickly after birth. Allopregnanolone follows the same kinetics of gradual increase and then sudden decline. Several studies have shown that low allopregnanolone is directly associated with symptoms of postpartum depressionStress and social isolation reduce the level of this molecule in the brain, and adults with depression generally have lower levels.

Based on these results, A new class of antidepressants Featured: Positive allosteric modulators of GABAA receptors. there Brexanolone It is already indicated in DPP in the United States (but not in France): it received the “Breakthrough Therapy” label and FDA approval in March 2019. Unlike classical antidepressants that have a long onset of action, this is a synthesis neurosteroid. It exerts a rapid antidepressant effect, starting within a few hours to a few days. Meta-analysis Randomized, placebo-controlled clinical trials confirm its efficacy and safety in this indication. However, brexanolone Requires intravenous infusion over 60 hours.

Another synthetic neurosteroid, this time Administered orally, zoranoloneIt was recently FDA approved (At a dose of 50 mg/day, once a day, it should be taken For 14 days In the evening with a fatty meal and in combination with contraceptives).

The US agency based its decision on two recent experiences.