The Carlat Psychiatry Podcast So Long, Brexanolone
Jul 14, 2025
Brexanolone has stepped aside, leading to the rise of zuranolone in treating postpartum depression. This transition raises intriguing questions about potency and safety, especially for breastfeeding mothers. The podcast dives deep into the classifications of postpartum depression and reveals zuranolone's unique properties as a neurosteroid. Don't miss insights on its potential effects on bipolar disorder and a comparison to current treatment options, setting the stage for a broader discussion on mental health.
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Potency Difference: IV Vs Oral
- IV brexanolone had a large treatment effect with an effect size of 1.2, much higher than oral zuranolone's moderate effect size of 0.5.
- This potency difference is key, as IV medications often achieve higher plasma levels and stronger effects than oral formulations.
Why IV Brexanolone Was Withdrawn
- IV brexanolone faced many challenges: lengthy 60-hour infusion, REMS requirements, and the need for monitored certified healthcare settings.
- These factors led Sage Therapeutics to withdraw it and develop an oral alternative with easier administration.
Zuranolone's Fast-Acting Mechanism
- Zuranolone works quickly, showing results within three days, making it useful for postpartum depression's urgent needs.
- It specifically targets the drop in neurohormones like allopregnanolone, a core cause in postpartum depression.