Practical Considerations of Zuranolone Use in Treatment of MDD

Roger S. McIntyre, MD, FRCPC: You know, it's interesting because earlier I had mentioned in passing brexanolone, which many would remember is approved as an intravenous [IV] treatment for adults with postpartum depression. And that's given over a period of up to, say, 60 hours. And obviously it's IV so, has to be within the medical setting. Oral zuranolone does not require it be in an inpatient setting or in that type of setting to be part of an outpatient setting. In the remaining minute or 2, we have left, Carmen, many of our colleagues might be wondering, “Well, okay, you're talking about a new target GABA. It's implicated in the pathogenesis of depression. It's also now a target capable of rapidly alleviating depressive symptomatology. We're talking about a 2-week prescription in the case of zuranolone in patients with postpartum depression. Carmen, I know you see a lot of patients. You are involved in so [many] aspects of a lived experience. Our colleagues might be wondering, is there anything different [that we] need to tell patients? Is there any sort of general tips I should tell patients about a treatment like this?

Carmen Kosicek, MSN, PMHNP-BC: It gets to create the excitement and to paint the vision that, hey, it's not a new new med, because again, this has been being used [through] IV, because that's the perception from some patients of, “Oh, it's a new med,” like there would be negative, which it's not. This has been studied. It's already been utilized and now finally it's in its oral format. I think the bigger thing is to educate patients that, “Hey, if you're really ready, open, and willing to try something to help your depression, please let me send the prescription to a pharmacy that has this on the shelf and knows how to get it into your hands.” That is truly what needs to be directed from the prescriber. Obviously, you have to have consent from the patient, but if you send some of these newer meds, it would be no different if you and I worked in oncology, Dr McIntyre, a big box pharmacy in your hometown is not likely to have all of those oncology medications. It is no different here in psychiatry. You need to utilize a specialty pharmacy where you can get them. I think the next bigger point to providers is as you paint this picture of hope for patients who are willing even ask simple questions of, “Do you have a locked mailbox? If you do have a locked mailbox, these medications can be delivered without you being home to then be signed for later because it's showcasing that it went to your locked mailbox and you can sign the form that you have a locked mailbox. So, whether you're in a rural community, suburban or urban, now with this oral formulation of the medications… you finally have quick, fast, short-term treatment options. For MDD [major depressive disorder], it's time to learn not only about the med, but how to get it.

Roger S. McIntyre, MD, FRCPC: Yeah, absolutely. Well put. And just one very practical question, Carmen. Many might be wondering if a woman [who has postpartum depression] is taking this for a couple of weeks, can she breastfeed at the same time?

Carmen Kosicek, MSN, PMHNP-BC: You know, excellent question. There's always a question in the literature about that. You have to be mindful that it could pass through into breast milk. And, again, it's the risk vs benefit that truly needs to be looked at. If you have a woman with this bad postpartum depression, it is also okay as an option to consider pump and dump. So, continue to have the ability with the milk supply growing. But that's what I would say, because no matter what the data is, it truly should be up to the mom to truly make that decision. Even from what we know, if it does or does not pass into breast milk, I would always phrase it that if there's a possibility of concern, it's okay to pump and dump so that way you can continue your milk supply. And if we don't treat the mom with postpartum depression, the mom's not going to be in turn able to care for the baby.

Transcript is AI-generated and edited for clarity and readability.