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The U.S. Food and Drug Administration (FDA) has given its stamp of approval to Zurzuvae (zuranolone), marking it as the first oral medication specifically designed to treat postpartum depression (PPD) in adults. PPD is a major depressive episode that typically occurs after childbirth but can also manifest during the later stages of pregnancy. Until now, PPD treatment options were limited to intravenous injections administered by healthcare providers in specific healthcare facilities.
Tiffany R. Farchione, M.D., the director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research, emphasized the seriousness of postpartum depression. She highlighted that women experiencing PPD might grapple with feelings of sadness, guilt, worthlessness, and in severe cases, even harbor thoughts of harming themselves or their child. Furthermore, PPD’s impact on the maternal-infant bond can have significant consequences for the child’s physical and emotional development. The approval of an oral medication like Zurzuvae is expected to offer a valuable treatment option for women dealing with these extreme, and at times, life-threatening emotions.
Similar to other forms of depression, PPD is characterized by a persistent sense of sadness and/or loss of interest in activities that were once enjoyable. Affected individuals may experience a decreased ability to experience pleasure and present with symptoms like cognitive impairment, feelings of inadequacy, loss of energy, and even suicidal thoughts.
Zurzuvae’s effectiveness in treating PPD in adults was demonstrated through two thorough and robust clinical studies. These studies were randomized, double-blind, placebo-controlled, and conducted at multiple centers. Participants in the trials were women diagnosed with PPD, meeting the criteria for a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders. The onset of their symptoms occurred either during the third trimester of pregnancy or within four weeks after childbirth.
In Study 1, patients received a daily dose of 50 mg of Zurzuvae or a placebo, taken in the evening for 14 days. In Study 2, patients received another zuranolone product that was approximately equivalent to 40 mg of Zurzuvae or a placebo, following the same 14-day regimen. Participants were closely monitored for at least four weeks following the 14-day treatment period. The primary endpoint for both studies was the change in depressive symptoms, assessed using the total score from the 17-item Hamilton depression rating scale (HAMD-17) on Day 15. Patients in the Zurzuvae treatment groups exhibited significantly greater improvements in their symptoms compared to those in the placebo groups. These positive effects were sustained up to Day 42, which was four weeks after the last dose of Zurzuvae.
The labeling for Zurzuvae includes a boxed warning alerting users to the potential impact on their ability to drive and perform other hazardous activities. Patients may not accurately assess their degree of impairment, necessitating caution. To mitigate potential risks, patients should refrain from driving or operating heavy machinery for at least 12 hours after taking Zurzuvae.
Some of the most common side effects associated with Zurzuvae include drowsiness, dizziness, diarrhea, fatigue, symptoms of the common cold (nasopharyngitis), and urinary tract infections. It is essential to be aware that Zurzuvae may trigger suicidal thoughts and behavior. Furthermore, the medication may cause fetal harm, so women taking Zurzuvae should use effective contraception while on the treatment and for one week after discontinuing its use.
The recommended daily dose for Zurzuvae is 50 mg, to be taken once every day for a total of 14 days. It is best taken in the evening, preferably with a fatty meal.
The FDA granted priority review and fast-track designation to the application for the approval of Zurzuvae, recognizing its significance in addressing the critical need for an effective oral treatment for PPD.
The FDA’s approval of Zurzuvae was granted to Sage Therapeutics, Inc., a pharmaceutical company committed to advancing treatments for mental health conditions.
Sources : https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression
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