Brexanolone, marketed by Sage Therapeutics as Zulresso, was approved in March 2019, as a treatment for postpartum depression.  It has been available for almost two months, and we are very eager to hear about patients’ and clinicians’ experiences with this new medication.  

Because of some concerns about Zulresso’s side effects, including excessive sedation and sudden loss of consciousness, it was released through a Risk Evaluation and Mitigation Strategy (REMS) program that requires the drug to be administered by a health care provider in a certified health care facility.  During the 60-hour infusion, patients must be monitored using continuous pulse oximetry.  

In the Boston area, we do not yet have any certified administration sites.  According to the company, there are now 100 certified sites in the United States.  A list of certified healthcare settings offering treatment with Zulresso is available by calling Sage Central at 844-472-4379.

In the upcoming issue of OB-Gyn News, Dr. Lee Cohen will discuss the use of brexanolone in greater detail.  

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.


Ruta Nonacs, MD PhD



Stress, mood, and cortisol during daily life in women with Premenstrual Dysphoric Disorder (PMDD).

Beddig T, Reinhard I, Kuehner C.  Psychoneuroendocrinology. 2019 Jul 23.

Women with PMDD reported particular high daily life stress and high arousal negative affect toward stressors during the late luteal phase. High momentary stress levels were linked to lower levels of high arousal positive affect and to higher levels of rumination in PMDD women compared to controls irrespective of cycle phase. Moreover, PMDD was associated with a delayed cortisol awakening response peak and a flattened diurnal cortisol slope. 



No articles this week



Predictors and outcomes of suicidal ideation during peripartum period.

Martini J, Bauer M, Lewitzka U, Voss C, Pfennig A, Ritter D, Wittchen HU.  J Affect Disord. 2019 Jul 5;257:518-526. 

Risk of peripartum suicidality was increased in women with a history of suicide attempt (OR?=?17.84) and decreased with women living together with the partner (OR?=?0.14) and in women with adequate social support (OR?=?0.35).

Screening and Treatment After Implementation of a Universal Perinatal Depression Screening Program.

Miller ES, Wisner KL, Gollan J, Hamade S, Gossett DR, Grobman WA.  Obstet Gynecol. 2019 Aug;134(2):303-309.

The frequency of completion of depression screening at the first prenatal visit (0.1% vs 65.5%), in the third trimester (0.0% vs 42.7%), and at the postpartum visit (69.5% vs 90.0%) increased after initiation of the policy (P<.001 for all).



Paternal antidepressant use as a negative control for maternal use: assessing familial confounding on gestational length and anxiety traits in offspring.

Cohen JM, Wood ME, Hernández-Díaz S, Ystrom E, Nordeng H.

Int J Epidemiol. 2019 Aug 1. 

These results support the suggested effect of maternal use of antidepressants in pregnancy on shorter gestation; however, they suggest familial confounding could explain the association between maternal use of antidepressants and anxiety traits in the offspring.



Brexanolone for postpartum depression: A meta-analysis of randomized controlled studies.

Zheng W, Cai DB, Zheng W, Sim K, Ungvari GS, Peng XJ, Ning YP, Wang G, Xiang YT.  Psychiatry Res. 2019 Jul 4;279:83-89. 

A single brexanolone infusion appears to have ultra-rapid antidepressant effect for PPD, lasting for up to 1 week. 


GABAAR Modulator for Postpartum Depression.

Mody I.  Cell. 2019 Jan 10;176(1-2):1. 

A discussion of brexanolone, a new therapy for PPD which consists of administering a synthetic neurosteroid during the postpartum period to alleviate the mood disorder.


Resting-state functional connectivity, cortical GABA, and neuroactive steroids in peripartum and peripartum depressed women: a functional magnetic resonance imaging and spectroscopy study.

Deligiannidis KM, Fales CL, Kroll-Desrosiers AR, Shaffer SA, Villamarin V, Tan Y, Hall JE, Frederick BB, Sikoglu EM, Edden RA, Rothschild AJ, Moore CM.  Neuropsychopharmacology. 2019 Feb;44(3):546-554. 

PPD is associated with altered default mode network (DMN) connectivity; cortical GABA+/Cr concentrations are associated with postpartum resting-state functional connectivity (RSFC) and allopregnanolone is associated with postpartum intra-dorsomedial prefrontal cortex (DMPFC) connectivity.


The Role of Allopregnanolone in Pregnancy in Predicting Postpartum Anxiety Symptoms.

Osborne LM, Betz JF, Yenokyan G, Standeven LR, Payne JL.  Front Psychol. 2019 Jul 16;10:1033. Free Article

In both healthy and mood- and anxiety-disordered women who remained well throughout the perinatal period, we found that second trimester allopregnanolone predicted postpartum anxiety symptoms, with a similar trend toward the prediction of postpartum depressive symptoms (though without statistical significance). 


Gestational Weight Gain and Postpartum Depression in Women with Class III Obesity.

Adkins LD, Tucker A, Gatta LA, Siegel AM, Reiff E, Brown HL, Dotters-Katz SK.  Am J Perinatol. 2019 Aug 5. 

A relationship between gestational weight gain and PPD in class III obese women was not found in this cohort.


Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament.

Takács L, Smolík F, Putnam S.  PLoS One. 2019 Aug 5.Free Article

Mothers’ confidence in their ability to parent is influenced by their experience with a difficult infantand by their depressive symptoms during the child’s first year of life. Depressive symptoms are, in turn, aggravated by mothers’ low perceived competences in the parenting role.


Comparison of public mother-baby psychiatric units in Australia: similarities, strengths and recommendations.

Galbally M, Sved-Williams A, Kristianopulos D, Mercuri K, Brown P, Buist A.  Australas Psychiatry. 2019 Apr;27(2):112-116. 



No articles this week



Self-reported Daily, Weekly, and Monthly Cannabis Use Among WomenBefore and During Pregnancy.Young-Wolff KC, Sarovar V, Tucker LY, Conway A, Alexeeff S, Weisner C, Armstrong MA, Goler N.  JAMA Netw Open. 2019 Jul 3. Free Article

Between 2009 and 2017, the prevalence of reported cannabis use in the year before pregnancy increased from 7% to 13% in California, with the sharpest increase for daily use, from 1.2% to 3.1%. During this same time period, the prevalence of cannabis use during pregnancy increased from 2.0% to 3.4%.



Prevalence of mental health problems in preschoolers and the impact of maternal depression.

Pires AJ, de Matos MB, Scholl CC, Trettim JP, Coelho FT, da Cunha Coelho FM, Pinheiro KAT, Pinheiro RT, de Avila Quevedo L.  Eur Child Adolesc Psychiatry. 2019 Aug 7.

The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. 


Associations of postpartum mother-infant bonding with maternal childhood maltreatment and postpartum mental health: a cross-sectional study.

Lehnig F, Nagl M, Stepan H, Wagner B, Kersting A.

BMC Pregnancy Childbirth. 2019 Aug 5;19(1):278.  Free Article

Almost 46% of the included women reported at least one type of childhood maltreatment with emotional neglect being most prevalent. 13% displayed at least mild postpartum depressive symptomatology and 20% scored above the 75th percentile for postpartum anxiety.  Higher severity of maternal emotional neglect in childhood, higher levels of postpartum depression and higher education were significantly related to more postpartum mother-infant bonding impairment. In contrast, higher severity of maternal physical neglect was significantly associated with less postpartum MIB impairment.


Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort.

Porter E, Lewis AJ, Watson SJ, Galbally M. Infant Behav Dev. 2019 Aug 9;57:101336. 

Both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children’s social and emotional development. 



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No articles this week



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