Brexanolone and current methods of treating postpartum and perinatal depression

Objective.
Postpartum depression (PPD) is estimated to affect between 6.5 and 12.9% of women who have given birth. If untreated, the disorder can lead to serious consequences for the patient and her offspring – compromising the formation of the relationship between mother and child. Drugs used to treat postpartum depression should be selected individually to achieve the best possible therapeutic effect, taking into account the severity of the depression, the risk of side effects and other factors determining the course of therapy. In our work, we compare selected treatments for PPD with an indication of the side effects associated with medication. The paper aims to evaluate brexanolone, a drug that is a synthetic form of the hormone allopregnanolone, a progesterone derivative, comparing it with the main pharmacological treatments for PPD, detailing the mechanisms of action of the above-mentioned groups of drugs and the side effects they induce.

Literature review.
The literature was reviewed in terms of the efficacy and safety of drugs used in PPD.

Conclusions.
Pharmacological treatment should be avoided if the patient’s condition allows it. If necessary, SSRIs are the first choice drugs. If these are contraindicated, the use of TCAs may be considered, and in the most severe and resistant to treatment cases, the use of electroconvulsive therapy or a neurosteroid that acts on GABAergic conductivity of the CNS – allopregnanolone (as a drug, allopregnanolone is referred to as brexanolone). Sertraline appears to be the safest drug for women who are pregnant or in the postpartum period. An alternative to sertraline in lactating mothers is paroxetine or nortriptyline therapy. In our opinion, brexanolone will not replace SSRIs, due to the long duration of inpatient infusions and the indication for use only after delivery and not during pregnancy. It is important to bear in mind that this is a relatively new drug, so its action profile and potential side effects will only become apparent in future studies, so according to the current state of knowledge it should only be used when necessary.