Brexanolone and pospartum depression: is there a place for it in Portugal?

Abstract

Background: Postpartum depression is defined as a  major depressive episode, related temporarily related to childbirth, with specific characteristics, namely the presence of more anxious and obsessive symptoms, the slower response to treatment, the more frequent need for association of psychotropic drugs and the probable relationship with hormonal decrease after delivery. The recommended treatment for postpartum depression, despite its specificities, is the same as for any major depressive episode. Brexanolone, the first specific drug for the treatment of postpartum depression, has recently been approved in the United States of America.

Aims: The authors’ objectives were to carry out a bibliographic review about brexanolone, later discussing its importance and applicability, mainly in Portugal.

Methods: A bibliographic search was carried out on the main scientific research platforms, using the terms brexanolone, allopregnanolone and postpartum depression treatment. The brexanolone administration leaflet, approved by the FDA, was also consulted.

Results and Conclusions: Brexanolone is an analogue of pregnanolone, an endogenous metabolite of progesterone, administered intravenously. It has a rapid effect, with maintenance of therapeutic results at 30 days after administration, especially in cases of severe postpartum depression. It is a safe drug, but in needs of medical surveillance, due to the risk of excessive sedation and loss of consciousness. Although brexanolone is unlikely to be a first-line treatment in postpartum depression, it can be an attractive option in cases of severe depression, resistant to other treatments, or when a rapid response is needed.