Can a steroid treatment combat postpartum depression?

TeachableMedicalNews article 02072020

Teachable moment in classrooms:

1. chemical basis of life chapter – lipids and steroids
2. nervous system chapter – role of neurotransmitters in the life of a neuron
3. nervous system chapter – effects of excitatory and inhibitory neurotransmitters

The news item:  A new drug, called Zulresso, for the treatment of postpartum depression was in the news recently:

FDA approves first postpartum depression drug. It works quickly but costs more than $20K, report says

Brexanolone, sold as Zulresso, is delivered as a continuous IV infusion over 60 hours. It works quickly and costs $20,000 or more.

The article mentions symptoms and the frequency of postpartum depression.

So, Why Do I Care??  Postpartum depression occurs in over 10% of mothers within a year of delivery.  With about 4 million births per year in the US, about 600,000 women are affected by clinical depression. Postpartum depression not only harms the mother, but may negatively affect her relationship with the child and the husband.

Plain English, Please!!! First, let’s talk about depression.  The depressed psychological state typically means an extended feeling of sadness, and loss of interest.  This psychological state comes from the increased activity in some part of the brain, while slower activity in other parts of the brain.

Second, let’s talk about neurotransmitters.  The activity of any part of our brain is determined by the balance of excitatory and inhibitory chemicals; those chemicals are called neurotransmitters. Our brain is like a car, when increased activity is needed, the brain steps on the gas, and excitatory neurotransmitters are made, and when slower activity is needed, the brain steps on the brake, and inhibitory neurotransmitters are made.  In postpartum depression some groups of neurons are overly active, because they are missing the braking action of inhibitory neurotransmitters. The chemical allopregnanolone, the active ingredient in the new drug, Zulresso, creates a breaking action on those overly active parts of the brain.

Third, let’s talk about steroids in the brain.  Very recent research determined that some steroids can act as a replacement for the braking action for parts of the brain.  This is unusual, because steroids are commonly known for causing development of male and female sexual characteristics, for regulating blood pressure or the sodium balance of the body. Allopregnanolone is acting as a neuro-steroid, and increases the effect of the inhibitory neurotransmitters (hence the breaking action) in the parts of the brain that are overly active during depression.