Zulresso is an injectable medication given intravenously (IV) by a healthcare provider in a certified health facility. It is administered continuously over a total of 60 hours or 2.5 days. Your doctor must prescribe and acquire Zulresso for you from Sage Therapeutics, the manufacturer. Because Zulresso is a controlled substance, the federal government closely monitors its use. No generic form is currently available, so it is only available by the brand name, Zulresso.
Uses
Zulresso is a treatment for postpartum depression, a condition experienced by about 1 in 8 people who have given birth. Symptoms of postpartum depression include sadness, trouble bonding with the baby, anxious or intrusive thoughts, thoughts of self-harm or harming the baby, irritability, difficulty concentrating. It is one of the most common pregnancy complications faced by people who have given birth. Traditional antidepressants prescribed for postpartum depression can take weeks to be effective. Since Zulresso is administered directly into a vein, it works much more quickly. In trials, people with moderate PPD and those with severe PPD showed statistically significant improvement in symptoms within 60 hours of administration. This improvement remained significant at 30 days post-treatment. There are no off-label uses of Zulresso reported at this time.
Side Effects
As with any medication, knowing the potential side effects is important. While some side effects are more common than others, patients should note any changes and report it to their health care provider immediately. Common side effects of Zulresso include sleepiness, dizziness, dry mouth, and hot flashes or flushed skin. An allergic reaction, while rare, can and may occur when taking Zulresso. Symptoms include a rash, hives, itching, wheezing, tightness in the chest or throat, trouble breathing, swallowing, and swelling of the mouth, face, lips, tongue, or throat. Patients taking Zulresso are monitored by a medical professional every two hours while they are awake. Some clinical trial participants experienced intensified feelings of depression while on Zulresso. If you experience suicidal thoughts or ideation, worsening depression, or any other changes to your mood or outlook, it’s essential to let your physician know immediately. A rare but severe side effect is excessive sedation and sudden loss of consciousness during treatment. This is another reason why Zulresso is only administered in a healthcare facility with frequent monitoring.
Dosage
Zulresso is only approved for use with adults. A health care provider must be available on site to continuously monitor the patient, and intervene as necessary, for the duration of the infusion. During the 60-hour treatment, the dosage is increased after the first four hours and then again after 24 hours. It is at its highest level during the 24- to 52-hour mark and then is decreased until the treatment is completed.
Modifications
The healthcare provider administering Zulresso will determine if any modifications are necessary. If excessive sedation occurs during treatment, your healthcare provider may stop the infusion until symptoms resolve. Additionally, they may decide to resume treatment at a lower dose. The provider should immediately stop the infusion if monitoring equipment indicates a dip in blood oxygen levels.
Missed Dose
Because Zulresso is only available in a certified healthcare facility, missing a dose is not a concern. Once you receive the 60-hour treatment, no further dosing is needed.
Interactions
Taking certain drugs and other substances at the same time as Zulresso may cause adverse reactions. Central nervous system depressants like alcohol, opioids, and benzodiazepines may increase the likelihood or severity of adverse reactions to sedation. In some studies, patients taking antidepressants reported sedation after they received Zulresso. Before using Zulresso, tell your provider about your medications, including vitamins and supplements. Keep a list of all your medications with you, and share the list with your healthcare team. Check with your provider if you have health questions or concerns.
Warnings and Precautions
Zulresso comes with a black box warning that excessive sedation and sudden loss of consciousness can occur. More specifically, the warning states: Currently, the risk of suicidality in patients taking Zulresso is unknown. As with any treatment, if a patient begins to experience suicidal thoughts and behaviors during treatment with Zulresso, treatment should be discontinued. Until any sedative effects of the drug have dissipated, you should avoid driving or other potentially hazardous activities requiring mental alertness. Zulresso is not recommended for people who may be pregnant since it might cause harm to fetuses. Those with kidney disease or other renal problems are not candidates for treatment with Zulresso. The medication also passes into breast milk. Talk to your healthcare provider about the risks and benefits of breastfeeding and the best way to feed your baby while receiving Zulresso.
Overdose
The facility administering Zulresso will be responsible for any potential issues related to an overdose of the drug. The patient does not handle or administer this drug. A study is underway to determine the safety and efficacy of at-home Zulresso administration. However, no changes have been made to the rule that it must be administered in a certified facility. Check with your healthcare provider for additional health information about common problems or adverse side effects associated with this medicine. Call your provider for medical advice about side effects. You also may report side effects to the FDA at 1-800-FDA-1088.
Similar Drugs
Before Zulresso, doctors treated postpartum depression with antidepressants. Some of the more commonly prescribed drugs are serotonin-reuptake inhibitors (SSRIs) which include sertraline (Zoloft) and fluoxetine (Prozac), and serotonin-norepinephrine reuptake inhibitor (SNRI) such as venlafaxine. These may still be effective for some people with PPD.
How to Care for Yourself
The postpartum period is a time of physical and emotional transitions that can lead to feelings of anxiety, depression, and worry. While these emotions can reflect expectable mood swings during this trying time, many people will develop more severe symptoms that result in a diagnosis of postpartum depression. If you have received this diagnosis, you might be looking for things you can do to help manage the symptoms. In addition to professional treatment that may include psychotherapy, Zulresso, and other medications, there are many ways to help manage the symptoms of depression during the postpartum period. Most importantly, remember that you are not alone. Postpartum depression can affect anyone, regardless of the number of pregnancies they’ve had, their age, or their ethnicity. Asking for help is the first step to relieving the symptoms you may be experiencing.
