1932

Abstract

Depressive disorders present an enormous global public health burden. A notable treatment gap exists between the prevalence of depression and our ability to provide rapid-acting, effective treatment that achieves remission. Brexanolone and zuranolone, the first US Food and Drug Administration–approved drugs for postpartum depression, signify a critical advancement in addressing the unmet needs of a vulnerable patient population. Psilocybin shows promise for treatment-resistant depression and for those who have struggled to find relief with existing treatments. This review discusses transformative therapies that represent significant advancements in postpartum depression, major depressive disorder, and treatment-resistant depression.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-050423-095712
2025-01-27
2025-04-18
Loading full text...

Full text loading...

/deliver/fulltext/med/76/1/annurev-med-050423-095712.html?itemId=/content/journals/10.1146/annurev-med-050423-095712&mimeType=html&fmt=ahah

Literature Cited

  1. 1.
    Malhi GS, Mann JJ. 2018.. Depression. . Lancet 392:(10161):2299312
    [Google Scholar]
  2. 2.
    Kupcova I, Danisovic L, Klein M, et al. 2023.. Effects of the COVID-19 pandemic on mental health, anxiety, and depression. . BMC Psychol. 11::108
    [Google Scholar]
  3. 3.
    Lee B. 2023.. National, state-level, and county-level prevalence estimates of adults aged ≥18 years self-reporting a lifetime diagnosis of depression—United States. , 2020.. Morb. Mortal. Wkly. Rep. 72:(24):64450
    [Google Scholar]
  4. 4.
    Kuehner C. 2017.. Why is depression more common among women than among men?. Lancet Psychiatry 4:(2):14658
    [Google Scholar]
  5. 5.
    Burt VK, Stein K. 2002.. Epidemiology of depression throughout the female life cycle. . J. Clin. Psychiatry 63:(Suppl. 7):915
    [Google Scholar]
  6. 6.
    Schiller CE, Meltzer-Brody S, Rubinow DR. 2015.. The role of reproductive hormones in postpartum depression. . CNS Spectr. 20:(1):4859
    [Google Scholar]
  7. 7.
    Cui L, Li S, Wang S, et al. 2024.. Major depressive disorder: hypothesis, mechanism, prevention and treatment. . Signal Transduct. Target. Ther. 9:(1):30
    [Google Scholar]
  8. 8.
    Mojtabai R, Amin-Esmaeili M, Spivak S, et al. 2021.. Remission and treatment augmentation of depression in the United States. . J. Clin. Psychiatry 82:(6):21m13988
    [Google Scholar]
  9. 9.
    Patterson R, Balan I, Morrow AL, et al. 2024.. Novel neurosteroid therapeutics for post-partum depression: perspectives on clinical trials, program development, active research, and future directions. . Neuropsychopharmacology 49:(1):6772
    [Google Scholar]
  10. 10.
    Riddle JN, Richardson ER, Nathan MD, et al. 2023.. Zuranolone: FAQs for clinicians and patients. . MDedge. https://www.mdedge.com/psychiatry/article/265845/major-depressive-disorder/zuranolone-faqs-clinicians-and-patients
    [Google Scholar]
  11. 11.
    Gavin NI, Gaynes BN, Lohr KN, et al. 2005.. Perinatal depression: a systematic review of prevalence and incidence. . Obstet. Gynecol. 106:(5, Part 1 ):107183
    [Google Scholar]
  12. 12.
    Kim DR, Epperson CN, Weiss AR, et al. 2014.. Pharmacotherapy of postpartum depression: an update. . Expert Opin. Pharmacother. 15:(9):122334
    [Google Scholar]
  13. 13.
    Am. Psychiatr. Assoc. 2022.. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC:: Am. Psychiatr. Publ. , 5th ed.., text rev. [DSM-V-TR]
    [Google Scholar]
  14. 14.
    McKee K, Admon LK, Winkelman TNA, et al. 2020.. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. . BMC Womens Health 20::150
    [Google Scholar]
  15. 15.
    Gentile S, Fusco ML. 2017.. Untreated perinatal paternal depression: effects on offspring. . Psychiatry Res. 252::32532
    [Google Scholar]
  16. 16.
    Netsi E, Pearson RM, Murray L, et al. 2018.. Association of persistent and severe postnatal depression with child outcomes. . JAMA Psychiatry 75:(3):24753
    [Google Scholar]
  17. 17.
    Cox EQ, Sowa NA, Meltzer-Brody SE, et al. 2016.. The perinatal depression treatment cascade: baby steps toward improving outcomes. . J. Clin. Psychiatry 77:(9):20901
    [Google Scholar]
  18. 18.
    Dubber S, Reck C, Müller M, et al. 2015.. Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. . Arch. Women's Ment. Health 18:(2):18795
    [Google Scholar]
  19. 19.
    Field T. 2010.. Postpartum depression effects on early interactions, parenting, and safety practices: a review. . Infant Behav. Dev. 33:(1):16
    [Google Scholar]
  20. 20.
    Hoffman C, Dunn DM, Njoroge WFM. 2017.. Impact of postpartum mental illness upon infant development. . Curr. Psychiatry Rep. 19:(12):100
    [Google Scholar]
  21. 21.
    Jahan N, Went TR, Sultan W, et al. 2021.. Untreated depression during pregnancy and its effect on pregnancy outcomes: a systematic review. . Cureus 13:(8):e17251
    [Google Scholar]
  22. 22.
    Rohr J, Vahidy FS, Bartek N, et al. 2023.. Reducing psychiatric illness in the perinatal period: a review and commentary. . World J. Psychiatry 13:(4):14960
    [Google Scholar]
  23. 23.
    Fitelson E, Kim S, Baker AS, et al. 2010.. Treatment of postpartum depression: clinical, psychological and pharmacological options. . Int. J. Women's Health 3::114
    [Google Scholar]
  24. 24.
    Ölmestig TK, Siersma V, Birkmose AR, et al. 2021.. Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study. . BMC Pregnancy Childbirth 21:(1):777
    [Google Scholar]
  25. 25.
    Trost SL, Beauregard JL, Smoots AN, et al. 2021.. Preventing pregnancy-related mental health deaths: insights from 14 US maternal mortality review committees, 2008–17. . Health Aff. 40:(10):155159
    [Google Scholar]
  26. 26.
    Pinna G. 2020.. Allopregnanolone, the neuromodulator turned therapeutic agent: thank you, next?. Front. Endocrinol. 11::236. Corrigendum . 2020.. Front. Endocrinol. 11::507
    [Google Scholar]
  27. 27.
    Beall D, Reichstein T. 1938.. Isolation of progesterone and allopregnanolone from the adrenal. . Nature 142:(3593):479
    [Google Scholar]
  28. 28.
    Uzunov DP, Cooper TB, Costa E, et al. 1996.. Fluoxetine-elicited changes in brain neurosteroid content measured by negative ion mass fragmentography. . PNAS 93:(22):12599604
    [Google Scholar]
  29. 29.
    Concas A, Mostallino MC, Porcu P, et al. 1998.. Role of brain allopregnanolone in the plasticity of γ-aminobutyric acid type A receptor in rat brain during pregnancy and after delivery. . PNAS 95:(22):1328489
    [Google Scholar]
  30. 30.
    Walton N, Maguire J. 2019.. Allopregnanolone-based treatments for postpartum depression: Why/how do they work?. Neurobiol. Stress 11::100198
    [Google Scholar]
  31. 31.
    Bhatti NA, Jobilal A, Asif K, et al. 2023.. Exploring novel therapeutic approaches for depressive disorders: the role of allopregnanolone agonists. . Cureus 15:(8):e44038
    [Google Scholar]
  32. 32.
    Kanes S, Colquhoun H, Gunduz-Bruce H, et al. 2017.. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. . Lancet 390:(10093):48089
    [Google Scholar]
  33. 33.
    Meltzer-Brody S, Colquhoun H, Riesenberg R, et al. 2018.. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. . Lancet 392:(10152):105870
    [Google Scholar]
  34. 34.
    Martinez Botella G, Salituro FG, Harrison BL, et al. 2017.. Neuroactive steroids. 2. 3α-Hydroxy-3β-methyl-21-(4-cyano-1H-pyrazol-1′-yl)-19-nor-5β-pregnan-20-one (SAGE-217): a clinical next generation neuroactive steroid positive allosteric modulator of the (γ-aminobutyric acid)A receptor. . J. Med. Chem. 60:(18):781019
    [Google Scholar]
  35. 35.
    Sage Ther. 2019.. Sage Therapeutics announces SAGE-217 meets primary and secondary endpoints in phase 3 clinical trial in postpartum depression. Press Release, Jan. 7. https://investor.sagerx.com/news-releases/news-release-details/sage-therapeutics-announces-sage-217-meets-primary-and-secondary
    [Google Scholar]
  36. 36.
    Deligiannidis KM, Meltzer-Brody S, Gunduz-Bruce H, et al. 2021.. Effect of zuranolone vs placebo in postpartum depression: a randomized clinical trial. . JAMA Psychiatry 78:(9):95159
    [Google Scholar]
  37. 37.
    Deligiannidis KM, Meltzer-Brody S, Maximos B, et al. 2023.. Zuranolone for the treatment of postpartum depression. . Am. J. Psychiatry. 180:(9):66875
    [Google Scholar]
  38. 38.
    Sage Ther. 2024.. Label: ZULRESSO- brexanolone injection, solution. DailyMed, Natl. Libr. Med., Natl. Inst. Health, Bethesda, MD:, updated July 17. https://www.dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b40f3b2a-1859-4ed6-8551-444300806d13
    [Google Scholar]
  39. 39.
    Wald J, Henningsson A, Hanze E, et al. 2022.. Allopregnanolone concentrations in breast milk and plasma from healthy volunteers receiving brexanolone injection, with population pharmacokinetic modeling of potential relative infant dose. . Clin. Pharmacokinet. 61:(9):130719
    [Google Scholar]
  40. 40.
    Howard MM, Diaz Z, Battle CL. 2022.. Implementation of a hospital-based brexanolone program. . J. Psychiatr. Pract. 28:(5):4048
    [Google Scholar]
  41. 41.
    Biogen MA. 2024.. Label: ZURZUVAE- zuranolone capsule. DailyMed, Natl. Libr. Med., Natl. Inst. Health, Bethesda, MD:, updated July 9. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f18e53b0-d0bb-422d-8de7-ab64b7292b29
    [Google Scholar]
  42. 42.
    LactMed. 2006.. Zuranolone. Drugs Lact. Database, Natl. Libr. Med., Natl. Inst. Health, Bethesda, MD:, updated July 15, 2024
    [Google Scholar]
  43. 43.
    LactMed. 2006.. Brexanolone. Drugs Lact. Database, Natl. Libr. Med., Natl. Inst. Health, Bethesda, MD:, updated Aug. 15, 2023
    [Google Scholar]
  44. 44.
    Griffiths RR, Johnson MW, Carducci MA, et al. 2016.. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. . J. Psychopharmacol. Oxf. Engl. 30:(12):118197
    [Google Scholar]
  45. 45.
    Meara K. 2024.. Psilocybin analog for treatment of depression receives FDA breakthrough therapy designation. . Drug Topics. https://www.drugtopics.com/view/psilocybin-analog-for-treatment-of-depression-receives-fda-breakthrough-therapy-designation
    [Google Scholar]
  46. 46.
    Dold M, Kasper S. 2017.. Evidence-based pharmacotherapy of treatment-resistant unipolar depression. . Int. J. Psychiatry Clin. Pract. 21:(1):1323
    [Google Scholar]
  47. 47.
    Rush AJ, Trivedi MH, Wisniewski SR, et al. 2006.. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. . Am. J. Psychiatry 163:(11):190517
    [Google Scholar]
  48. 48.
    Keller MB, Shapiro RW, Lavori PW, et al. 1982.. Recovery in major depressive disorder: analysis with the life table and regression models. . Arch. Gen. Psychiatry 39:(8):90510
    [Google Scholar]
  49. 49.
    Davis AK, Barrett FS, May DG, et al. 2021.. Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. . JAMA Psychiatry 78:(5):48189
    [Google Scholar]
  50. 50.
    Gukasyan N, Davis AK, Barrett FS, et al. 2022.. Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: prospective 12-month follow-up. . J. Psychopharmacol. 36:(2):15158
    [Google Scholar]
  51. 51.
    Raison CL, Sanacora G, Woolley J, et al. 2023.. Single-dose psilocybin treatment for major depressive disorder: a randomized clinical trial. . JAMA 330:(9):84353
    [Google Scholar]
  52. 52.
    Carhart-Harris R, Giribaldi B, Watts R, et al. 2021.. Trial of psilocybin versus escitalopram for depression. . N. Engl. J. Med. 384:(15):140211
    [Google Scholar]
  53. 53.
    Carhart-Harris RL, Bolstridge M, Rucker J, et al. 2016.. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. . Lancet Psychiatry 3:(7):61927
    [Google Scholar]
  54. 54.
    Carhart-Harris RL, Bolstridge M, Day CMJ, et al. 2018.. Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. . Psychopharmacology 235:(2):399408
    [Google Scholar]
  55. 55.
    Compass Pathw. 2024.. Therapist training. . Compass Pathways. https://compasspathways.com/our-work/therapist-training/
    [Google Scholar]
  56. 56.
    Goodwin GM, Aaronson ST, Alvarez O, et al. 2022.. Single-dose psilocybin for a treatment-resistant episode of major depression. . N. Engl. J. Med. 387:(18):163748
    [Google Scholar]
  57. 57.
    Goodwin GM, Croal M, Feifel D, et al. 2023.. Psilocybin for treatment resistant depression in patients taking a concomitant SSRI medication. . Neuropsychopharmacology 48:(10):149299
    [Google Scholar]
  58. 58.
    Ross S, Bossis A, Guss J, et al. 2016.. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. . J. Psychopharmacol. 30:(12):116580
    [Google Scholar]
  59. 59.
    Barrett FS, Johnson MW, Griffiths RR. 2015.. Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin. . J. Psychopharmacol. 29:(11):118290
    [Google Scholar]
  60. 60.
    Maclean KA, Leoutsakos J-MS, Johnson MW, et al. 2012.. Factor analysis of the Mystical Experience Questionnaire: a study of experiences occasioned by the hallucinogen psilocybin. . J. Sci. Study Relig. 51:(4):72137
    [Google Scholar]
  61. 61.
    Murphy R, Kettner H, Zeifman R, et al. 2021.. Therapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression. . Front. Pharmacol. 12::788155
    [Google Scholar]
  62. 62.
    Usona Inst. 2021.. Investigator's brochure for psilocybin. Investig. Broch. 129532 , Usona Inst., Madison, WI:
    [Google Scholar]
/content/journals/10.1146/annurev-med-050423-095712
Loading
/content/journals/10.1146/annurev-med-050423-095712
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error