Zuranolone for Postpartum Depression After Highly Lethal Suicide Attempt: Two Case Illustrations and a Narrative Literature Review

Abstract

Background

In the United States, suicide is one of the leading causes of death in the first year postpartum, possibly accounting for up to 20% of deaths. The Food and Drug Administration recently approved 2 fast-acting medications, brexanolone and zuranolone, for the treatment of postpartum depression (PPD), which shares many clinical features with postpartum suicidality.

Objective

Determining the efficacy of zuranolone in the treatment of severe PPD in the context of highly lethal suicide attempts.

Methods

We describe 2 illustrative cases of zuranolone treatment of PPD after a gunshot suicide attempt. Following treatment, both women demonstrated a rapid reduction in depressive symptoms and readiness for safe discharge. We also conducted a review of the literature on suicide attempts associated with PPD.

Results

Our case series demonstrated that zuranolone may effectively treat PPD with rapid-onset highly lethal suicide attempts.

Conclusions

Postpartum suicidality is complex and often emerges rapidly. We advocate for more research on fast-acting novel treatments, such as zuranolone and brexanolone, for PPD and postpartum suicidality.