Zuranolone: What to know about the pill for postpartum depression
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In the year after giving birth, about one in eight people who give birth in the U.S. experience the debilitating symptoms of postpartum depression (PPD), including lack of energy and feeling sad, anxious, hopeless, and overwhelmed.
Postpartum depression is a serious, potentially life-threatening condition that can affect a person’s bond with their baby. Although it’s frequently confused with the so-called “baby blues,” it’s not the same.
The baby blues include similar, temporary symptoms that affect up to 80 percent of people who have recently given birth and usually go away within the first few weeks. PPD usually begins within the first month after giving birth and can last for months and interfere with a person’s daily life if left untreated. Thankfully, PPD is treatable and there is help available.
On August 4, the FDA approved zuranolone, branded as Zurzuvae, the first-ever oral medication to treat PPD. Until now, besides other common antidepressants, the only medication available to treat PPD specifically was the IV injection brexanolone, which is difficult to access and expensive and can only be administered in a hospital or health care setting.
Read on to find out more about zuranolone: what it is, how it works, how much it costs, and more.
What is zuranolone?
Zurzuvae is the brand name for zuranolone, an oral medication to treat postpartum depression. Developed by Sage Therapeutics in partnership with Biogen, it’s now available in the U.S. Zurzuvae is typically prescribed as two 25 mg capsules a day for 14 days. In clinical trials, the medication showed to be fast-acting, improving PPD symptoms in just three days.
How does zuranolone work?
Zuranolone is a neuroactive steroid, a type of medication that helps the neurotransmitter GABA’s receptors, which affect how the body reacts to anxiety, stress, and fear, function better.
“Zuranolone can be thought of as a synthetic version of [the neuroactive steroid] allopregnanolone,” says Dr. Katrina Furey, a reproductive psychiatrist, clinical instructor at Yale University, and co-host of the Analyze Scripts podcast. “Women with PPD have lower levels of allopregnenolone compared to women without PPD.”
How is it different from other antidepressants?
“What differentiates zuranolone from other previously available oral antidepressants is that it has a much more rapid response and a shorter course of treatment,” says Dr. Asima Ahmad, an OB-GYN, reproductive endocrinologist, and founder of Carrot Fertility.
“It can take effect as early as on day three of treatment, versus other oral antidepressants that can take up to six to 12 weeks to take full effect.”
What are Zurzuvae’s side effects?
According to the FDA, the most common side effects of Zurzuvae include dizziness, drowsiness, diarrhea, fatigue, the common cold, and urinary tract infection. Similar to other antidepressants, the medication may increase the risk of suicidal thoughts and actions in people 24 and younger. However, NPR noted that this type of labeling is required for all antidepressants, and researchers didn’t see any reports of suicidal thoughts in their trials.
“Drug trials also noted that the side effects for zuranolone were not as severe,” says Ahmad. “[There was] no sudden loss of consciousness as seen with brexanolone or weight gain and sexual dysfunction, which can be seen with other oral antidepressants.”
She adds: “Given the lower incidence of side effects and more rapid-acting onset, zuranolone could be a viable option for many,” including those looking for a treatment that offers faster symptom relief.
Can someone breastfeed while taking zuranolone?
It’s complicated. In clinical trials, participants were asked to stop breastfeeding (which, according to Furey, is common in early clinical trials).
A small study of people who were nursing while taking zuranolone found that 0.3 percent of the medication dose was passed on to breast milk, which, Furey says, is a pretty low amount of exposure for the baby. Ahmad says that “though some data suggests that the risk of harm to the baby may be low, there is still overall limited data.”
Overall, people should talk to their health care provider about the risks and benefits of breastfeeding while on the medication.
“A lot of factors will need to be weighed, such as overall health of the infant, age of the infant, etc., when making this decision,” Furey says.
How much does Zurzuvae cost?
Zurzuvae’s price before insurance coverage is $15,900 for the 14-day treatment. However, the Policy Center for Maternal Mental Health says insurance companies and Medicaid are expected to cover it because it’s the only drug of its kind.
Less than 1 percent of U.S. insurers have issued coverage guidelines so far, so it’s still unknown how much it will cost patients after insurance. Some insurers require patients to try another antidepressant first (like the more common SSRIs) before covering Zurzuvae. For uninsured and underinsured people, Sage Therapeutics said it will offer copay assistance.
The hefty price tag and potential issues with coverage may widen existing health disparities, says Ahmad. “We need to ensure that we are seeking out solutions to enable wide-scale access to all PPD treatments so that people have access to whatever treatment may work best for them.”
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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You could be stress eating these holidays – or eating your way to stress. 5 tips for the table
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The holiday season can be a time of joy, celebration, and indulgence in delicious foods and meals. However, for many, it can also be an emotional and stressful period.
This stress can manifest in our eating habits, leading to what is known as emotional or stress eating.
There are certain foods we tend to eat more of when we’re stressed, and these can affect our health. What’s more, our food choices can influence our stress levels and make us feel worse. Here’s how.
Dean Clarke/Shutterstock Why we might eat more when stressed
The human stress response is a complex signalling network across the body and brain. Our nervous system then responds to physical and psychological events to maintain our health. Our stress response – which can be subtle or trigger a fight-or-flight response – is essential and part of daily life.
The stress response increases production of the hormones cortisol and insulin and the release of glucose (blood sugars) and brain chemicals to meet demand. Eating when we experience stress is a normal behaviour to meet a spike in energy needs.
But sometimes our relationship with food becomes strained in response to different types of stress. We might attach shame or guilt to overeating. And anxiety or insecurity can mean some people under-eat in stressful times.
Over time, people can start to associate eating with negative emotions – such as anger, sadness, fear or worry. This link can create behavioural cycles of emotional eating. “Emotional eaters” may go on to develop altered brain responses to the sight or smell of food.
What stress eating can do to the body
Stress eating can include binge eating, grazing, eating late at night, eating quickly or eating past the feeling of fullness. It can also involve craving or eating foods we don’t normally choose. For example, stressed people often reach for ultra-processed foods. While eating these foods is not necessarily a sign of stress, having them can activate the reward system in our brain to alleviate stress and create a pattern.
Short-term stress eating, such as across the holiday period, can lead to symptoms such as acid reflux and poor sleep – particularly when combined with drinking alcohol.
In the longer term, stress eating can lead to weight gain and obesity, increasing the risks of cancer, heart diseases and diabetes.
While stress eating may help reduce stress in the moment, long-term stress eating is linked with an increase in depressive symptoms and poor mental health.
If you do over eat at a big gathering, don’t try and compensate by eating very little the next day. Peopleimage.com – Yuri A/Shutterstock What we eat can make us more or less stressed
The foods we choose can also influence our stress levels.
Diets high in refined carbohydrates and sugar (such as sugary drinks, sweets, crackers, cakes and most chocolates) can make blood sugar levels spike and then crash.
Diets high in unhealthy saturated and trans fats (processed foods, animal fats and commercially fried foods) can increase inflammatory responses.
Rapid changes in blood sugar and inflammation can increase anxiety and can change our mood.
Meanwhile, certain foods can improve the balance of neurotransmitters in the brain that regulate stress and mood.
Omega-3 fatty acids, found in fish and flaxseeds, are known to reduce inflammation and support brain health. Magnesium, found in leafy greens and nuts, helps regulate cortisol levels and the body’s stress response.
Vitamin Bs, found in whole grains, nuts, seeds, beans and animal products (mostly B12), help maintain a healthy nervous system and energy metabolism, improving mood and cognitive performance.
5 tips for the holiday table and beyond
Food is a big part of the festive season, and treating yourself to delicious treats can be part of the fun. Here are some tips for enjoying festive foods, while avoiding stress eating:
1. slow down: be mindful about the speed of your eating. Slow down, chew food well and put down your utensils after each bite
2. watch the clock: even if you’re eating more food than you normally would, sticking to the same timing of eating can help maintain your body’s response to the food. If you normally have an eight-hour eating window (the time between your first meal and last meal of the day) then stick to this even if you’re eating more
3. continue other health behaviours: even if we are eating more food or different food during the festive season, try to keep up other healthy behaviours, such as sleep and exercise
4. stay hydrated: make sure to drink plenty of fluids, especially water. This helps our body function and can help with feelings of hunger. When our brain gets the message something has entered the stomach (what we drink) this can provide a temporary reduction in feelings of hunger
5. don’t restrict: if we have a big day of eating, it can be tempting to restrict eating in the days before or after. But it is never a good idea to overly constrain food intake. It can lead to more overeating and worsen stress.
Reaching for cookies late at night can be characteristic of stress eating. Stokkete/Shutterstock Plus 3 bonus tips to manage holiday stress
1. shift your thinking: try reframing festive stress. Instead of viewing it as “something bad”, see it as “providing the energy” to reach your goals, such as a family gathering or present shopping
2. be kind to yourself and others: practise an act of compassion for someone else or try talking to yourself as you would a friend. These actions can stimulate our brains and improve wellbeing
3. do something enjoyable: being absorbed in enjoyable activities – such as crafting, movement or even breathing exercises – can help our brains and bodies to return to a more relaxed state, feel steady and connected.
For support and more information about eating disorders, contact the Butterfly Foundation on 1800 33 4673 or Kids Helpline on 1800 551 800. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.
Saman Khalesi, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, CQUniversity Australia; Charlotte Gupta, Senior Postdoctoral Research Fellow, Appleton Institute, HealthWise research group, CQUniversity Australia, and Talitha Best, Professor of Psychology, NeuroHealth Lab, Appleton Institute, CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How We Age: The Science of Longevity – by Dr. Coleen Murphy
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The author is not a glossy “name brand” and has nothing to sell (besides her book). This shows, because it’s clearly not a book that was rushed out as a marketing ploy. Indeed, she begins with the words:
❝This book took me several years to write and is largely based on information I gathered while teaching my class, “Molecular Mechanisms of Longevity: The Genetics, Genomics, and Cell Biology of Aging,” at Princeton University.❞
~ Dr. Coleen Murphy
Thus, as you may imagine, it’s a thorough book, thoughtful, with conscientious attention to detail. As a reader, you are essentially getting the knowledge of a Princeton genomics class.
She covers what’s going on in our genes, in our cells, and in our bodies, when we age; why some animals don’t, and what things affect that. She talks biomarkers of aging and the industry gold standard “Health-Related Quality of Life” metrics. We learn about insulin signalling and FOXO targets; the role of caloric restriction or intermittent fasting, topics such as molecular homeostasis in the regulation of longevity (hello senolytics and chaperone-mediated autophagy), the microbiome and epigenetics, as well as mitochondrial management, cell replacement (including induced pluripotent stem cells), and even DNA repair. And yes, a lot about cognitive aging and how to slow it too.
The style is academic and/but perfectly readable; she explains everything as we go. We’ll note, though, that it’s not dry academic—her personality comes through throughout, in a good way that makes it a pleasant read as well as an informative one.
Bottom line: if you’d like a much deeper understanding of the mechanics of aging than we have room to get into in our articles at 10almonds, this book is a highly recommendable perfect opportunity.
Click here to check out How We Age, and learn about the science of longevity!
PS: we’ve reviewed a few books about the science of aging/longevity recently, and they’ve each been good, but if you’re going to get only one, we recommend this one, as in this reviewer’s opinion, it’s the best 😎
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30 Days Of Weight Vest Use: Lessons Learned
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Robin, from “The Science of Self-Care”, has insights:
How to have an easier time of it
Per peer-reviewed science (linked under the video on YouTube), there are some benefits:
- Cardiovascular fitness: increases workout intensity, improving heart and lung health.
- Muscle strength & endurance: strengthens core, legs, glutes, and calves.
- Bone density: helps prevent osteoporosis through weight-bearing exercise.
- Caloric expenditure: burns more calories, aiding in weight loss.
- Balance & posture: improves balance, though posture effects were mixed.
She chose a 30 lb weighted vest, which felt much heavier than expected. Initially, this was uncomfortable but became comforting over time (much like a weighted blanket). She also found that walks became noticeably more intense, leading to increased sweating and hunger.
Over the course of the month, she found:
- Week 1: adjusting to the extra weight; walks felt significantly harder.
- Weeks 2-3: strength improvements; carrying groceries felt easier, walking without the vest felt effortless.
- Week 3: started craving the weighted vest, but also began experiencing shoulder discomfort.
- Week 4: reduced walk duration to 20 minutes due to shoulder strain.
She concluded that the vest design was flawed—all weight rested on shoulders instead of distributing across the body, which led to shoulder discomfort and posture issues. To mitigate these things, she switched to wearing the vest around the waist like a skirt. She now plans to try a weighted belt for better weight distribution, though also simply a different kind of vest would work better (the kind that looks like combat body armor distributes the weight a lot more easily)
In short, her verdict:
- Weighted walking: 10/10, highly beneficial and easy to incorporate into daily routines.
- Vest used: 2/10, poor weight distribution, causing discomfort and shoulder strain.
For more on all of this, plus links to the relevant scientific papers, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Weight Vests Against Osteoporosis: Do They Really Build Bone?
Take care!
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Outlive – by Dr. Peter Attia
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We know, we know; this diet, that exercise, don’t smoke or drink, get decent sleep”—a lot of books don’t go beyond this level of advice!
What Dr. Attia offers is a multi-vector approach that covers the above and a lot more.
Themes of the book include:
- The above-mentioned things, of course
- Rethinking medicine for the age of chronic disease
- The pros and cons of…
- caloric restriction
- dietary restriction
- intermittent fasting
- Pre-emptive interventions for…
- specific common cause-of-death conditions
- specific common age-related degenerative conditions
- The oft-forgotten extra pillar of longevity: mental health
The last one in the list there is covered mostly in the last chapter of the book, but it’s there as a matter of importance, not as an afterthought. As Dr. Attia puts it, not only are you less likely to take care of your physical health if you are (for example) depressed, but also… “Longevity is meaningless if your life sucks!”
So, it’s important to do things that promote and maintain good physical and mental health.
Bottom line: if you’re interested in happy, healthy, longevity, this is a book for you.
Click here to check out Dr. Attia’s “Outlive” on Amazon today!
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Heal & Reenergize Your Brain With Optimized Sleep Cycles
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Sometimes 8 hours sleep can result in grogginess while 6 hours can result in waking up fresh as a daisy, so what gives? Dr. Tracey Marks explains, in this short video.
Getting more than Zs in
Sleep involves 90-minute cycles, usually in 4 stages:
- Stage 1: (drowsy state): brief muscle jerks; lasts a few minutes.
- Stage 2: (light sleep): sleep spindles for memory consolidation; 50% of total sleep.
- Stage 3 (deep sleep): tissue repair, immune support, brain toxin removal via the glymphatic system.
- Stage 4 (REM sleep): emotional processing, creativity, problem-solving, and dreaming.
Some things can disrupt some or all of those. To give a few common examples:
- Alcohol: impairs REM sleep.
- Caffeine: hinders deep sleep even if consumed hours before bed.
- Screentime: delays sleep onset due to blue light (but not by much); the greater problem is that it can also disrupt REM sleep due to mental stimulation.
To optimize things, Dr. Marks recommends:
- 90-minute rule: plan sleep to align with full cycles (e.g: 22:30 to 06:00 = 7½ hours, which is 5x 90-minute cycles).
- Smart alarms: use sleep-tracking apps with built-in alarm, to wake you up during light sleep phases.
- Strategic naps: keep naps to 20 minutes or a full 90-minute cycle.
- Pink noise: improves deep sleep.
- Meal timing: avoid eating within 3 hours of bedtime.
- Natural light: get morning light exposure in the morning to strengthen circadian rhythm.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Calculate (And Enjoy) The Perfect Night’s Sleep
Take care!
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