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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Bulgarian Split Squats: How To Get The Best Glute Strength & Size
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Even without considering aesthetics, the glutes are very important muscles (you absolutely cannot have a healthy back and hips without strong glutes).
Bulgarian split squats have a name that makes them sound complicated; they’re actually very simple, but there are mistakes that people make that sabotage their progress.
Professional coach Elisi Wolf explains in this video:
Mistakes most people make
There are quite a few, but bear with us, as they really do come together—and once you understand them, you’ll have it for life;
- Lack of neural pathway establishment: most people skip the step of building a mind-muscle connection before adding weight. Focus on bodyweight movements first until you can feel your glutes working.
- Not focusing on glute contraction: avoid counting reps; it distracts the brain. Don’t use weights too soon, as they can prevent neural pathway development. Focus on time under tension and feeling the glutes before adding resistance.
- Not lowering slowly enough: slow, controlled movements give the brain time to activate the glutes. This increases time under tension and improves neural pathway formation.
- Not wearing knee sleeves: knee sleeves stabilize the joint, allowing the brain to recruit the glutes more efficiently.
- Not leaning over to the working side: staying upright distributes weight to the back leg instead of the glute, whereas leaning over the working side maximizes glute activation.
- Holding two dumbbells instead of one: two dumbbells force your body to stay level, reducing glute activation. Instead, hold a single dumbbell on the opposite side to improve balance and allow for a greater lean. You can even rest it on your thigh if you like; you’re not here for an arm workout, after all, and allowing the body to focus on one task is better.
- Not pushing out the working knee: pushing the knee outward mimics a sprinting motion, engaging the glutes more effectively.
- Allowing the pelvis to tilt down: if the pelvis tilts as you lower, the glutes disengage. Keeping the pelvis level ensures the glute medius stays activated.
For more on all of these plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Strong Curves: A Woman’s Guide to Building a Better Butt and Body – by Bret Contreras & Kellie Davis
Take care!
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The FIRST Program: Fighting Insulin Resistance with Strength Training – by Dr. William Shang
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A lot of advice about fighting insulin resistance focuses on diet. And, that’s worthwhile! How we eat does make a huge difference to our insulin responses (as does fasting). But, we expect our regular 10almonds readers either know these things now, or can read one of several very good books we’ve already reviewed about such.
This one’s different: it focuses, as the title promises, on fighting insulin resistance with strength training. And why?
It’s because of the difference that our body composition makes to our metabolism. Now, our body fat percentage is often talked about (or, less usefully but more prevalently, even if woefully misleadingly, our BMI), but Dr. Shang makes the case for it being our musculature that has the biggest impact; because of how it hastens our metabolism, and because of how it is much healthier for the body to store glycogen in muscle tissue, than just cramming whatever it can into the liver and visceral fat. It becomes relevant, then, that there’s a limit to how much glycogen can be stored in muscle tissue, and that limit is how much muscle you have.
This is not, however, 243 pages to say “lift some weights, lazybones”. Rather, he explains the relevant pathophysiology (we will be more likely to adhere to things we understand, than things we do not), and gives practical advice on exercising the different kinds of muscle fibers, arguing that the whole is greater than the sum of its parts, as well as outlining an exercise program for the gym, plus a chapter on no-gym exercises too.
The style is quite dense, which may be offputting for some, but it suffices to take one’s time and read thoughtfully; the end result is worth it.
Bottom line: if you’d like to keep insulin resistance at bay, this book is an excellent extra tool for that.
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Tasty Tofu Scramble
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If you’re trying to eat more plant-based, this is a great way to enjoy a culinary experience that hits the same notes as scrambled egg, with many similar nutritional benefits too, and some of its own!
You will need
- 1 cup (10oz) silken tofu
- ¼ bulb garlic, crushed
- 1 tbsp nutritional yeast
- 2 tsp chia seeds
- 2 tsp dried thyme, or 1 tsp fresh thyme, stripped (i.e. pulled off the stalks)
- 2 tsp turmeric
- 2 tsp black pepper, coarse ground
- 1 tsp red chili flakes
- ½ tsp MSG, or 1 tsp low-sodium salt
- Extra virgin olive oil, for frying
Method
(we suggest you read everything at least once before doing anything)
1) Heat a skillet with olive oil in it; if you want a low-calorie option, you can use quite little oil here; the tofu is a lot more forgiving than egg in this regard and is almost impossible to burn unless you actively try. If you don’t want a low-calorie option, feel free to be generous with the oil if you prefer; it’ll go into the tofu and make it fattier, much like egg.
2) Add the tofu. You can just drop it (carefully) straight in; you don’t need to press it or anything.
3) Scramble it with a spatula, just the same as you would if it were egg.
4) Add the rest of the ingredients, mixing them in as you continue to scramble it, until it reaches the desired consistency.
5) Serve! Serving it on wholegrain toast is a great option—but this dish can also be enjoyed any other way you might use scrambled eggs (including for making
egg-friedtofu-fried rice; just stir it into our Tasty Versatile Rice recipe!)Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Plant vs Animal Protein: Head to Head
- Black Pepper’s Impressive Anti-Cancer Arsenal
- Capsaicin For Weight Loss And Against Inflammation
- The Many Health Benefits Of Garlic
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- If You’re Not Taking Chia, You’re Missing Out
Take care!
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Celery vs Carrot – Which is Healthier?
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Our Verdict
When comparing celery to carrot, we picked the carrot.
Why?
In terms of macros, carrot has more protein, carbs, and fiber, and is thus the “most food per food” option. The carb:fiber ratio is such that they have about the same glycemic index (when raw, anyway).
In the category of vitamins, celery has more of vitamins B9 and K, while carrot has more of vitamins A, B1, B2, B3, B5, B6, C, E, and choline. An easy win for carrot here.
When it comes to minerals, celery has more calcium and selenium, while carrot has more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. Another clear win for carrot.
In short, both are very respectable foods, but carrot simply has more in it, and it’s all good.
Enjoy!
Want to learn more?
You might like to read:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
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Top 5 Anti-Aging Exercises
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There are some exercises that get called such things as “The King of Exercises!”, but how well-earned is that title and could it be that actually a mix of the top few is best?
The Exercises
While you don’t have to do all 5, your body will thank you if you are able to:
- Plank: strengthens most of the body, and can reduce back pain while improving posture.
- Squats: another core-strengthening exercise, this time with an emphasis on the lower body, which makes for strong foundations (including strong ankles, knees, and hips). Improves circulation also, and what’s good for circulation is good for the organs, including the brain!
- Push-ups: promotes very functional strength and fitness; great for alternating with planks, as despite their similar appearance, they work the abs and back more, respectively.
- Lunges: these are great for lower body strength and stability, and doing these greatly reduces the risk of falling.
- Glute Bridges: this nicely rounds off one’s core strength, increasing stability and improving posture, as well as reducing lower back pain too.
If the benefits of these seem to overlap a little, it’s because they do! But each does some things that the others don’t, so put together, they make for a very well-balanced workout.
For advice on how to do each of them, plus more about the muscles being used and the benefits, enjoy:
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You might also like to read:
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Gut Health 2.0
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Gene Expression & Gut Health
This is Dr. Tim Spector. After training in medicine and becoming a consultant rheumatologist, he’s turned his attention to medical research, and is these days a specialist in twin studies, genetics, epigenetics, microbiome, and diet.
What does he want us to know?
For one thing: epigenetics are for more than just getting your grandparents’ trauma.
More usefully: there are things we can do to improve epigenetic factors in our body
DNA is often seen as the script by which our body does whatever it’s going to do, but it’s only part of the story. Thinking of DNA as some kind of “magical immutable law of reality” overlooks (to labor the metaphor) script revisions, notes made in the margins, directorial choices, and ad-lib improvizations, as well as the quality of the audience’s hearing and comprehension.
Hence the premise of one of Dr. Spector’s older books, “Identically Different: Why We Can Change Our Genes”
(*in fact, it was his first, from all the way back in 2013, when he’d only been a doctor for 34 years)
Gene expression will trump genes every time, and gene expression is something that can often be changed without getting in there with CRISPR / a big pair of scissors and some craft glue.
How this happens on the micro level is beyond the scope of today’s article; part of it has to do with enzymes that get involved in the DNA transcription process, and those enzymes in turn are despatched or not depending on hormonal messaging—in the broadest sense of “hormonal”; all the body’s hormonal chemical messengers, not just the ones people think of as hormones.
However, hormonal messaging (of many kinds) is strongly influenced by something we can control relatively easily with a little good (science-based) knowledge: the gut.
The gut, the SAD, and the easy
In broad strokes: we know what is good for the gut. We’ve written about it before at 10almonds:
Making Friends With Your Gut (You Can Thank Us Later)
This is very much in contrast with what in scientific literature is often abbreviated “SAD”, the Standard American Diet, which is very bad for the gut.
However, Dr. Spector (while fully encouraging everyone to enjoy an evidence-based gut-healthy diet) wanted to do one better than just a sweeping one-size-fits-all advice, so he set up a big study with 15,000 identical twins; you can read about it here: TwinsUK
The information that came out of that was about a lot more than just gene expression and gut health, but it did provide the foundation for Dr. Spector’s next project, ZOE.
ZOE crowdsources huge amounts of data including individual metabolic responses to standardized meals in order to predict personalized food responses based on individual biology and unique microbiome profile.
In other words, it takes the guesswork out of a) knowing what your genes mean for your food responses b) tailoring your food choices with your genetic expression in mind, and c) ultimately creating a positive feedback loop to much better health on all levels.
Now, this is not an ad for ZOE, but if you so wish, you can…
- Get the free ZOE gut health guide (this is good, but generic, gut health information)
- Take the ZOE home gut health test (quiz followed by offers of lab tests)
- Browse the ZOE Health Academy, its education wing
Want to know more?
Dr. Spector has a bunch of books out, including some that we’ve reviewed previously:
- Spoon-Fed: Why Almost Everything We’ve Been Told About Food Is Wrong
- The Diet Myth: The Real Science Behind What We Eat
- Food for Life: The New Science of Eating Well
You can also check out our own previous main feature, which wasn’t about Dr. Spector’s work but was very adjacent:
The Brain-Gut Highway: A Two-Way Street
Enjoy!
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