Q: 27 years old, recently postpartum female is admitted to ICU with severe unipolar depression and suicidal ideation; which of the following is a drug of choice? - select one
A) Brexanolone
B) Zuranolone
C) Fluoxetine
D) Paroxetine
E) Sertraline
Answer: B
Zuranolone is classified as a neuroactive steroid. It provides a rapid response and is usually well tolerated. It is recommended by the practice guidelines from the American College of Obstetricians and Gynecologists. It is given as 50 mg orally each evening for 2 weeks. Another advantage is that it can be combined with other antidepressants. The only care that needs to be taken is administering it with fat-containing food, which facilitates absorption.
Though Brexanolone is also a rapid-acting neuroactive steroid, it requires 60 hours of infusions. It can be used as an alternative to quinolone but should not be given to patients who failed quinolone because it is the same class of drug.
Other choices in the question (Choices C, D, and E) are the second line of drugs, which can be used as maintenance drugs later.
#psychiatry
#ob-gyn
References:
1. The American College of Obstetricians and Gynecologists. Zuranolone for the Treatment of Postpartum Depression. Practice Advisory. August 2023. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2023/08/zuranolone-for-the-treatment-of-postpartum-depression? (Accessed on October 01, 2024).
2. Patterson R, Balan I, Morrow AL, Meltzer-Brody S. Novel neurosteroid therapeutics for post-partum depression: perspectives on clinical trials, program development, active research, and future directions. Neuropsychopharmacology 2024; 49:67.
3. HIGHLIGHTS OF PRESCRIBING INFORMATION FOR ZURANOLONE. Revised 11/2023. https://documents.sage-biogen.com/us/zurzuvae/pi.pdf (Accessed on October 6, 2024).
No comments:
Post a Comment