Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development

Autor: Ariela Frieder, Madeleine Fersh, Kristina M. Deligiannidis, Rachel Hainline
Rok vydání: 2019
Předmět:
Postpartum depression
Ganaxolone
medicine.medical_specialty
Neuroactive steroid
Pregnanolone
Article
law.invention
Depression
Postpartum
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Drug Development
Randomized controlled trial
law
Internal medicine
medicine
Animals
Humans
Pharmacology (medical)
GABA Modulators
reproductive and urinary physiology
Depression (differential diagnoses)
Randomized Controlled Trials as Topic
United States Food and Drug Administration
business.industry
beta-Cyclodextrins
Allopregnanolone
Pregnanes
medicine.disease
United States
030227 psychiatry
Drug Combinations
Psychiatry and Mental health
chemistry
Pyrazoles
Major depressive disorder
Antidepressant
Female
Neurology (clinical)
business
Neurosteroids
030217 neurology & neurosurgery
medicine.drug
Zdroj: CNS Drugs. 33:265-282
ISSN: 1179-1934
1172-7047
DOI: 10.1007/s40263-019-00605-7
Popis: Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
Databáze: OpenAIRE
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