This Pill Treats Postpartum Depression. So Why Don’t More People Take It?

Amanda was no stranger to depressive moods. But after giving birth to her second child in four years, she felt worse than she’d ever felt in her life.

The pharmacist and mother of two from South Carolina, whose last name has been withheld to protect her privacy, had dealt with anxiety and depression on and off throughout adulthood. Amanda could usually manage her symptoms with an SSRI, or selective serotonin reuptake inhibitor, the most prescribed type of antidepressant medication.

That worked even after the traumatizing birth of her first child. She had an unplanned cesarean section following a lengthy, painful, and unintentionally unmedicated labor. The way she felt after giving birth for a second time, however, was “unlike anything I’ve ever known,” Amanda told Rewire News Group.

The birth itself went smoothly. But afterward, Amanda said, she felt no joy whatsoever and sobbed constantly. She didn’t want to kiss her child or say his name out loud. She would go an entire day without eating, even though her postpartum body had higher nutritional needs than normal.

Alarmed, Amanda brought up her symptoms at her six-week check-up with her OB-GYN. She was prescribed Zoloft, an SSRI that had previously worked for her. This time, it didn’t. After a few more SSRI trials and meetings with different OB-GYN providers, she recalled being told, “I don’t know what else to do for you.”

But there is, in fact, a pill specifically designed to treat postpartum depression. Why didn’t anyone tell Amanda about it?

What is postpartum depression?

Postpartum depression (PPD) affects at least 1 in 8 people nationwide. The brain and body undergo numerous changes after birth that can affect mental health.

One change is hormonal. Estrogen and progesterone plummet after pregnancy.

“Certain women have abnormal mood responses to changing levels of hormones,” psychiatrist Katie Unverferth, Medical Director of the UCLA Maternal Mental Health Program, told RNG in an email. “The large drop in estrogen and progesterone in the postpartum is such a time, and can trigger baby blues or the more severe postpartum depression.”

At the same time, other chemicals in the brain called neurosteroids are rapidly shifting in the postpartum period. These naturally occurring substances act on GABA receptors, which help the brain calm anxiety and help regulate mood. The key neurosteroid during pregnancy is “a very calming neurosteroid” called allopregnanolone, Dr. Sarah Oreck, reproductive psychiatrist and CEO of Mavida Health, told RNG via email.

“Allopregnanolone levels rise dramatically during pregnancy and then drop precipitously after delivery,” Oreck said. “This sudden decline is thought to be one mechanism underlying postpartum depression in vulnerable individuals.”

“PPD tends to be a very anxious depression,” added Unverferth.

People often feel sad and irritable, and experience obsessive thinking—especially disturbing thoughts around accidental harm happening to the infant, she added. A sense of overwhelm tends to be in the PPD mix, too.

Public awareness of PPD got a boost last year with the film Die My Love. The movie, released in November 2025, stars Jennifer Lawrence as a young mother with severe postpartum depression and psychosis. During the press tour for the film, Lawrence spoke openly about her own experience with postpartum anxiety after the birth of her second child. She described a disconnect and guilt around feeling like not being a good mother to her infant son.

“There’s not really anything like postpartum,” she told Variety. “It’s extremely isolating.”

Long road to PPD treatment

Until 2019, there were no confirmed FDA approved treatments for PPD beyond SSRIs, which won’t work for everyone and can take weeks to kick in if they do.

Then, in 2019, came brexanolone, the first-ever treatment approved by the FDA specifically for postpartum depression. While clinical trials suggested that the drug, marketed under the drug name Zulresso, could improve depression symptoms, logistical challenges dramatically limited its use.

Without insurance coverage, brexanolone was estimated to cost $34,000. It also needed to be administered via a 60-hour IV infusion in a hospital—a very long time for a new parent to be separated from their newborn and family.

In August 2023, the FDA approved zuranolone, prescribed under the brand name Zurzuvae, and the manufacturer discontinued brexanolone in 2025.

With her pharmaceutical background, Amanda had actually heard of zuranolone. She used her expertise to research the drug and couldn’t find much information online from other moms who had taken the treatment, even after posting in a social media group of 40,000 moms who are pharmacists.

“I got crickets. Nothing, not a single response,” Amanda said. “No one could give me any insight on what to do, how to obtain it, what it was like, side effects, no one.”

She convinced her psychiatrist to prescribe it anyway.

How zuranolone soothes the postpartum brain

Zuranolone is a synthetic version of allopregnanolone, the neurosteroid that declines post-pregnancy. Typically taken once daily for 14 days, psychiatrists believe that it likely works fast in the brain to restore levels of this mood-regulating neurosteroid, potentially within days.

This allows the nervous system to calm and emotions to stabilize, Oreck explained.

In a manufacturer-funded clinical trial for zuranolone, patients who were given the drug compared to the placebo had lower measures of clinical depression scores. Some saw mood improvement within three days.

Within the first week of taking zuranolone, Amanda said she felt a “hormonal reset.”

“It was like day one of giving birth started that day. I became a mother to my son that day. Because before that, I was not a mother. … I did nothing but keep this child alive for the first three months of his life. But once I took that medicine, it was like, reset,” said Amanda. “Okay, now we can restart our bonding.”

By day around three, her appetite returned. She doesn’t remember the first food she actually enjoyed—it was probably chicken nuggets or the Costco hotdogs that she was also feeding her toddler—but at some point, eating felt normal again.

Appetite loss was also what tipped off Karlee, a mother in Arkansas, that she might have PPD. Karlee spoke with RNG using her first name only to protect her daughter’s privacy.

Karlee had a history of anxiety symptoms that she had managed with prescription medication since adolescence. But when she brought her infant daughter home from the hospital in July 2024, her persistent anxiety became untenable.

“The very first night, I was terrified that she was going to stop breathing in the middle of the night … so I was like, someone has to stay up and stare at her,” Karlee told RNG.

“The anxiety and depression are so overwhelming,” she wrote on July 24, 2024, in a journal she kept to document her postpartum journey, recalling her third day home as “the most scared of my mental health I have ever been in my life.”

This anxiety and panic continued for more than a month. By that point, Karlee became used to her “meltdowns,” as she described them to RNG in an email. Exhaustion seeped into her bones; her milk supply was low. Breastfeeding parents may need to consume 500 additional calories per day, but Karlee said she was not taking in enough food.

Unlike Amanda, Karlee didn’t have to work to discover Zurzuvae; her psychiatrist recommended it immediately. She saw Karlee’s face in a telehealth call and knew something wasn’t right.

Karlee started the treatment about five-and-a-half weeks postpartum. It wasn’t an immediate “magic turning point,” Karlee said. But, slowly, by late summer, she felt herself climbing back to her baseline.

“I still have my moments, but they are manageable,” she remarked in her postpartum journal.

Zurzuvae is not currently FDA-approved to treat other mental health conditions of pregnancy, including postpartum psychosis and postpartum anxiety. Still, given that mental health conditions are a leading cause of death in postpartum and pregnant people in the U.S., the doctors RNG interviewed were willing to take a chance on the drug.

Oreck said she has prescribed the medication for patients with postpartum anxiety symptoms.

“I’m careful to counsel patients that this is an off-label use,” she said. “The medication hasn’t been specifically studied for anxiety in clinical trials, so we don’t have the same robust evidence base as we do for PPD.”

Challenges to widespread adoption

Some 500,000 people in the U.S. are diagnosed with PPD each year. Zurzuvae’s original manufacturer, Sage Therapeutics (later acquired by Supernus Pharmaceuticals), reported that 2,000 Zurzuvae prescriptions were shipped out in the last quarter of 2024, according to a 2025 Psychiatry Online article—up 40 percent from the second quarter of that year.

Those figures still fall well short of the potential market for this drug. If the treatment works, why do so few people use it?

Providers appear to be one part of the story. Initially, some insurance companies required zuranolone be prescribed by a psychiatrist, which experts said dramatically limited access to the drug. In practice, OB-GYNs are the most likely prescribers of any postpartum medication, since they are generally the only providers doing a dedicated postpartum mental health screening—at least for new parents who don’t have an existing psychiatric provider.

Even when an insurance company covers a zuranolone prescription from an OB-GYN, providers’ ability to gauge how someone is faring postpartum based on a series of routine questions is limited. That’s especially true if the doctor-patient relationship is new or if the patient isn’t open about or aware of their mental health challenges.

Karlee felt somewhat uncomfortable discussing her mental health in the sterile environment of her OB-GYN’s office. As a result, at a follow-up appointment two weeks after giving birth, she scored within the normal range on the postpartum mental health screening—even though she was in the throes of postpartum depression.

Unverferth also believes that many providers lack training and education around the medication.

“It is a very new medication that has a very unique way of dosing it,” she said, adding that some mental health providers may not be comfortable prescribing a 14-day dose of a calming, sedating medication.

Other providers—and some patients—could also be leery of Zurzurvae’s sedative nature. After taking a dose, patients cannot drive for 12 hours and may be too sleepy to properly care for an infant overnight. Breastfeeding is not advised during the 14-day treatment course.

These side effects didn’t bother Amanda. She had a supportive partner to pitch in if needed on night feedings, and she woke up nightly at 3 a.m. to feed her son. But she spoke with other moms who’d taken Zurzuvae and said they were too “zonked out” to fully function at night.

Yet as with so many health-care challenges in the United States, the main problem may be insurance, according to a 2025 article in Psychiatry Online about barriers to accessing this “innovative oral pharmacological treatment for postpartum depression.”

Without coverage, Zurzurvae costs about $15,000 for the two-week course.

The Policy Center for Maternal Mental Health reports that insured patients whose plans don’t automatically cover the medication won’t necessarily be shut out from the drug entirely. But they could be required to try other less-expensive treatments first, like SSRIs, delaying their recovery.

Zurzuvae also has a copay assistance program that can help ease the out-of-pocket costs. But it only applies to people who have commercial insurance. That won’t help uninsured PPD sufferers.

Amanda and Karlee understand these barriers, and they’re working to help more people with PPD get treatment. Amanda posts online about her experience with Zurzurvae and invites people to reach out to her with questions. So far, she’s walked two moms through the process of getting prior approval and copay assistance.

Karlee speaks out about zuranolone to any moms who will listen, she said. If doctors aren’t necessarily talking up the drug yet, it falls on patients to educate each other.

“I really wanted to put it out there that women need to trust themselves,” she said.

Editor’s note (Feb. 25, 2026): The dek, or teaser, of this article has been corrected to reflect that Zurzurvae is the first oral pill to be approved for postpartum depression, not the first medication. The first medication was Zulresso.

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