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Review
. 2022 Feb;34(2):e13019.
doi: 10.1111/jne.13019. Epub 2021 Aug 30.

Development of neuroactive steroids for the treatment of postpartum depression

Handan Gunduz-Bruce  1 , Koji Takahashi  1 , Ming-Yi Huang  1
Affiliations
Review

Development of neuroactive steroids for the treatment of postpartum depression

Handan Gunduz-Bruce et al. J Neuroendocrinol. 2022 Feb.

Abstract

Postpartum depression (PPD) is a common major depressive episode surrounding childbirth, with estimated rates ranging from 5.5% to 23.5% of all live births across Europe and the USA based on the presence of key symptoms. PPD has been associated with significant impairments in both maternal functioning and mother-infant attachment, and these impairments can have lasting effects on the emotional and cognitive development of children. Although the precise pathophysiology of PPD is unknown, preclinical findings suggest that large fluctuations in neurosteroid hormone levels can induce physiological plasticity in the expression of functional GABAA receptors during pregnancy and the postpartum period, and that deficits in this plasticity may underpin a biological mechanism that contributes to the manifestation of depressive symptoms. Here, we review the controlled clinical trials to date that have assessed the efficacy of pharmacological treatments for PPD, including oestradiol, selective serotonin reuptake inhibitors, brexanolone (an iv formulation of allopregnanolone) and an investigational neuroactive steroid and GABAA positive allosteric modulator, zuranolone. Coupled with the GABAergic deficits implicated in major depressive disorder, these findings highlight not only the potential role of GABAA receptor plasticity in the pathophysiology of PPD, but also the novel therapeutic approach of using positive allosteric modulators targeting GABAergic transmission to treat women affected by PPD.

Keywords: GABA positive allosteric modulator; neuroactive steroid; postpartum depression.

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Figures

FIGURE 1
FIGURE 1
Mechanism of action of the positive allosteric modulator allopregnanolone on synaptic and extrasynaptic GABAA receptors. Allopregnanolone binds both synaptic and extrasynaptic GABAA receptors, acting as a positive allosteric modulator to increase the frequency and duration of channel opening, thus increasing hyperpolarizing GABAergic current., BZD, benzodiazepine; GABA, γ‐aminobutyric acid; GABAA, γ‐aminobutyric acid type A; NAS, neuroactive steroid
See this image and copyright information in PMC

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