Zuranolone in Palliative Care: Promise and Practicality for the Rapid Treatment of Depression

Abstract

Zuranolone is an orally available antidepressant classified as a neuroactive steroid. Neuroactive steroids act as positive allosteric modulators for both synaptic and extrasynaptic GABA, making them distinct from currently available drugs targeting major depression and insomnia. By modulating GABA binding sites, neuroactive steroids enhance the function of GABA, which is depressed in major depression. The drug has a rapid onset of action, which differs from currently available antidepressants that are used in palliative care. This paper will provide clinicians with an update on a new antidepressant with potential benefits for the palliative care population. The paper will review the pharmacology, pharmacodynamics, safety profile, and clinical studies showing its effectiveness in major depression and how it can potentially be helpful in the palliative care population.

Keywords: GABA; allopregnanolone; depression; hospice; neurosteroids; rapid onset antidepressants.