Support your patients by making postpartum depression (PPD) intervention a priority

PPD overview for healthcare professionals, including information
about PPD and postpartum depression treatment resources

Prevalence Screening & conversation Symptom presentation
Identifying postpartum depression

Drs. Danielle Johnson, Greg Mattingly, and Bassem Maximos dig into the signs of PPD and how to engage in supportive, stigma-free conversations with patients.

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Prevalence

PPD is one of the most common medical conditions associated with pregnancy1

Despite its prevalence, PPD is underdiagnosed and undertreated, leaving many women without the support they need1,2

About 1 in 8 women report experiencing PPD symptoms after giving birth5

Figure derived from independent studies of US data from different populations analyzed using different methodologies.

Screening & conversation

Any woman can be at risk for PPD

Screening and open conversations are essential for timely intervention

ACOG recommends 
screening for depressive symptoms during pregnancy and after delivery1

Women
scoring 10 or higher on the EPDS should be evaluated for perinatal depression1

Conversations
with patients can help 
reveal what a screener alone might miss

Download the EPDS screener tool

Symptom presentation

It's important to notice how patients describe their symptoms
to help identify postpartum depression

The ways they describe the signs of PPD may often not match clinical terms9,10:

Mood

  • Persistent sad or “empty” mood
  • Loss of interest or pleasure in daily activities
  • Irritability or frustration
  • Feelings of worthlessness or guilt
  • Hopelessness or pessimism
  • Anxiety or obsessive thinking
  • Feeling overwhelmed
  • Uncontrollable anger
  • Thoughts of death, suicide attempts, or self-harm

Cognitive

  • Impaired ability to think or concentrate
  • Difficulty making decisions
  • Memory problems

Somatic/psychomotor

  • Difficulty sleeping, waking early, or oversleeping
  • Restlessness or having trouble sitting still
  • Abnormal changes in weight or appetite
  • Fatigue or abnormal decrease in energy

Infant-related

  • Trouble bonding or forming an attachment with the baby
  • Persistent doubts about ability to care for the baby
  • Thoughts of infant-related harm

If your patient is having these intense symptoms, it's important to evaluate them using the DSM-5-TR® criteria.

Provide your patients with our conversation guide to help them talk about depressive symptoms they may be experiencing.

Download the conversation guide
DSM-5-TR® criteria11

For patients to meet the DSM-5-TR® criteria for a major depressive episode with peripartum onset, they must have 5 or more of the below symptoms nearly every day* during the same 2-week period and change from previous functioning. At least 1 symptom must be either depressed mood or loss of interest/pleasure.

  • Depressed mood most of the day​
  • Loss of interest/pleasure in almost all activities most of the day​
  • Significant change in weight or appetite​
  • Insomnia or hypersomnia​
  • Psychomotor agitation or retardation​
  • Fatigue or loss of energy​
  • Feelings of worthlessness or excessive guilt​
  • Difficulty concentrating or making decisions​
  • Thoughts of death or suicidal ideation​

Additional criteria:

  • Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning​
  • Episode is not attributable to the physiological effects of a substance or to another medical condition​
  • Symptom onset occurs during pregnancy or within 4 weeks after delivery​

*”Nearly every day” does not apply to weight gain and recurrent suicidal thoughts or actions or recurrent thoughts of death.​


These are not the complete diagnostic criteria for PPD. The criteria listed here are adapted from the DSM-5-TR®. DSM-5® is a registered trademark of the American Psychiatric Association.
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Rapid PPD symptom relief as early as Day 3 with ZURZUVAE
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References: 1. American College of Obstetricians and Gynecologists. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-1261. 2. Cox EQ, Sowa NA, Meltzer-Brody SE, et al. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. 2016;77(9):1189-1200. 3. Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization — United States, 2017–2019. MMWR Morb Mortol Wkly Rep. 2022;71(17):585-591. 4. Bauman BL, Ko JY, Coz S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR Morb Mortol Wkly Rep. 2020;69(19):575-581. 5. Data on File. Biogen and Supernus Pharmaceuticals. 2025. 6. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final Data for 2018. Natl Vital Stat Rep. 2019;68(13):1-47. 7. Gregory ECW, Ely DM. Trends and Characteristics in Gestational Diabetes: United States, 2016–2020. Natl Vital Stat Rep. 2022;71(3):1-15. 8. Corbetta-Rastelli CM, Friedman AM, Sobhani NC, Arditi B, Goffman D, Wen T. Postpartum Hemorrhage Trends and Outcomes in the United States, 2000–2019. Obstet Gynecol. 2023;141(1):152-161. 9. Thurgood S, Avery DM, Williamson L. Postpartum depression (PPD). Am J Clin Med. 2009;6:17-22. 10. Perinatal depression. National Institutes of Mental Health. https://www.nimh.nih.gov/health/publications/perinatal-depression. Accessed December 8, 2025. 11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Publishing; 2022.

INDICATION

ZURZUVAE® (zuranolone) is indicated for the treatment of postpartum depression (PPD) in adults.

 

IMPORTANT SAFETY INFORMATION

WARNING: IMPAIRED ABILITY TO DRIVE OR ENGAGE IN OTHER POTENTIALLY HAZARDOUS ACTIVITIES

ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects.

Advise patients not to drive or engage in other potentially hazardous activities until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence, or the degree of driving impairment caused by ZURZUVAE.

 

WARNINGS AND PRECAUTIONS

Impaired Ability to Drive or Engage in Other Potentially Hazardous Activities

  • ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects
  • Advise patients not to drive a motor vehicle or engage in other potentially hazardous activities requiring complete mental alertness, such as operating machinery, until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence or the degree of driving impairment caused by ZURZUVAE

Central Nervous System Depressant Effects

  • ZURZUVAE can cause CNS depressant effects such as somnolence and confusion
  • Somnolence developed in 36% of patients who received ZURZUVAE (50 mg) and in 6% of patients who received placebo daily. Some ZURZUVAE-treated patients developed confusional state. One of these cases was severe, and was also associated with somnolence, dizziness, and gait disturbance
  • A higher percentage of ZURZUVAE-treated patients, compared to placebo-treated patients, experienced somnolence, dizziness, or confusion that required dosage reduction, interruption, or discontinuation
  • Because ZURZUVAE can cause CNS depressant effects, patients may be at higher risk of falls
  • Other CNS depressants such as alcohol, benzodiazepines, opioids, tricyclic antidepressants, or drugs that increase zuranolone concentration, may increase impairment of psychomotor performance or CNS depressant effects such as somnolence, cognitive impairment, and the risk of respiratory depression in ZURZUVAE-treated patients
  • To reduce the risk of CNS depressant effects and/or mitigate CNS depressant effects that occurs with ZURZUVAE treatment:
    • If patients develop CNS depressant effects, consider dosage reduction or discontinuation of ZURZUVAE
    • If use with another CNS depressant is unavoidable, consider dosage reduction
    • Reduce the ZURZUVAE dosage in patients taking strong CYP3A4 inhibitors

Suicidal Thoughts and Behavior

  • In pooled analyses of placebo-controlled trials of chronically administered antidepressant drugs (SSRIs and other antidepressant classes) that included approximately 77,000 adult patients and 4,500 pediatric patients, the incidence of suicidal thoughts and behaviors in antidepressant-treated patients age 24 years and younger was greater than in placebo-treated patients. There was considerable variation in risk of suicidal thoughts and behaviors among drugs, but there was an increased risk identified in young patients for most drugs studied. There were differences in absolute risk of suicidal thoughts and behaviors across the different indications, with the highest incidence in patients with major depressive disorder (MDD)
  • ZURZUVAE does not directly affect monoaminergic systems. Consider changing the therapeutic regimen, including discontinuing ZURZUVAE, in patients whose depression becomes worse or who experience emergent suicidal thoughts and behaviors

Embryo-fetal Toxicity

  • Based on findings from animal studies, ZURZUVAE may cause fetal harm when administered to a pregnant woman
  • Advise a pregnant woman of the potential risk to an infant exposed to ZURZUVAE in utero. Advise females of reproductive potential to use effective contraception during treatment with ZURZUVAE and for one week after the final dose
 

ADVERSE REACTIONS

  • The most common adverse reactions (≥5% and greater than placebo) in ZURZUVAE-treated patients were somnolence, dizziness, diarrhea, fatigue, nasopharyngitis, and urinary tract infection
 

DRUG INTERACTIONS

CNS Depressant Drugs and Alcohol

  • Caution should be used when ZURZUVAE is administered in combination with other CNS drugs or alcohol. If use with another CNS depressant is unavoidable, consider dosage reduction

Strong CYP3A4 Inhibitors

  • Reduce the ZURZUVAE dosage when used with a strong CYP3A4 inhibitor

CYP3A4 Inducers

  • Avoid concomitant use of ZURZUVAE with CYP3A4 inducers
 

USE IN SPECIFIC POPULATIONS

Pregnancy

  • There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including ZURZUVAE, during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants/
  • Based on findings from animal studies, ZURZUVAE may cause fetal harm. Advise pregnant women of the potential risk to a fetus. Available data on ZURZUVAE use in pregnant women from the clinical development program are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

Lactation

  • Available data from a clinical lactation study in 14 women indicate that zuranolone is present in low levels in human milk. There are no data on the effects of zuranolone on a breastfed infant and limited data on the effects on milk production
  • The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZURZUVAE and any potential adverse effects on the breastfed child from ZURZUVAE or from the underlying maternal condition

Hepatic Impairment

  • The recommended ZURZUVAE dosage in patients with severe hepatic impairment (Child-Pugh C) is lower than patients with normal hepatic function

Renal Impairment

  • The recommended ZURZUVAE dosage in patients with moderate and severe renal impairment is lower than those with normal renal function
 

DRUG ABUSE AND DEPENDENCE

  • ZURZUVAE contains zuranolone, a Schedule IV controlled substance
  • Zuranolone has abuse potential with associated risks of misuse, abuse, and substance use disorder including addiction
  • ZURZUVAE may produce physical dependence
 

Please see full Prescribing Information, including Boxed Warning.

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