Last week, the FDA approved the first oral medication for postpartum depression, and today

I'll bring you 10 things you need to know about Zarel alone.

Welcome to the Carlatte Psychiatry podcast. I'm Chris Aiken, the editor-in-chief of the Carlat

Psychiatry Report, and our co-host

Kelly Newsom is out today on vacation. The FDA approved Xeranolone, brand name Zerzouva,

for postpartum depression last week. The approval was a Pyrrhic victory for Sage Therapeutics, the company that developed the

drug to replace its predecessor, Brexanalone, the cumbersome IV drug that was approved for

postpartum depression in 2019 as Zoresso. Brexanolone, Zoresso, was a scientific breakthrough, but not a financial success.

Sage had to lay off half its workforce shortly after the drug's release.

The drug worked well, but it was hard to deliver, requiring an overnight IV infusion,

oxygen checks because Brexenolone is so sedating that it can knock people unconscious.

Think back to 2020 when Brexenolone was first hitting the pharmacy shelves and COVID precautions were in full swing.

Were you in any position to open an overnight IV clinic then?

Probably not. Even hospitals didn't rise to the occasion. Most of us were trying to figure out how to deliver care with as little contact as possible back then.

Only about 1,000 women have received brachshenolone, and the minuscule market has not helped its pricing.

A single treatment costs $34,000 for the drug alone, and more for the overnight monitoring.

So Sage was hoping to break out of this morass with an oral version that women could take at home,

and that is where Zoran alone comes in.

Zoran alone is sedating, but so far no one has lost consciousness on it.

It comes with a simple warning, though, not to drive for 12 hours after taking it.

Just dose it all at night, and do take that warning seriously because there is evidence of driving impairment within those 12 hours. And Zareloan

has the bioavailability that Brexenolone lacked, so it can be taken orally, although it does

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