Zuranolone for Postpartum Depression After Highly Lethal Suicide Attempt: Two Case Illustrations and a Narrative Literature Review

BACKGROUND: In the United States, suicide is one of the leading causes of death in the first year postpartum, possibly accounting for up to 20% of deaths. The Food and Drug Administration recently approved 2 fast-acting medications, brexanolone and zuranolone, for the treatment of postpartum depression (PPD), which shares many clinical features with postpartum suicidality. OBJECTIVE: Determining the efficacy of zuranolone in the treatment of severe PPD in the context of highly lethal suicide attempts. METHODS: We describe 2 illustrative cases of zuranolone treatment of PPD after a gunshot suicide attempt. Following treatment, both women demonstrated a rapid reduction in depressive symptoms and readiness for safe discharge. We also conducted a review of the literature on suicide attempts associated with PPD. RESULTS: Our case series demonstrated that zuranolone may effectively treat PPD with rapid-onset highly lethal suicide attempts. CONCLUSIONS: Postpartum suicidality is complex and often emerges rapidly. We advocate for more research on fast-acting novel treatments, such as zuranolone and brexanolone, for PPD and postpartum suicidality.