Key Takeaways

Zurzuvae (zuranolone) differs from traditional antidepressants because it's the first oral treatment approved for postpartum depression (PPD), but it's not approved for major depressive disorder. It’s faster-acting than most traditional antidepressants, has a unique mechanism of action and is only taken for 14 days, with symptom improvement starting as early as the third day.

Zurzuvae’s mechanism for treatment of PPD is due to its action on GABA-A receptors, while the more traditional selective serotonin reuptake inhibitors (SSRIs) are work at serotonin (5HT) receptors.

Side effects

Zurzuvae should be taken in the evening, as it can cause sleepiness in about 36% of patients and dizziness / vertigo in about 13%. Many traditional antidepressants may also be associated with drowsiness, sleepiness or dizziness as a side effect, but this will differ based on the treatment you are taking.

The most common side effects with Zurzuvae in at least 5% of patients are somnolence (drowsiness, sleepiness), dizziness / vertigo, diarrhea, fatigue, nasopharyngitis (common cold), and urinary tract infections.

Side effects with traditional antidepressants like the selective serotonin reuptake inhibitors (SSRIs) will vary, but commonly include insomnia (trouble sleeping) or drowsiness, dizziness, anxiety, sexual dysfunction, nausea, diarrhea, and appetite changes.

Cost

The cost of Zurvuvae is around $16,000 for a 14-day treatment based on the manufacturer's retail price, but most people never pay this price. Your cost may vary based on your prescription insurance or any patient assistance, coupons or copay cards provided by the manufacturer.

Patient assistance programs from the manufacturer of Zurzuvae may be an option for some patients. Visit here to learn more about Zurzuvae cost and insurance coverage.

This medicine will be shipped to you from a specialty pharmacy after approval by your benefit provider.

Abuse potential

Zurzuvae is a Schedule 4 controlled substance with some potential for misuse, abuse, addiction and withdrawal, but it’s only given as a one-time, 14 day treatment. Traditional antidepressants like the SSRIs, are not controlled by the DEA, and are typically taken for several months or longer when used for PPD.

Studies have shown it has abuse potential similar to the benzodiazepine alprazolam (Xanax), also a Schedule 4 controlled substance.

How fast does Zurzuvae work?

In studies, Zurzuvae significantly improved symptoms of postpartum depression (PPD) as early as the 3rd day after starting treatment and effects were sustained through day 45, based on the SKYLARK Phase 3, placebo-controlled study.

A quick-acting agent like Zurzuvae may have an advantage for patients with severe PPD, where faster onset may be preferable. Zurzuvae is available as 20 mg, 25 mg and 30 mg oral capsules and can be used alone or in addition to other oral antidepressant therapy.

Traditional oral antidepressants like the selective serotonin reuptake inhibitors (SSRIs) - for example fluoxetine (Prozac) or sertraline (Zoloft) - can take up 4 to 8 weeks for the full antidepressant effect to occur.

Zurzuvae mechanism of action (how it works)

Zurzuvae has a different mechanism of action from many other antidepressants like the selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). It is classified as a neuroactive steroid (NAS) gamma-aminobutyric acid (GABA)-A receptor positive modulator. GABA is the major inhibitor signaling pathway in the central nervous system and helps regulate brain function.

This differs from agents like the SSRIs and SNRIs. Zurzuvae’s mechanism for treatment of PPD is thought to be due to its action on GABA-A receptors, while SSRIs are thought to work at serotonin (5HT) receptors, and SNRIs act at serotonin and norepinephrine receptors.

GABA, serotonin and norepinephrine are all neurotransmitters that act as chemical messengers in the central nervous system and brain. Chemical messengers carry signals between cells in the body. In general, antidepressants may work at many other different receptors in the nervous system, depending upon their pharmacology and chemical structure.

How often do you take Zurzuvae?

Zurzuvae is taken by mouth once daily in the evening for 14 days. This is the full length of the treatment course. You should take each dose with a fat-containing food (containing 400 to 1,000 calories; 25% to 50% fat). Talk to your healthcare provider about which types of high-fat foods you should eat.

It is not known if it is safe to continue using Zurzuvae after the 14 day single treatment course. Take Zurzuvae exactly as your healthcare provider tells you to take it.

Zurzuvae can make you sleepy and slow your reactions, so you should take it in the evening for the entire 14-day treatment course. Do not drive, operate machinery or perform other dangerous activities for at least 12 hours after taking your dose. You may not be able to tell on your own if you can drive safely or tell how much Zurzuvae is affecting you.

You may also be at a higher risk for falls during treatment due to the effects like sleepiness, drowsiness, slow thinking, dizziness, confusion, and trouble walking.

Take your dose in the evening so that it does not interfere with your daily activities, like work, school or parenting. In studies, over one-third of people taking a Zurzuvae 50 mg dose experienced sleepiness, a very common side effect.

Do not drink alcohol or take other medicines that make you sleepy or dizzy while taking this medicine without talking to your healthcare provider. The combination can increase your central nervous system (CNS) effects like sleepiness or slow your motor skills and thinking ability.

Tell your doctor if these symptoms worsen or interfere with your daily activities. You may need a dose adjustment or a different medicine for postpartum depression.

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What is postpartum depression (PPD)?

Postpartum depression (PPD) is a major depressive episode that usually starts after childbirth but can also start during the later stages of pregnancy. PPD can make it difficult for a mother to bond with her child and can delay emotional and physical development.

Roughly 1 in 8 women (12.5%) experience symptoms of postpartum depression (PPD), such as:

• Intense anxiety
• Trouble sleeping
• Sadness, crying
• Shame
• Guilt
• Stress
• Panic attacks
• Suicidal thoughts or actions

Which antidepressants are used for postpartum depression (PPD)?

In addition to common SSRIs like fluoxetine (Prozac) or sertraline (Zoloft), other more traditional antidepressants that your doctor may prescribe "off-label" for PPD include serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and desvenlafaxine (Pristiq), bupropion (Wellbutrin SR), or mirtazapine (Remeron).

Off-label use refers to prescribing a medication for a different purpose than those formally approved by the FDA and found in the package labeling of the drug.

An FDA approved faster-acting option like Zurzuvae may be preferred in some cases of postpartum depression.

Group or individual psychotherapy (“talk” therapy) should also be added to treatment options, when possible. Electroconvulsive therapy may be a life-saving option in severe cases PPD, but it is not frequently used.

Lifestyle adjustments, like a focus on proper sleep, exercise, healthy eating, social interactions and help with the new baby and household chores should also be addressed.

In March 2019, the FDA approved Sage Therapeutics’ Zulresso (brexanolone) injection for PPD in adults, but it was discontinued by the manufacturer in December 2024 due to business reasons.

Your healthcare provider will decide which antidepressant agent or other therapy may be best for you based on your condition, medical history and the benefit versus risks of the different options.

To learn more about treatment for PPD, you can read: Medications used in the treatment of postpartum depression (PPD).

Is Zurzuvae a controlled substance?

Yes, Zurzuvae is a Schedule 4 controlled substance, which means it has some abuse potential. In studies, zuranolone (the active ingredient) was shown to have abuse potential similar to alprazolam (Xanax), a schedule 4 benzodiazepine controlled substance.

Zuranolone has the potential for the development of misuse, abuse, and substance use disorder including addiction. It can also cause physical dependence and has been reported to lead to mild-to-moderately severe withdrawal symptoms such as:

• Trouble sleeping
• Fast heart beat
• Decreased appetite
• Nightmares
• Nausea
• Excessive sweating
• Paranoia

Most other traditional antidepressants such as the SSRIs or SNRIs are not classified as controlled substances, but can cause discontinuation symptoms like insomnia, nausea, anxiety or fatigue in some people. To help avoid this, these medicines are often slowly discontinued.

How much does Zurzuvae cost?

The cash price of Zurvuvae around $16,000 for a 14-day treatment based on the manufacturer's retail price. Your cost may vary based on your prescription insurance or any patient assistance, coupons or copay cards provided by the manufacturer.

To learn more about the cost of Zurzuvae, visit the Drugs.com Price Guide.

Zurzuvae is available through specialty pharmacy networks, not from your local retail pharmacy. Your doctor will need to complete an Insurance Prior Authorization form for you to access the medication.

This medicine is covered for about 95% of patients with commercial insurance and Medicaid, according to the manufacturer. Sage Therapeutics can also support eligible patients with patient access programs and copay assistance through the Zurzuvae Savings Card Program. Eligible patients with commercial insurance may pay as little as a $0 copay for their prescription. Certain restrictions may apply.

Zurzuvae is available as a brand name drug only - a generic version is not yet available. View generic Zurzuvae availability to learn more.

Many other antidepressants, including most of the SSRIs, are now available in the U.S. as a generic option, which can bring their costs to less than $20 per month, depending upon the generic option prescribed and any pharmacy discounts. To view generic prices, search on generic drug names here.

You can also access a Drugs.com Drug Discount Card here.

Talk to your healthcare provider if you have concerns about the costs of your PPD treatment, as more affordable options may be available for you. Do not skip treatment due to costs.

This is not all the information you need to know about Zurzuvae (zuranolone) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

References

• Deligiannidis KM, Meltzer-Brody S, Gunduz-Bruce H, et al. Effect of Zuranolone vs Placebo in Postpartum Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(9):951–959. doi:10.1001/jamapsychiatry.2021.1559
• FDA Approves First Oral Treatment for Postpartum Depression. Aug 4, 2023. US Food and Drug Administration (FDA). Accessed Sep 2, 2025 at https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression
• Zurzuvae FDA Approval History. Drugs.com. Accessed Sep 2, 2025 at https://www.drugs.com/history/zurzuvae.html
• Viguera A (author). Severe postpartum unipolar major depression: Choosing treatment. Up to Date. Accessed Sep 27, 2023 at https://www.uptodate.com/contents/severe-postpartum-unipolar-major-depression-choosing-treatment
• Zurzuvae (zuranolone) prescribing information. 7/2024. Biogen / Sage Therapeutics. Cambridge, MA. Accessed Sept 2, 2025 at https://documents.sage-biogen.com/us/zurzuvae/pi.pdf

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