The Medicines and Healthcare products Regulatory Agency (MHRA) approved zuranolone in August 2025 for the treatment of moderate or severe postnatal depression (PND) in adults following childbirth.
Zuranolone is an oral synthetic version of allopregnanolone, a naturally occurring neuroactive steroid that modulates gamma-aminobutyric acid. During pregnancy, allopregnanolone levels rise and then drop sharply after birth. For some women, this sudden shift is what is thought to contribute to PND.
Unlike traditional antidepressants, which can take weeks to work and are usually taken for months, zuranolone is given as a 14-day course, with improvements sometimes seen within just three days.
The approval of treatments developed specifically for perinatal mental health, like zuranolone, does feel like a genuine step forward. At present, there are no medicines licensed in the UK for perinatal mental health conditions, so the idea that we may potentially soon have something targeted to this population is exciting. The different mode of action of both zuranolone (which has been available in the United States since 2023), and its predecessor brexanolone, suggest that these conditions may need a different treatment approach, and could pave the way for more research in an area that has long been underexplored.
However, although zuranolone has recently been granted MHRA approval in the UK, the National Institute for Health and Care Excellence (NICE) is currently reviewing whether it represents value for money.
In its draft guidance, also published in August 2025, NICE does not recommend its routine use, citing both cost (a course in the United States is priced around US$16,000) and questions about how long the benefits last, as most studies only follow patients for a relatively short period.
Separately, there are also uncertainties around its use in breastfeeding. Early data suggest only minimal transfer into breast milk, but the evidence base is small, and some experts currently advise pausing breastfeeding during treatment. A final decision from NICE is expected in October 2025.
Nevertheless, we also need to keep the bigger picture in mind. Suicide remains one of the leading causes of maternal death in the UK, and while medication is never the whole answer, rapid-acting treatments like zuranolone could offer vital hope for women in severe distress.
Whatever the outcome of the NICE decision, pharmacy professionals have a crucial role. We are often well placed to spot early signs of PND or anxiety, to listen without judgement, and to guide women and their families towards local services and support.
If zuranolone does enter practice, pharmacists will also be central to conversations about how it works, what to expect in terms of benefits and side-effects, and how it fits alongside breastfeeding or other medicines. Perhaps, most importantly, we can help reduce stigma around perinatal mental health by making these conversations feel safe and routine.
James Lee, lead pharmacist, specialist community perinatal mental health service, Devon Partnership NHS Trust
