Quiet Confessions: Psychiatric Hospitalization Part Seven (Zulresso)

In this "Quiet Confession," I’m taking you back into the timeline of my perinatal psychiatric inpatient stays to focus on a specific event: my experience with the Zulresso (Brexanolone) infusion. 

At the time, in 2022, this was the only FDA-approved treatment specifically for postpartum depression, and in my darkest moments, I had latched onto it as a "miracle drug" that would magically stop my intrusive thoughts and physical suffering.

Key Takeaways

• The Weight of "Magical Thinking": How we often latch onto a specific treatment as a "cure-all" when we are desperate for relief.
• The Science of Zulresso: It works with GABA receptors to counteract the sharp drop in hormones after birth, though it requires a 60-hour inpatient stay.
• Community in Crisis: The powerful support found among other "moms in the unit" who hyped each other up during treatment.
• Advocacy & Insurance: The logistical hurdles of accessing cutting-edge maternal mental health care.
• Evolution of Care: Why Zulresso was eventually withdrawn from the market in 2025 in favor of more accessible oral treatments like Zurzuvae.

Transcript

Chelsea Myers (00:00)
Hey, welcome back to another quiet confession. A little mini episode where just you and I get to hang out We are currently on a journey together through my three separate experiences in an inpatient psychiatric setting.

while I was struggling with my postpartum mental health disorders. Last time I talked to you, really focused on the relationships that I made and connections that I made and I think that was an interesting thing for me to revisit. There's definitely other little instances and I'm sure they'll pop up here and there as we go along but...

I'm going to kind of jump back into the timeline a little bit. I'm fast forwarding and condensing as much as I can. And maybe I'll come back and talk about other things, but I wanted to focus today on my experience with the Zulresso infusion, otherwise known as Brexanolone. At the time in 2022, it was the only FDA approved treatment specifically

for postpartum depression. Since then, they have sort of taken what they've learned from that and they have created forms of this treatment. ⁓ One is a pill.

you take over the course of two weeks But Zulresso just so that we are all on the same page, was, like I said, an FDA approved 60-hour continuous IV treatment that was designed to rapidly treat moderate to severe postpartum depression.

Usually you would expect to see results within two to three days.

And for science nerds or people who just like to understand things like me, the way it works is with your GABA receptors to counteract the drop in some of your post-birth hormone levels. But there are some risks involved and the most notable one is severe sedation. So you essentially are hooked up to an IV and stuck in a hospital bed for three

while it is being administered. At the time studies showed that it significantly reduced depressive symptoms in the target population which was

adults with moderate to severe postpartum depression, typically within the first six months of giving birth, which will play into my story as well. And yeah, you're monitored in a hotel room. Not in a hotel room. You're monitored in a hospital setting. And yeah, some of the side effects that you could expect were drowsiness, dry mouth, dizziness, and maybe a little flushing.

in how that relates to my story, I had known about Zulresso months before I ever found out that I would be receiving it.

In my OCD spirals late into the nights and early mornings, prior to even my first hospitalization, I was googling every treatment there was for postpartum mental health disorders. And at the time, I didn't know the wide variety of postpartum and perinatal mental health disorders. I just kind of was familiar with postpartum depression and postpartum anxiety. And early on in my experience, I was being told

was experiencing severe postpartum anxiety. So like I said, when things were getting really bad, I was looking into different inpatient programs and I also found Zulresso and I kind of became convinced and slowly over time latched more onto the idea that this would be the miracle drug that

would cure me of everything that was going on with me. would make the nausea stop. It would make the constant intrusive thoughts stop. It would make all of the suffering that I was going through physically and mentally every day, it would just magically make it stop. For a lot of people who were experiencing postpartum depression at the time, this was honestly, it was honestly a miracle. It was the first time

in the history of people giving birth that we had an FDA approved treatment that was specifically for postpartum depression. ⁓ I learned at UNC that it wasn't necessarily targeted toward anxiety, but it could have some positive effects on that as well because a lot of the time postpartum depression and anxiety work in tandem. So I knew what it was.

I knew that it was a three-day infusion. I didn't understand necessarily the science behind it until later, until researching it later. But I had it in the back of my mind. So even at my first hospitalization in Vermont, in Southern Vermont, I had written about it in my journal. I'm like, wonder if Zulresso is the answer to this or if I can just beat this on my own.

Um, Zulresso came immediately

when I first started my journey at UNC. And it was interesting. It came up through the psychiatrists and the doctors that I was working with, but it also came up

from the other moms in the perinatal unit, apparently, because it was so new at the time. So this was November of 2022. UNC was really kind of like a trial area. Like they were really, really at the forefront of trying this out on their postpartum.

patients, postpartum mental health patients. so several of the other moms that I had talked to had been spoken to about Zulresso. And I can't remember for sure, but I think one of them had tried it, but had like only a moment, like a little bit of relief for a little while and then was back for recurring symptoms. But

It was interesting. do remember one of the other moms saying like, yeah, they really push Brexanolone. think they're trialing it here. So I don't know. Maybe you'd be a good candidate. I latched on to anything and everything that I thought would help me. And so when my...

doctors brought it up in our daily meetings, I was like, yes, yes, please, please, please, please. And it kind of became a waiting game. It was like, they had to talk to my insurance and they had to see if I would be a good candidate. And because I was approaching the six month postpartum point, because I had my daughter in June, ⁓ would I still be eligible?

And because my symptoms were so kind of all over the place and they had a hard time pinning down an exact diagnosis for quite a while, they were like, would this even be helpful at all? ⁓ But I do remember one of the doctors just, I don't know, she seemed sort of dead set, like we're going to get this to happen for you. And I was happy about that.

I wanted that because we'll go back to my magical thinking. I thought that this was why I was in North Carolina, why I was at this hospital, why I had these doctors that I needed Zulresso and that it was going to fix everything. Before we could even get there, there were weeks ⁓ in between. So I was still doing the regular like...

everyday monotony that we've talked about. Meeting with the doctors, meeting with the therapists, meeting with the OTs, ⁓ doing all the things that I was supposed to do, trying to eat as best as I could, and just following a routine while I was in this limbo of, I getting Zulresso? Am I not getting Zulresso? And

there was like two days in which it really was a question of is my insurance going to approve this or not. And the doctor that I was working with even went so far to say like, if your insurance doesn't approve this, we can.

work together because we're also doing a research study. It just means that the process would look a little different. Like you'd have to wear electrodes and we'd have to monitor brain activity and you'd have to like fill out these assessments and all of this stuff. And I was like, I don't care. I'll do all of it. ⁓ so there was like one or two days where I was like, okay, is my insurance going to approve this or am I going to be part of a research study? And for someone who has really high health anxiety and who knew

what Zulresso was supposed to do but not how it worked or what I was actually putting in my body. ⁓ I didn't care. I was gung-ho. I was like, just give it to me, please. It was evening time.

It was right around dinner time and a nurse at the nurse's station stopped me and she said, I just got a call. ⁓ they told me to let you know that your insurance approved the Zulresso infusion. So you will be starting that next week. And this was, this was midweek. So I still had like a week to wait before I could do it, but I got so excited. I asked the nurse if I could hug her.

I felt like this overwhelming sense of relief and joy. It was fleeting. It kind of overtook my body and then everything kind of set back in again because I didn't really have control over my symptoms. But for that moment, I had hope. I was like, this is it. And I called my family, I called my husband to let them know. And we had a plan.

The plan was, obviously I still had to wait until everything was set, but my husband would fly down and spend those three days with me while I was hooked up to an IV and couldn't go anywhere. And then we, if the treatment worked,

I would be discharged. So first I would be discharged from the psychiatric unit into a different unit of the hospital to receive the infusion. If the infusion worked, I would be totally discharged and I would be able to fly home. We decided we would take an extra day and spend a day in the hotel in North Carolina just to kind of like slow down a little bit.

⁓ If it didn't work and I was still experiencing the same level of symptoms, then I would be readmitted back into the perinatal psychiatric inpatient unit.

So our backup plan was my husband would come down and if it didn't work, he would fly home. And then whenever I was able to be discharged for real, my mom would fly down and take me home. Cause we didn't know how long it could be days. could be weeks. It could have been months. We had no idea. None of this had a timeline. That was, I think what was most.

Ugh. That was the most disheartening thief of hope ⁓ possible. Like, you can't imagine just being told, we don't know when this is gonna stop, but it will stop. I got to the point where I didn't believe them that it would stop, but regardless. We're talking about Zulresso today. as...

As the time approached and as we were waiting

Like I said, I was still attending all of my therapies and all of my groups. I do recall as we were like getting into the end of November and the beginning of December, things shifted to like Christmas. do remember OT got permission to take us down to their little kitchen and we made Christmas cookies and we shared them with the other gentle crisis patients and that was, that was

kind of a really cool moment because it was right before I was supposed to start my Zulresso infusion so it was kind of like my in my eyes it was my goodbye to the unit and to everyone and I shared my cookies and yeah and I remember everyone that I had sort of formed a connection with was so

even people that I didn't form like a close connection with it was the night before and even the morning of and people were telling me You've got this this is going to work. You are going to go home You've been here so long like you are a good mom you're gonna go home to your kids and They were all sort of

giving me these tiny drops of hope to hold onto even when they were still struggling with their own demons and struggling with their own mental health.

crises or situations or whatever the case may be. They were so kind in giving me those little glimmers and I will be forever grateful for that because it did. It hyped me up. It made me feel like what I was doing was going to work and that it was the right choice. The funniest thing for me to remember

in very unfunny situation was that the nurses and the OTs and the other patients made it their mission ⁓ to create a list for me of all of the foods that I needed to try while I was basically bed bound for three days. Because we had learned over my time there that there were so many restaurants and foods and things that

I had never had being from New England and we were in the south and like up until that point I'd never had crumble I'd never had insomnia cookies which I Love it or hate it a hill I will die on is that insomnia cookies is way better than crumble cookies But anyway having both now we have both in Vermont now. We didn't at the time There were other places that I had like Chick-fil-a I'd never had chick-fil-a

I don't eat chicken fillet now, I don't eat meat now, but I did at the time. ⁓ There was... ⁓ I wish I could remember the other places. One was like a barbecue type place, but it had a specific name and it was a chain, ⁓ but I can't remember what it was called. Cheesecake Factory. We didn't have a Cheesecake Factory. Yeah, so the list goes on and on and...

everyone worked on it together the patients the nurses the ot's that like everyone made this list because at that point i was able to eat a little bit and my husband needed to eat anyway so ⁓ yeah we we did a lot of door dashing during my Zulresso infusion and i tried almost everything on the list i obviously couldn't do everything

so the process was, I had to fill out my ⁓ discharge papers from the perinatal unit and I had to make my action plan and I had to do all of that stuff and pack up all my stuff and get all my things back that had been...

locked away safe and then I was taken to a different part of the hospital and my husband was not there yet he would be joining us later they got me to my room which was actually on

a unit where patients who had cancer or other conditions similar would receive their transfusions if they had to be inpatient. So it was a very, very quiet space because the people there were very, very sick. ⁓ But I got to my room. They got me all set up and

Honestly, we just started the drip and I had to wait. I was just waiting for my husband to come. I don't think it made me drowsy. I don't remember sleeping a lot. ⁓ I do remember within the first couple of hours saying to the nurse, because they had to check on me every once in a while, that

I felt excited and she told me that that was a really good sign. She said that if I was feeling excited this early on

then it was a good sign that this was going to work for me. And boy did I hold on to that. And I do, think it carried me through the infusion. ⁓ things weren't perfect, but my husband did arrive. He could have stayed in a hotel, like the hospital gave him all kinds of resources and they would have like helped him financially in finding a place to stay. And, but he slept on the pullout couch and stayed with me every night. We watched

a lot of TV and ate a lot of food and every time we ordered something we also ordered things for the nurses on the unit. We know the power.

of nurses. We know the powers of CNAs. ⁓ Because of my husband's motorcycle accident, we have a completely different view of the role that nurses and CNAs and the people that do the real work in a hospital setting.

of connecting with the patient, making sure the patient is receiving the care that they need, when they need it, checking in on them mentally and physically. The job is so demanding and exhausting. ⁓ through all of my husband's and my hospital stays, whether psychiatric or ICU or neurosurge or any of those things, nurses and CNAs have been our superheroes. So.

Whenever we are inpatient, which we don't like to be, such is life, we make sure that try to show our thanks to our nurses and our CNAs. So anytime we would order food from DoorDash, we would order something for them as well.

And I mean, yeah, that's how we spent three days. ⁓ Just hooked up to this IV. I could take the IV pool with me and we would take walks around the unit just to get out of the room. But like I said, it was really quiet and dark because the people there were very sick. ⁓ And I felt for each and every one of them. But all I could really focus on was.

I just want this to work. I just want this to work. After the third day, my doctors from the perinatal unit came and checked with me. They did a rating scale with me, so they checked for suicidality as well as depression and anxiety. My scores were better, and I guess they were to a point that the doctors felt comfortable discharging me.

This will come back and I'm gonna do...

a standalone episode about all of the medications that I was prescribed during this entire experience, but they did discharge me with a prescription for Ativan, which is a medication that I struggled with throughout this whole process. But they told me, they said, if you need this, take this. This is not a failure. So, yeah, they discharged me with

At the time I was on several different medications but Ativan was one of them and I said okay Like that was it pack your bags go to the pharmacy pick up your prescriptions and you're good to go we got an uber and went to the hotel and Even there I already Didn't feel right

I already was incredibly anxious. And that could have been normal. Anxious about flying home, anxious about getting back into a routine, anxious about getting back to my baby who I loved more than anything, but even holding her was incredibly triggering. But I knew something wasn't quite right. And my husband did too.

And that's where I'm stop for now because we'll continue on the timeline. But just for updates on treatment for for perinatal and postpartum mental health disorders, I don't actually think that they are still using Zulresso. ⁓

Yeah, it was officially withdrawn from the market April 14th, 2025. So almost a year ago today as I record this. It just...

the it was discontinued not because it wasn't helpful but because it was really hard to justify the treatment process. It's really hard to get a mom, especially a newly postpartum mom, to be in a hospital setting where you may not necessarily be able to have your baby with you and you're going to be really sedated and you're stuck to an IV for three days. So that

That wasn't a thing anymore. So they refocused their attention to an oral treatment, Zurzuvae. It was lower cost, lower like logistics. But still it did cause some marked drowsiness. So you did still have to make sure you had somebody with you.

So it was a 14-day medication for specifically postpartum depression. And you took it once daily in the evening with food. And again, it was supposed to offer pretty immediate effects, like within three or four days.

It was reported that by most patients taking it that they saw significant improvement.

as early as three days and with the effects lasting as long as 45 days. And at that point, you may even be at a point where you're coming out of this anyway. So that was another like miracle kind of thing. It was a thing you could take at home. You could stay with your family, stay with your baby, but the side effects were...

just, you know, sedation and you weren't able to drive or operate machinery, which also makes me laugh because it always makes me think of like driving a forklift or something. And most insurance companies covered it.

So it seems Zurzuvae is still what they are marketing for postpartum depression treatment.

And yes, it's a 14 day thing, but you can start seeing results in three days, which is incredible. And the fact that it took until 2025 or 2022, if you count Brexan alone, Zulresso, to start mass producing a treatment specifically for birthing people experiencing one of the most common

complications of childbirth and one of the leading causes of death, postpartum, postpartum mental health disorders and suicidal tendencies. It still blows my mind, but it also doesn't because of the world we live in. But that was my experience with Zulresso I have...

high hopes for Zurzuvae and I really hope that research continues and that there can be treatment available to anyone that needs it alongside traditional methods of recovery like therapy and

Regularly meeting with your doctors and regularly monitoring your hormone levels and your Your thyroid levels and all of those things. It just you know, we all need to be Taken seriously, and if you've been following my story, you know My case was a little unique ⁓ but that's Women and birthing people need to be listened to they need to be validated they need to be trusted we know what's going on in our bodies even if we don't know what the root cause is so

Anyway, on that note, that is gonna do it for me today.

As always, if you have any questions, if you had your own experience with Zulresso or Zurzuvae I would love to chat with you. I would love to hear how your experience was either similar or different to mine. If you want to be featured in a sound bite or on social media, that would be awesome too. I'd love to kind of get a bunch of us to sort of talk about this experience because...

Unless you know about it, you don't really know about it. ⁓ that's a weird sentence to say, but, but truly like, if, if you had no idea, if you weren't in this, this area of, of like seeking all the treatments available, you may not know what's available to you and your doctors may not even know. So let's talk about it. Hit me up on Instagram at quiet connection podcast. Send me an email, Chelsea at quiet connection podcast.com or fill out

our contact form at quietconnectionpodcast.com.

And until next week, please take care of yourself. Get some rest. I hope that the weather is starting to warm up and that the sun is starting to shine for you. We just had a day of 70 degree weather followed by a day of snow storms. And we had a tornado in between there too, which doesn't happen in Vermont. So, you know, it's chaos like the rest of my life, but I'm going to drink some water and take a little rest. I'll see you.

you

next week.