Zuranolone Use in MDD Patients at Risk for Bipolar Disorder

Risk Assessment and Treatment Considerations

• Patients with bipolar disorder have significantly higher rates of suicidality compared to those with MDD alone, with a lifetime prevalence of suicide attempts of 29.2% in bipolar disorder versus 5.6% in MDD 1, 2
• The risk of dying by suicide is 8.66 times higher in bipolar disorder compared to 13.42 times higher in major depression when compared to the general population 2, 3
• Early identification of bipolar risk is critical as misdiagnosis of bipolar disorder as MDD can lead to inappropriate treatment and worse outcomes, according to the American Academy of Child and Adolescent Psychiatry 4
• The American Academy of Child and Adolescent Psychiatry recommends conducting thorough screening for previous manic/hypomanic episodes, family history of bipolar disorder, and early age of depression onset in patients with possible bipolar risk 4
• Cognitive behavioral therapy (CBT) should be strongly considered as first-line treatment for patients with MDD who have risk factors for bipolar disorder, as recommended by the Annals of Internal Medicine 5, 6
• If pharmacotherapy is necessary, mood stabilizers rather than antidepressants alone should be considered as the primary treatment approach, according to the Journal of the American Academy of Child and Adolescent Psychiatry 4
• For patients requiring antidepressant treatment, second-generation antidepressants with lower rates of manic switch (such as bupropion) may be preferable to zuranolone, as recommended by the Annals of Internal Medicine 5, 6
• Educate patients and families about early warning signs of mania/hypomania that would require immediate medical attention, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 4
• Consider prophylactic mood stabilizer coverage if there are strong indicators of bipolar risk but zuranolone treatment is deemed necessary, according to the Journal of the American Academy of Child and Adolescent Psychiatry 4