CLINICAL PREDICTORS OF SUSTAINED REMISSION VERSUS RECURRENCE IN WOMEN WITH POSTPARTUM-ONSET MAJOR DEPRESSION FOLLOWING ZURANOLONE TREATMENT: A SYSTEMATIC REVIEW OF PROGNOSTIC FACTORS

Abstract

Postpartum depression (PPD) is one of the most common psychiatric complications of the perinatal period and is associated with significant consequences for maternal health, child development, and family dynamics. The approval of zuranolone as the first short-course oral treatment for this condition represents a significant therapeutic advance; however, uncertainties remain regarding the clinical factors that predict the maintenance of response after treatment ends. This study aimed to identify and synthesize available evidence on prognostic factors associated with sustained remission and the risk of recurrence in women with postpartum depression treated with zuranolone. A systematic review was conducted following PRISMA guidelines, using the PECO strategy to define the research question. The literature search was performed in MEDLINE/PubMed, EMBASE, LILACS, and Cochrane CENTRAL, supplemented by gray literature, and included eligible phase III randomized clinical trials, longitudinal extension studies, and observational studies. Data were synthesized through qualitative analysis, focusing on identifying key prognostic factors related to therapeutic response. The evidence demonstrated that clinical remission achieved at the end of the 14-day treatment cycle is the primary indicator of sustained response through day 45. Factors associated with sustained remission included the presence of concomitant anxiety and insomnia symptoms that responded to treatment and the use of the 50 mg dose. Conversely, greater baseline depression severity, a history of recurrent depressive episodes, and the need for retreatment were associated with a higher likelihood of clinical recurrence. In conclusion, zuranolone promotes a rapid and clinically relevant antidepressant response in postpartum depression; however, the durability of this benefit varies according to the patients' clinical profiles. Identifying prognostic factors can contribute to personalized monitoring, the optimization of therapeutic strategies, and the implementation of precision medicine approaches in the management of postpartum depression.