OBJECTIVES: Postnatal depression (PND) is a maternal mental health condition linked to negative outcomes for both mothers and infants, impacting the personal development of mothers and optimal child development. Despite being treatable, it remains underdiagnosed and undertreated, affecting up to 17% puerperal women globally. The aim was to understand the current and future treatment landscape for PND.

METHODS: In assessing the current treatment landscape, we searched for clinical guidelines for PND in the US, UK, EU4, China, Japan, and Australia, as well as the documents from regulatory bodies (FDA, MHRA, EMA, NMPA, PMDA, TGA). For insights into the future treatment landscape, we searched for ongoing Phase 3 trials on ClinicalTrials.gov.

RESULTS: Clinical guidelines were available in the US, UK, Japan, and Australia but were absent in EU4 and China. Recommended treatments for PND are largely aligned among countries and encompass short-term psychological interventions such as cognitive behavioural therapy and pharmacotherapy including tricyclic antidepressants, selective serotonin reuptake inhibitors, or serotonin-noradrenaline reuptake inhibitors. The American College of Obstetricians and Gynecologists had recommended exploring novel therapies like intravenous brexanolone and oral zuranolone for severe PND. Brexanolone received FDA approval in 2019 and zuranolone in 2023, addressing the need for rapid-onset treatments; however, these therapies have not obtained approval from the MHRA, EMA, NMPA, PMDA, and TGA. No ongoing trials of novel therapies were identified in these regions.

CONCLUSIONS: Women's health has remained significantly under-researched, contributing to global disparities in PND management. In most countries, access to innovative treatments was limited due to the lack of policies, advocacy, and clinical trials. Severe side effects associated with brexanolone and zuranolone emphasised the urgent need for the development of newer therapies with improved safety profiles. Enhancing policy frameworks and research efforts is crucial to advancing PND treatment outcomes worldwide and mitigating adverse effects on both women and their infants.