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The Neurobiology of Postpartum Depression

Published online by Cambridge University Press:  07 November 2014

Abstract

Postpartum psychiatric changes can range from maternity blues to psychosis. Causality is still undetermined, but explanations for these disturbances often focus on hormonal changes and dysregulation. Researchers have begun the process of delineating what neurobiological factors may be associated with depressive disorders in pregnancy and the postpartum. This article reviews the current literature on the roles of gonadal and pituitary hormones in the psychopathophysiology of postpartum mood disorders. Other biological factors, such as biogenic amines, neuroactive steroids, cholesterol, and fatty acids, are also discussed. The potential benefits of neuroimaging to aid in understanding neuropsychiatric changes that occur in the context of postpartum depression are also considered.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2005

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References

REFERENCES

1.Diagnositc and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Sadock, BJ, Sadock, VA. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 7th ed. CDRom version. New York, NY: Lippincott Williams & Williams; 2000:12761283.Google Scholar
3.Bloch, M, Daly, RC, Rubinow, DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry. 2003;44:234246.Google Scholar
4.O'Hara, MW, Schlechte, JA, Lewis, DA, Varner, MW. Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables. J Aborm Psychol. 1991;100:6373.CrossRefGoogle ScholarPubMed
5.Hannah, P, Adams, D, Lee, A, Glover, V, Sandler, M. Links between early post-partum mood and post-natal depression. Br J Psychiatry. 1992;160:777780.CrossRefGoogle ScholarPubMed
6.Henshaw, C, Foreman, D, Cox, J. Postnatal blues: a risk factor for postnatal depression. J Psychosom Obstet Gynaecol. 2004;25:267272.CrossRefGoogle ScholarPubMed
7.Miller, LJ. Postpartum depression. JAMA. 2002;287:762765.CrossRefGoogle ScholarPubMed
8.Flores, DL, Hendrick, V. Etiology and treatment of postpartum depression. Curr Psychiatry Rep. 2002;4:461466.CrossRefGoogle ScholarPubMed
9.Mastorakos, G, Ilias, I. Maternal hypothalamic-pituitary-adrenal axis in pregnancy and the postpartum period: Postpartum-related disorders. Ann N Y Acad Sci. 2000;900:95106.CrossRefGoogle ScholarPubMed
10.Magiaku, M, Mastorakos, G, Rabin, D, Dubbert, B, Gold, PW, Chrousos, GP. Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: Implications for the increase in psychiatric manifestations at this time. J Clin Erdocrinol Metab. 1996;81:19121917.Google Scholar
11.O'Hara, MW, Schlechte, JA, Lewis, DA, Wright, EJ. Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen Psychiatry. 1991;48:801806.CrossRefGoogle ScholarPubMed
12.Feksi, A, Harris, B, Walker, RF, Riad-Fahmy, D, Newcombe, RG. ‘Maternity blues’ and hormone levels in saliva. J Affect Disord. 1984;6:351355.Google Scholar
13.Nott, PN, Franklin, M, Armitage, C, Gelder, MG. Hormonal changes and mood in the puerperium. Br J Psychiatry. 1976;128:379383.CrossRefGoogle ScholarPubMed
14.Harris, B, Johns, S, Fung, H, et al.The hormonal environment of post-natal depression. Br J Psychiatry. 1989;154:660667.Google Scholar
15.Kuevi, V, Causon, R, Dixson, AF, et al.Plasma amine and hormone changes in ‘post-partum blues’. Clin Endocrinol (Oxf). 1983;19:3946.Google Scholar
16.Nappi, RE, Petraglia, F, Luisi, S, Polatti, F, Farina, C, Genazzani, AR. Serum allopregnanolone in women with postpartum “blues”. Obstet Gynecol. 2001;97:7780.Google Scholar
17.Buckwalter, JG, Stanczyk, FZ, McCleary, CA, et al.Pregnancy the postpartum, and steroid hormones: effects on cognition and mood. Psychoneuroendocrinology. 1999;24:6984.CrossRefGoogle ScholarPubMed
18.Hohlagschwandtner, M, Husslein, P, Klier, C, Ulm, B. Correlation between serum testosterone levels and peripartal mood states. Acta Obstet Gynecol Scand. 2001;80:326330.Google Scholar
19.Abou-Saleh, MT, Ghubash, R, Karim, L, Krymski, M, Bhai, I. Hormonal aspects of postpartum depression. Psychoneuroendocrinology. 1998;23:465475.Google Scholar
20.Gard, PR, Handley, SL, Parsons, AD, Waldron, G. A multivariate investigation of postpartum mood disturbance. Br J Psychiatry. 1986;148:567575.Google Scholar
21.Harris, B, Lovett, L, Newcombe, RG, Read, G, Walker, RF, Riad-Fahmy, D. Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. BMJ. 1994;308:949953.CrossRefGoogle ScholarPubMed
22.Heidrich, A, Schleyer, M, Spingler, H, et al.Postpartum blues: relationship between not-protein bound steroid hormones in plasma and postpartum mood changes. J Affect Disord. 1994;30:9398.Google Scholar
23.Harris, B, Lovett, L, Smith, J, Read, G, Walker, R, Newcombe, RG. Cardiff puerperal mood and hormone study. III. Postnatal depression at 5 to 6 weeks postpartum, and its hormonal correlates across the peripartum period. Br J Psychiatry. 1996;168:739744.CrossRefGoogle ScholarPubMed
24.Rupprecht, R, Holsboer, F. Neuroactive steroids: mechanisms of action and neuropsychopharmacological perspectives. Trends Neurosci. 1999;22:410416.CrossRefGoogle ScholarPubMed
25.Stell, BM, Brickley, SG, Tang, CY, Farrant, M, Mody, I. Neuroactive steroids reduce neuronal excitability by selectively enhancing tonic inhibition mediated by delta sub-unit-containing GABAA receptor. Proc Natl Acad Sci U S A. 2003;100:1443914444.Google Scholar
26.Cabrera, RJ, Bregonzio, C, Laconi, M, Mampel, A. Allopregnanolone increase in striatal N-methyl-D-aspartic acid evoked [3H]dopamine realease is estrogen and progesterone dependent. Cell Mol Neurobiol. 2002;22:445454.Google Scholar
27.Romeo, E, Strohle, A, Spalletta, G, et al.Effects of antidepressant treatment on neuroactive steroids in major depression. Am J Psychiatry. 1998;155:910913.CrossRefGoogle ScholarPubMed
28.Strohle, A, Romeo, E, Hermann, B, et al.Concentrations of 3 alpha-reduced neuroactive steroids and their precursors in plasma of patients with major depression and after clinical recovery. Biol Psychiatry. 1999;45:274277.Google Scholar
29.Freeman, EW, Frye, CA, Rickeis, K, Martin, PAG, Smith, SS. Allopregnanolone levels and symptom improvement in severe premenstrual syndrome. J Clin Psychopharmacol. 2002;22:516520.CrossRefGoogle ScholarPubMed
30.Pearson Murphy, BEP, Steinberg, SI, Fen-Yun, H, Allison, CM. Neuroactive ring A-reduced metabolites of progesterone in human plasma during pregnancy: elevated levels of 5a-dihydroprogesterone in depressed patients during the latter half of pregnancy. J Endocrinol Metab. 2001;86:59815987.Google Scholar
31.Okano, T, Nomura, J. Endocrine study of the maternity blues. Prog Neuropsychopharmacol Biol Psychiatry. 1992;16:921932.Google Scholar
32.George, AJ, Copeland, JRM, Wilson, KCM. Prolactin secretion and the postpartum blues syndrome. Proceedings of the British Pharmacological Society Meeting. 9th-11th April. Abstract 102P.Google Scholar
33.Insel, TR, Hulihan, TJ. A gender-specific mechanism for pair bonding: oxytocin and partner preference formation in monogamous voles. Behav Neurosci. 1995;109:782789.Google Scholar
34.Ferguson, JN, Young, LJ, Hearn, EF, Matzuk, MM, Insel, TR, Winslow, JT. Social amnesia in mice lacking the oxytocin gene. Nat Genet. 2000;25:284288.Google Scholar
35.Rosenblum, LA, Smith, EL, Altemus, M, et al.Differing concentrations of corticotropin-releasing factor and oxytocin in the cerebrospinal fluid of bonnet and pigtail macaques. Psychoneuroendocrinology. 2002;27:651660.CrossRefGoogle ScholarPubMed
36.Neumann, ID, Torner, L, Wigger, A. Brain oxytocin: differential inhibition of neuroendocrine stress responses and anxiety-related behaviour in virgin, pregnant and lactating rat. Neuroscience. 2000;95:567575.Google Scholar
37.Sanders, G, Freilicher, J, Lightman, SL. Psychological stress of exposure to uncontrollable noise increases plasma oxytocin in high emotionality women. Psychoneuroendocrinoiogy. 1990;15:4758.Google Scholar
38.Turner, RA, Altemus, M, Enos, T, Cooper, B, McGuinness, T. Preliminary research on plasma oxytocin in normal cycling women: investigating emotion and interpersonal distress. Psychiatry. 1999;62:97113.Google Scholar
39.Nomura, M, Saito, J, Ueta, Y, Muglia, LJ, Pfaff, DW, Ogawa, S. Enhanced up-regulation of corticotropin-releasing hormone gene expression in response to restraint stress in the hypothalamic paraventricular nucleus of oxytocin gene-deficient male mice. J Neuroendocrinol. 2003;15:10541061.CrossRefGoogle ScholarPubMed
40.Keck, ME, Welt, T, Muller, MB, et al.Reduction of hypothalamic vasopressinergic hyper-drive contributes to clinically relevant behavioral and neuroendocrine effects of chronic paroxetine treatment in a psychopathological rat model. Neuropsychopharmacology. 2003;28:235243.Google Scholar
41.Wigger, A, Sanchez, MM, Mathys, KC, et al.Alterations in central neuropeptide expression, release and receptor binding in rats bred for high anxiety: critical role of vasopressin. Neuropsychopharmacology. 2004;114.Google Scholar
42.Purba, JS, Hoogendijk, WJ, Hofman, MA, Swaab, DF. Increased number of vasopressin-and oxytocin-expressing neurons in the paraventricular nucleus of the hypothalamus in depression. Arch Gen Psychiatry. 1996;53:137143.Google Scholar
43.Pitts, AF, Samuelson, SD, Meller, WH, Bissette, G, Nemeroff, CB, Kathol, RG. Cerebrospinal fluid corticotropin-releasing hormone, vasopressin, and oxytocin concentrations in treated patients with major depression and controls. Biol Psychiatry. 1995;38:330335.Google Scholar
44.van Londen, L, Goekopp, JC, van Kempen, GMJ, et al.Plasma levels of arginine vasopressin elevated in patients with major depression. Neuropsychopharmacology. 1997;17:284292.CrossRefGoogle ScholarPubMed
45.van Londen, L, Kerkhof, GA, ven den Berg, F, et al.Plasma arginine vasopressin and motor activity in major depression. Biol Psychiatry. 1998;43:196204.Google Scholar
46.Bethea, CL, Lu, NZ, Gundlah, C, Streicher, JM. Diverse actions of ovarian steroids in the serotonin neural system. Front Neuroenadocrinol. 2002;23:41100.Google Scholar
47.Shively, CA, Bethea, CL. Cognition, mood disorders, and sex hormones. ILAR J. 2004;45:189199.Google Scholar
48.Newport, DJ, Owens, MJ, Knight, DL, et al.Alterations in platelet serotonin transporter binding in women with postpartum onset major depression. J Psychiatr Res. 2004;38:467473.Google Scholar
49.Stein, G, Milton, F, Bebbington, P, Wood, K, Coppen, A. Relationship between mood disturbances and free and total plasma tryptophan in postpartum women. Br Med J. 1976;2:457.Google Scholar
50.Maes, M, Ombelet, W, Verkerk, R, Bosmans, E, Scharpe, S. Effects of pregnancy and delivery on the availability of plasma tryptophan to the brain: relationships to delivery-induced immune activation and early post-partum anxiety and depression. Psychol Med. 2001;31:847858.Google Scholar
51.Nonacs, RM, Soares, CN, Viguera, AC, Pearson, K, Poitras, JR, Cohan, LS. Bupropion SR for the treatment of postpartum depression: a pilot study. Int J Neuropsychopharmacol. 2005;8:445449.Google Scholar
52.Appleby, L, Warner, R, Whitton, A, Faragher, B. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ. 1997;29;314:932936.CrossRefGoogle Scholar
53.Misri, S, Reebye, P, Corral, M, Milis, L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004;65:12361241.Google Scholar
54.Wisner, KL, Perel, JM, Peindl, KS, Hanusa, BH, Piontek, CM, Findling, RL. Prevention of postpartum depression: a pilot randomized clinical trial. Am J Psychiatry. 2004;161:12901292.Google Scholar
55.Thompson, TL. Attenuation of dopamine uptake in vivo following priming with estradiol benzoate. Brain Res. 1999;834:164167.Google Scholar
56.Thompson, TL, Moore, CC, Smith, B. Estrogen priming modulates autoreceptor-mediated potentiation of dopamine uptake. Eur J Pharmacol. 2000;401:357363.Google Scholar
57.Thompson, TL, Moss, RL, Estrogen regulation of dopamine release in the nucleaus accumbens: genomic-and nongenomic-mediated effects. J Neurochem. 1994;62:17501756.Google Scholar
58.Levesque, D, Di Paolo, T. Modulation by estradiol and progesterone of the GTP effect on striatal D-2 dopamine receptors. Biochem Pharmacol. 1999;45:723733.CrossRefGoogle Scholar
59.Thompson, TL, Certain, ME. Estrogen mediated inhibition of dopamine transport in the striatum: regulation by G alpha i/o. Eur J Pharmacol. 2005;511:121126.Google Scholar
60.van Hartesveldt, C, Joyce, JN. Effects of estrogen on the basal ganglia. Neurosci Biobehav Rev. 1986;10:114.Google Scholar
61.Tsigos, C, Chrousos, GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Psychosom Res. 2002;53:865871.Google Scholar
62.Gundlah, C, Lu, NZ, Bethea, CL. Ovarian steroid regulation of monoamine oxidase-A and -B mRNAs in the macaque dorsal raphe and hypothalamic nuclei. Psychopharmacology (Berl). 2002;160:271282.Google Scholar
63.Engelberg, H. Low serum cholesterol and suicide. Lancet. 1992;339:727729.Google Scholar
64.Ploeckinger, B, Dantendorfer, K, Ulm, M, et al.Rapid decrease of serum cholesterol concentration and postpartum depression. BMJ. 1996;313:664.Google Scholar
65.Troisi, A, Moles, A, Panepuccia, L, Lo Russo, D, Palla, G, Scucchi, S. Serum cholesterol levels and mood symptoms in the postpartum period. Psychiatry Res. 2002;109:213219.Google Scholar
66.Nasta, MT, Grussu, P, Quatraro, RM, Cerutti, R, Grella, PV. Cholesterol and mood states at 3 days after delivery, J Psychosom Res. 2002;52:6163.Google Scholar
67.van Dam, RM, Schuit, AJ, Schouten, EG, Vader, HL, Pop, VJ. Serum cholesterol decline and depression in the postpartum period. J Psychosom Res. 1999;46:385390.Google Scholar
68.De Vriese, SR, Christophe, AB, Maes, M. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sci. 2003;73:31813187.Google Scholar
69.Hibbeln, JR. Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord. 2002;69:1529.Google Scholar
70.Otto, SJ, de Groot, RH, Hornstra, G. Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Prostaglandins Leukot Essent Fatty Acids. 2003;69:237243.Google Scholar
71.De Wilde, JP, Rivers, AW, Price, DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol. 2005;87:335353.CrossRefGoogle ScholarPubMed
72.Holdcroft, A, Hall, L, Hamilton, G, Counsell, SJ, Bydder, GM, Bell, JD. Phosphorus-31 brain MR spectroscopy in women during and after pregnancy compared with nonpregnant control subjects. AJNR Am J Neuroradiol. 2005;26:352356.Google Scholar
73.Anand, A, Shekhar, A. Brain imaging studies in mood and anxiety disorders: special emphasis on the amygdala. Ann N Y Acad Sci. 2003;985:370388.Google Scholar
74.Sheline, YI. Neuroimaging studies of mood disorder effects on the brain. Biol Psychiatry. 2003;54:338352.CrossRefGoogle ScholarPubMed
75.Maki, PM, Resnick, SM. Effects of estrogen on patterns of brain activity at rest and during cognitive activity: a review of neuroimaging studies. Neuroimage. 2001;14:789801.Google Scholar
76.Rode, C, Wagner, M, Gunturkun, O. Menstrual cycle affects functional cerebral assymetries. Neuropsychologia. 1995;33:855865.Google Scholar
77.Dietrich, T, Krings, T, Neulen, J, et al.Effects of blood estrogen level on cortical activation patterns during cognitive activation as measured by functional MRI. Neuroimage. 2001;13:425432.Google Scholar
78.Fernandez, G, Weis, S, Stoffel-Wagner, B, et al.Menstrual cycle-dependent neural plasticity in the adult human brain is hormone, task, and region specific. J Neurosci. 2003;23:37903795.Google Scholar
79.Smith, YR, Zubieta, JK, del Carmen, MG, et al.Brain opioid receptor measurements by positron emission tomography in normal cycling women: relationship to luteinizing hormone pulsatility and gonadal steroid hormones. J Clin Endocrinol Metab. 1998;83:44984505.Google ScholarPubMed
80.Rasgon, NL, Thomas, MA, Guze, BH, et al.Menstrual cycle-related brain metabolite changes using 1H magnetic resonance spectroscopy in premenopausal women: a pilot study. Psychiatry Res. 2001;106:4757.Google Scholar
81.Epperson, CN, Haga, K, Mason, GF, et al.Neuroimaging studies of mood disorder effects on the brain. Arch Gen Psychiatry. 2002;59:851858.Google Scholar