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Pawluski JL. The parental brain, perinatal mental illness, and treatment: A review of key structural and functional changes. Semin Perinatol 2024; 48:151951. [PMID: 39030131 DOI: 10.1016/j.semperi.2024.151951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
The transition to parenthood is perhaps the only time in adult life when the brain changes to such a significant degree in such a short period, particularly in birthing parents. It is also a time when there is an increased risk of developing a mental illness, which may be due, in part, to the increased neuroplasticity. Thus, we must develop interventions and treatments that support parents and promote parental brain health. This review will highlight key findings from current research on how human brain structure and function are modified with 1) the transition to parenthood, 2) parenting stress and perinatal mental illness, and 3) treatments aimed at promoting perinatal mental health. The focus will be on birthing parents and mothers, but brain changes in non-birthing parents will also be discussed. Improvements in our understanding of the parental brain, in health and with illness, will promote the well-being of generations to come.
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Affiliation(s)
- Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, F-35000, Rennes, France.
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2
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Hare MM, Barber A, Shaffer SA, Deligiannidis KM. Bidirectional associations between perinatal allopregnanolone and depression severity with postpartum gray matter volume in adult women. Acta Psychiatr Scand 2024. [PMID: 38923502 DOI: 10.1111/acps.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/30/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Perinatal depression (PND) is a debilitating condition affecting maternal well-being and child development. Allopregnanolone (ALLO) is important to perinatal neuroplasticity, however its relationship with depression severity and postpartum structural brain volume is unknown. METHOD We examined perinatal temporal dynamics and bidirectional associations between ALLO and depression severity and the association between these variables and postpartum gray matter volume, using a random intercept cross-lagged panel model. RESULTS We identified a unidirectional predictive relationship between PND severity and ALLO concentration, suggesting greater depression severity early in the perinatal period may contribute to subsequent changes in ALLO concentration (β = 0.26, p = 0.009), while variations in ALLO levels during the perinatal period influences the development and severity of depressive symptoms later in the postpartum period (β = 0.38, p = 0.007). Antepartum depression severity (Visit 2, β = 0.35, p = 0.004), ALLO concentration (Visit 2, β = 0.37, p = 0.001), and postpartum depression severity (Visit 3, β = 0.39, p = 0.031), each predicted the right anterior cingulate volume. Antepartum ALLO concentration (Visit 2, β = 0.29, p = 0.001) predicted left suborbital sulcus volume. Antepartum depression severity (Visit 1, β = 0.39, p = 0.006 and Visit 2, β = 0.48, p < 0.001) predicted the right straight gyrus volume. Postpartum depression severity (Visit 3, β = 0.36, p = 0.001) predicted left middle-posterior cingulate volume. CONCLUSION These results provide the first evidence of bidirectional associations between perinatal ALLO and depression severity with postpartum gray matter volume.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Anita Barber
- Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Scott A Shaffer
- The Mass Spectrometry Facility, UMass Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Departments of Psychiatry, Molecular Medicine and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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3
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Cardaci V, Carminati M, Tondello M, Pecorino B, Serretti A, Zanardi R. Understanding and treating postpartum depression: a narrative review. Int Clin Psychopharmacol 2024:00004850-990000000-00143. [PMID: 38941162 DOI: 10.1097/yic.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Postpartum depression (PPD) is an increasingly prevalent but still poorly characterized disorder. Causal and modulating factors include hormones fluctuations, such as estrogen, progesterone, and allopregnolone, pathways imbalances, such as oxytocin and kynurenine, chronobiological factors, and brain imaging alterations. Treatment may differ from the traditional major depression management, while selective serotonin reuptake inhibitors such as sertraline are commonly used and suggested by guidelines, neurosteroids such as brexanolone and the more convenient zuranolone have been recently approved. Newer neurosteroids such as ganaxolone, valaxanolone, and lysaxanolone are currently under development, but also esketamine and psychedelics are promising potential treatments. Other somatic treatments including brain stimulation techniques and light therapy also showed benefit. PPD is therefore increasingly understood as, at least partially, independent from major depressive disorder. Specific and individualized treatments including pharmacological and non-pharmacological therapies are progressively being introduced in the routine clinical practice.
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Affiliation(s)
- Vincenzo Cardaci
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Matteo Carminati
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Mattia Tondello
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Basilio Pecorino
- Department of Medicine and Surgery, Kore University of Enna, Enna
| | | | - Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
- Department of Psychiatry, Mood Disorder Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Guard M, Labonte AK, Mendoza M, Myers MJ, Duncan M, Drysdale AT, Mukherji E, Rahman T, Tandon M, Kelly JC, Cooke E, Rogers CE, Lenze S, Sylvester CM. Brexanolone Treatment in a Real-World Patient Population: A Case Series and Pilot Feasibility Study of Precision Neuroimaging. J Clin Psychopharmacol 2024; 44:240-249. [PMID: 38551454 PMCID: PMC11177577 DOI: 10.1097/jcp.0000000000001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE/BACKGROUND Brexanolone is approved for postpartum depression (PPD) by the United States Food and Drug Administration. Brexanolone has outperformed placebo in clinical trials, but less is known about the efficacy in real-world patients with complex social and medical histories. Furthermore, the impact of brexanolone on large-scale brain systems such as changes in functional connectivity (FC) is unknown. METHODS/PROCEDURES We tracked changes in depressive symptoms across a diverse group of patients who received brexanolone at a large medical center. Edinburgh Postnatal Depression Scale (EPDS) scores were collected through chart review for 17 patients immediately prior to infusion through approximately 1 year postinfusion. In 2 participants, we performed precision functional neuroimaging (pfMRI), including before and after treatment in 1 patient. pfMRI collects many hours of data in individuals for precision medicine applications and was performed to assess the feasibility of investigating changes in FC with brexanolone. FINDINGS/RESULTS The mean EPDS score immediately postinfusion was significantly lower than the mean preinfusion score (mean change [95% CI]: 10.76 [7.11-14.40], t (15) = 6.29, P < 0.0001). The mean EPDS score stayed significantly lower at 1 week (mean difference [95% CI]: 9.50 [5.23-13.76], t (11) = 4.90, P = 0.0005) and 3 months (mean difference [95% CI]: 9.99 [4.71-15.27], t (6) = 4.63, P = 0.0036) postinfusion. Widespread changes in FC followed infusion, which correlated with EPDS scores. IMPLICATIONS/CONCLUSIONS Brexanolone is a successful treatment for PPD in the clinical setting. In conjunction with routine clinical care, brexanolone was linked to a reduction in symptoms lasting at least 3 months. pfMRI is feasible in postpartum patients receiving brexanolone and has the potential to elucidate individual-specific mechanisms of action.
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Affiliation(s)
- Meg Guard
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Alyssa K. Labonte
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Molly Mendoza
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael J. Myers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Maida Duncan
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Andrew T. Drysdale
- New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Emily Mukherji
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Tahir Rahman
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Mini Tandon
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Jeannie C. Kelly
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Emily Cooke
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Shannon Lenze
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Chad M. Sylvester
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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Tebeka S, Gloaguen E, Mullaert J, He Q, Boland A, Deleuze JF, Jamet C, Ramoz N, Dubertret C. Genome-wide association study of early-onset and late-onset postpartum depression: the IGEDEPP prospective study. Eur Psychiatry 2024; 67:1-36. [PMID: 38555957 PMCID: PMC11059250 DOI: 10.1192/j.eurpsy.2024.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
Postpartum depression (PPD) appears at two peak periods: early-onset prior to 2 months after delivery and late-onset (2 months after delivery and beyond). The aim of our study is to evaluate the different genetic factors associated with early- and late-onset PPD. With the French multicenter interaction of gene and environment of depression during postpartum (IGEDEPP) cohort, we conducted a genome-wide association study (GWAS) on 234 women with early-onset PPD and 223 women with late-onset PPD, as well as 1,204 controls with no history of lifetime depression. We performed post-GWAS analyses: functional mapping and annotation of GWAS results using MAGMA thanks to Functional Mapping and Annotation of Genome-Wide Association Studies (FUMA), expression quantitative trait loci (QTL) analyses, mapping using data from the PsychENCODE and GTEx, and polygenic risk score (PRS) analysis based on published GWAS. We found two new significant candidate loci for early-onset PPD, rs6436132 in PTPRN gene on chromosome 2 and rs184644645 in RAD18 on chromosome 14, respectively, and one region of interest with five significant associated SNPs in chromosome 20 for late-onset PPD. Variant rs6436132 is the most significant associated with early-onset PPD, and it is a QTL that significantly modifies the expression and splicing of the PTPRN gene in different brain tissues. We also found an enrichment of uterus tissue in the early expression of PPD genes. PRS analysis showed a genetic overlap between both early and late-onset PPD and major depressive disorder, but only early-onset PPD overlaps with bipolar disorder. Our study presents two GWAS separately, highlighting two candidate loci for early-onset PPD and one different region of interest for late-onset PPD. These results have important consequences in our understanding of these disorders, especially since our data reinforce the hormonal pathophysiological hypotheses for early-onset PPD.
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Affiliation(s)
- Sarah Tebeka
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, team 1, 75014 Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Emilie Gloaguen
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Jimmy Mullaert
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
- IAME, INSERM, Université Paris Cité, Paris, France
| | - Qin He
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, team 1, 75014 Paris, France
| | - Anne Boland
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France
| | - Jean-Francois Deleuze
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France
| | - Camille Jamet
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, team 1, 75014 Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Nicolas Ramoz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, team 1, 75014 Paris, France
| | - Caroline Dubertret
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, team 1, 75014 Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
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Patterson R, Balan I, Morrow AL, Meltzer-Brody S. Novel neurosteroid therapeutics for post-partum depression: perspectives on clinical trials, program development, active research, and future directions. Neuropsychopharmacology 2024; 49:67-72. [PMID: 37715106 PMCID: PMC10700474 DOI: 10.1038/s41386-023-01721-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
This article reviews novel neurosteroid therapeutics for post-partum depression, with a focus on their development, clinical trial data, current practices, and future directions in this exciting field. We discuss the clinical impact of brexanolone and several other neurosteroids, particularly as they relate to the treatment of postpartum depression (PPD) and major depressive disorders outside of the perinatal period. There has been increasing interest in GABA signaling and modulation as it pertains to the development of altered circuity and depressive states. This scientific underpinning served as the rationale for the initial development of brexanolone. We review the clinical trials supporting its Food and Drug Administration (FDA) approval as the first rapidly acting antidepressant specific for PPD, and the subsequent development of a clinical brexanolone program at an academic medical center, highlighting new research and data from that site as well as the challenges with the delivery of this I.V. drug. In addition to the GABA signaling hypothesis, we discuss the new evidence demonstrating that brexanolone inhibits inflammatory signaling post-infusion, suggesting that inflammatory signaling may contribute to the etiology of PPD. Finally, we describe new and future directions in neurosteroid therapeutics, including the development of an oral agent, zuranolone, and the IV and oral formulations of ganaxolone. Ultimately, the hope is that these novel neurosteroid therapeutics will provide fast-acting treatment for these impairing disorders and improve our understanding of the underlying mechanisms of depressive disorders.
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Affiliation(s)
- Riah Patterson
- Department of Psychiatry and Emergency Medicine, MacNider Bldg. Suite 304, CB# 7160, Chapel Hill, NC, 27599-7160, USA.
| | - Irina Balan
- Department of Psychiatry, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - A Leslie Morrow
- Department of Psychiatry and Pharmacology, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC Center for Women's Mood Disorders, MacNider Bldg. Suite 304CB #7160, Chapel Hill, NC, 27599-7160, USA
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Sikes-Keilp C, Rubinow DR. GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder. CNS Drugs 2023; 37:679-693. [PMID: 37542704 DOI: 10.1007/s40263-023-01030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) is characterized by the predictable onset of mood and physical symptoms secondary to gonadal steroid fluctuation during the luteal phase of the menstrual cycle. Although menstrual-related affective dysfunction is responsible for considerable functional impairment and reduction in quality of life worldwide, currently approved treatments for PMDD are suboptimal in their effectiveness. Research over the past two decades has suggested that the interaction between allopregnanolone, a neurosteroid derivative of progesterone, and the gamma-aminobutyric acid (GABA) system represents an important relationship underlying symptom genesis in reproductive-related mood disorders, including PMDD. The objective of this narrative review is to discuss the plausible link between changes in GABAergic transmission secondary to the fluctuation of allopregnanolone during the luteal phase and mood impairment in susceptible individuals. As part of this discussion, we explore promising findings from early clinical trials of several compounds that stabilize allopregnanolone signaling during the luteal phase, including dutasteride, a 5-alpha reductase inhibitor; isoallopregnanolone, a GABA-A modulating steroid antagonist; and ulipristal acetate, a selective progesterone receptor modulator. We then reflect on the implications of these therapeutic advances, including how they may promote our knowledge of affective regulation more generally. We conclude that these and other studies of PMDD may yield critical insight into the etiopathogenesis of affective disorders, considering that (1) symptoms in PMDD have a predictable onset and offset, allowing for examination of affective state kinetics, and (2) GABAergic interventions in PMDD can be used to better understand the relationship between mood states, network regulation, and the balance between excitatory and inhibitory signaling in the brain.
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Affiliation(s)
- Christopher Sikes-Keilp
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC, 27514, USA
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Orchard ER, Voigt K, Chopra S, Thapa T, Ward PGD, Egan GF, Jamadar SD. The maternal brain is more flexible and responsive at rest: effective connectivity of the parental caregiving network in postpartum mothers. Sci Rep 2023; 13:4719. [PMID: 36959247 PMCID: PMC10036465 DOI: 10.1038/s41598-023-31696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
The field of neuroscience has largely overlooked the impact of motherhood on brain function outside the context of responses to infant stimuli. Here, we apply spectral dynamic causal modelling (spDCM) to resting-state fMRI data to investigate differences in brain function between a group of 40 first-time mothers at 1-year postpartum and 39 age- and education-matched women who have never been pregnant. Using spDCM, we investigate the directionality (top-down vs. bottom-up) and valence (inhibition vs excitation) of functional connections between six key left hemisphere brain regions implicated in motherhood: the dorsomedial prefrontal cortex, ventromedial prefrontal cortex, posterior cingulate cortex, parahippocampal gyrus, amygdala, and nucleus accumbens. We show a selective modulation of inhibitory pathways related to differences between (1) mothers and non-mothers, (2) the interactions between group and cognitive performance and (3) group and social cognition, and (4) differences related to maternal caregiving behaviour. Across analyses, we show consistent disinhibition between cognitive and affective regions suggesting more efficient, flexible, and responsive behaviour, subserving cognitive performance, social cognition, and maternal caregiving. Together our results support the interpretation of these key regions as constituting a parental caregiving network. The nucleus accumbens and the parahippocampal gyrus emerging as 'hub' regions of this network, highlighting the global importance of the affective limbic network for maternal caregiving, social cognition, and cognitive performance in the postpartum period.
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Affiliation(s)
- Edwina R Orchard
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
- Department of Psychology, Yale University, New Haven, CT, USA
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - Katharina Voigt
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
| | - Sidhant Chopra
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Tribikram Thapa
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
| | - Phillip G D Ward
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Gary F Egan
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Sharna D Jamadar
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia.
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia.
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia.
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Li B, Zhang S, Li S, Liu K, Hou X. Aberrant resting-state regional activity in patients with postpartum depression. Front Hum Neurosci 2023; 16:925543. [PMID: 36741780 PMCID: PMC9893784 DOI: 10.3389/fnhum.2022.925543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
Background Postpartum depression (PPD) is a common disorder with corresponding cognitive impairments such as depressed mood, memory deficits, poor concentration, and declining executive functions, but little is known about its underlying neuropathology. Method A total of 28 patients with PPD and 29 healthy postpartum women were recruited. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed in the fourth week after delivery. Individual local activity of PPD patients was observed by regional homogeneity (ReHo) during resting state, and the ReHo value was computed as Kendall's coecient of concordance (KCC) and analyzed for differences between voxel groups. Correlations between ReHo values and clinical variables were also analyzed. Result Compared with healthy postpartum women, patients with PPD exhibited significantly higher ReHo values in the left precuneus and right hippocampus. ReHo value was significantly lower in the left dorsolateral prefrontal cortex (dlPFC) and right insula. Furthermore, ReHo values within the dlPFC were negatively correlated with the Edinburgh PPD scale (EPDS) score. The functional connectivity (FC) of the right hippocampus to the left precuneus and left superior frontal gyrus (SFG) was stronger in patients with PPD than that in controls. Conclusion The present study provided evidence of aberrant regional functional activity and connectivity within brain regions in PPD, and it may contribute to further understanding of the neuropathology underlying PPD.
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Affiliation(s)
- Bo Li
- Department of Radiology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Shufen Zhang
- Department of Obstetrics, Shandong Second Provincial General Hospital, Jinan, China
| | - Shuyan Li
- Foreign Languages College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Kai Liu
- Department of Radiology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Xiaoming Hou
- Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China,*Correspondence: Xiaoming Hou ✉
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Rincón-Cortés M, Grace AA. Dopamine downregulation in novel rodent models useful for the study of postpartum depression. Front Behav Neurosci 2022; 16:1065558. [PMID: 36620861 PMCID: PMC9812956 DOI: 10.3389/fnbeh.2022.1065558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Postpartum depression (PPD) is the most common psychiatric disorder following childbirth and is characterized by maternal mood disturbances, impaired maternal responses, and disrupted caregiving- all of which negatively impact offspring development. Since PPD has detrimental consequences for both mother and child, clinical and preclinical research has focused on identifying brain changes associated with this disorder. In humans, PPD is linked to dysregulated mesolimbic dopamine (DA) system function and altered neural responses (i.e., decreased reward-related activity) to infant-related cues, which are considered hallmark features of PPD. In accordance, rodent models employing translational risk factors useful for the study of PPD have demonstrated alterations in mesolimbic DA system structure and function, and these changes are reviewed here. We also present two novel rodent models based on postpartum adversity exposure (i.e., pup removal, scarcity-adversity) which result in PPD-relevant behavioral changes (e.g., disrupted mother-infant interactions, deficits in maternal behavior, depressive-like phenotypes) and attenuated ventral tegmental area (VTA) DA neuron activity consistent with a hypodopaminergic state. Furthermore, we highlight open questions and future directions for these rodent models. In sum, human and rodent studies converge in showing blunted mesolimbic DA function (i.e., DA downregulation) in PPD. We propose that reduced activity of VTA DA neurons, resulting in downregulation of the mesolimbic DA system, interferes with reward-related processes necessary for maternal motivation and responsiveness. Thus, the mesolimbic DA system may constitute a therapeutic target for ameliorating reward-related deficits in PPD.
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Affiliation(s)
- Millie Rincón-Cortés
- Department of Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States,*Correspondence: Millie Rincón-Cortés
| | - Anthony A. Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
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Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder with peripartum onset: A multicenter, open-label, controlled proof-of-concept clinical trial (DELOS-1). J Affect Disord 2022; 316:34-41. [PMID: 35932937 DOI: 10.1016/j.jad.2022.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD). METHODS Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures. RESULTS The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC. LIMITATIONS This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression. CONCLUSION Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed. CLINICALTRIALS govNCT03972995.
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12
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Dye C, Lenz KM, Leuner B. Immune System Alterations and Postpartum Mental Illness: Evidence From Basic and Clinical Research. Front Glob Womens Health 2022; 2:758748. [PMID: 35224544 PMCID: PMC8866762 DOI: 10.3389/fgwh.2021.758748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/29/2021] [Indexed: 01/13/2023] Open
Abstract
The postpartum period is a time associated with high rates of depression and anxiety as well as greater risk for psychosis in some women. A growing number of studies point to aberrations in immune system function as contributing to postpartum mental illness. Here we review evidence from both clinical and animal models suggesting an immune component to postpartum depression, postpartum anxiety, and postpartum psychosis. Thus far, clinical data primarily highlights changes in peripheral cytokine signaling in disease etiology, while animal models have begun to provide insight into the immune environment of the maternal brain and how central inflammation may also be contributing to postpartum mental illnesses. Further research investigating peripheral and central immune function, along with neural and endocrine interactions, will be important in successfully developing novel prevention and treatment strategies for these serious disorders that impact a large portion of new mothers.
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Affiliation(s)
- Courtney Dye
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH, United States
| | - Kathryn M. Lenz
- Department of Psychology, The Ohio State University, Columbus, OH, United States
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
- Institute of Behavioral Medicine Research, The Ohio State University, Columbus, OH, United States
| | - Benedetta Leuner
- Department of Psychology, The Ohio State University, Columbus, OH, United States
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
- *Correspondence: Benedetta Leuner
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13
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Mundorf A, Bölükbas I, Freund N. Maternal separation: Does it hold the potential to model consequences of postpartum depression? Dev Psychobiol 2022; 64:e22219. [PMID: 35050513 DOI: 10.1002/dev.22219] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
The postpartum period is a sensitive time where women are especially vulnerable to develop postpartum depression (PPD), with 10%-15% of women affected. This review investigates whether the maternal separation (MS) paradigm in rodents holds the potential to help to understand mothers suffering from PPD. MS is a well-established stress model to investigate effects on infants, whereas effects on the dam are often overlooked. The database PubMed was searched for studies investigating effects of daily MS within the first weeks after parturition on dams in rats and mice and compared to findings in PPD mothers. MS was categorized as brief MS (5-45 min) with or without handling of pups and long MS (3-4 h and longer). MS alters maternal care, depressive-like behavior, anxiety, and aggression; leads to alterations in neuronal gene expression; and affects hormone and neurotransmitter levels similar to observations in PPD patients. Even though there are disparities between human and rodent mothers, with some results differing in directionality, as well as the reason for separation (self-induced in PPD, externally induced in MS), the overall effects found on neurobiological, hormonal, and behavioral levels mostly coincide. Thus, the MS paradigm can add relevant knowledge to existing PPD animal models, further advancing the study of PPD.
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Affiliation(s)
- Annakarina Mundorf
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany.,Institute for Systems Medicine and Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Ibrahim Bölükbas
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nadja Freund
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
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14
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Horáková A, Němcová H, Mohr P, Sebela A. Structural, functional, and metabolic signatures of postpartum depression: A systematic review. Front Psychiatry 2022; 13:1044995. [PMID: 36465313 PMCID: PMC9709336 DOI: 10.3389/fpsyt.2022.1044995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Postpartum depression (PPD) is a serious condition with debilitating consequences for the mother, offspring, and the whole family. The scope of negative outcomes of PPD highlights the need to specify effective diagnostics and treatment which might differ from major depressive disorder (MDD). In order to improve our clinical care, we need to better understand the underlying neuropathological mechanisms of PPD. Therefore, we conducted a systematic review of published neuroimaging studies assessing functional, structural, and metabolic correlates of PPD. METHODS Relevant papers were identified using a search code for English-written studies in the PubMed, Scopus, and Web of Science databases published by March 2022. Included were studies with structural magnetic resonance imaging, functional magnetic resonance imaging, both resting-state and task-related, magnetic resonance spectroscopy, or positron emission tomography. The findings were analyzed to assess signatures in PPD-diagnosed women compared to healthy controls. The review protocol was registered in PROSPERO (CRD42022313794). RESULTS The total of 3,368 references were initially identified. After the removal of duplicates and non-applicable papers, the search yielded 74 full-text studies assessed for eligibility. Of them, 26 met the inclusion criteria and their findings were analyzed and synthesized. The results showed consistent functional, structural, and metabolic changes in the default mode network and the salient network in women with PPD. During emotion-related tasks, PPD was associated with changes in the corticolimbic system activity, especially the amygdala. DISCUSSION This review offers a comprehensive summary of neuroimaging signatures in PPD-diagnosed women. It indicates the brain regions and networks which show functional, structural, and metabolic changes. Our findings offer better understanding of the nature of PPD, which clearly copies some features of MDD, while differs in others.
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Affiliation(s)
- Anna Horáková
- Center of Perinatal Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia
| | - Hana Němcová
- Center of Perinatal Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia
| | - Pavel Mohr
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czechia.,Clinical Center, National Institute of Mental Health, Klecany, Czechia
| | - Antonin Sebela
- Center of Perinatal Mental Health, National Institute of Mental Health, Klecany, Czechia.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czechia
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15
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Martínez-García M, Cardenas SI, Pawluski J, Carmona S, Saxbe DE. Recent Neuroscience Advances in Human Parenting. ADVANCES IN NEUROBIOLOGY 2022; 27:239-267. [PMID: 36169818 DOI: 10.1007/978-3-030-97762-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The transition to parenthood entails brain adaptations to the demands of caring for a newborn. This chapter reviews recent neuroscience findings on human parenting, focusing on neuroimaging studies. First, we describe the brain circuits underlying human maternal behavior, which comprise ancient subcortical circuits and more sophisticated cortical regions. Then, we present the short-term and long-term functional and structural brain adaptations that characterize the transition to motherhood, discuss the long-term effects of parenthood on the brain, and propose several underlying neural mechanisms. We also review neuroimaging findings in biological fathers and alloparents (such as other relatives or adoptive parents), who engage in parenting without directly experiencing pregnancy or childbirth. Finally, we describe perinatal mental illnesses and discuss the neural responses associated with such disorders. To date, studies indicate that parenthood is a period of enhanced brain plasticity within brain areas critical for cognitive and social processing and that both parenting experience and gestational-related factors can prime such plasticity.
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Affiliation(s)
- Magdalena Martínez-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Sofia I Cardenas
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jodi Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes, France
| | - Susanna Carmona
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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16
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Deligiannidis KM, Meltzer-Brody S, Gunduz-Bruce H, Doherty J, Jonas J, Li S, Sankoh AJ, Silber C, Campbell AD, Werneburg B, Kanes SJ, Lasser R. Effect of Zuranolone vs Placebo in Postpartum Depression: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:951-959. [PMID: 34190962 PMCID: PMC8246337 DOI: 10.1001/jamapsychiatry.2021.1559] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 12/28/2022]
Abstract
Importance Postpartum depression (PPD) is one of the most common medical complications during and after pregnancy, negatively affecting both mother and child. Objective To demonstrate the efficacy and safety of zuranolone, a neuroactive steroid γ-aminobutyric acid receptor-positive allosteric modulator, in PPD. Design, Setting, and Participants This phase 3, double-blind, randomized, outpatient, placebo-controlled clinical trial was conducted between January 2017 and December 2018 in 27 enrolling US sites. Participant were women aged 18 to 45 years, 6 months or fewer post partum, with PPD (major depressive episode beginning third trimester or ≤4 weeks postdelivery), and baseline 17-item Hamilton Rating Scale for Depression (HAMD-17) score of 26 or higher. Analysis was intention to treat and began December 2018 and ended March 2019. Interventions Randomization 1:1 to placebo:zuranolone, 30 mg, administered orally each evening for 2 weeks. Main Outcomes and Measures Primary end point was change from baseline in HAMD-17 score for zuranolone vs placebo at day 15. Secondary end points included changes from baseline in HAMD-17 total score at other time points, HAMD-17 response (≥50% score reduction) and remission (score ≤7) rates, Montgomery-Åsberg Depression Rating Scale score, and Hamilton Rating Scale for Anxiety score. Safety was assessed by adverse events and clinical assessments. Results Of 153 randomized patients, the efficacy set comprised 150 patients (mean [SD] age, 28.3 [5.4] years), and 148 (98.7%) completed treatment. A total of 76 patients were randomized to placebo, and 77 were randomized to zuranolone, 30 mg. Zuranolone demonstrated significant day 15 HAMD-17 score improvements from baseline vs placebo (-17.8 vs -13.6; difference, -4.2; 95% CI, -6.9 to -1.5; P = .003). Sustained differences in HAMD-17 scores favoring zuranolone were observed from day 3 (difference, -2.7; 95% CI, -5.1 to -0.3; P = .03) through day 45 (difference, -4.1; 95% CI, -6.7 to -1.4; P = .003). Sustained differences at day 15 favoring zuranolone were observed in HAMD-17 response (odds ratio, 2.63; 95% CI, 1.34-5.16; P = .005), HAMD-17 score remission (odds ratio, 2.53; 95% CI, 1.24-5.17; P = .01), change from baseline for Montgomery-Åsberg Depression Rating Scale score (difference, -4.6; 95% CI, -8.3 to -0.8; P = .02), and Hamilton Rating Scale for Anxiety score (difference, -3.9; 95% CI, -6.7 to -1.1; P = .006). One patient per group experienced a serious adverse event (confusional state in the zuranolone group and pancreatitis in the placebo group). One patient in the zuranolone group discontinued because of an adverse event vs none for placebo. Conclusions and Relevance In this randomized clinical trial, zuranolone improved the core symptoms of depression as measured by HAMD-17 scores in women with PPD and was generally well tolerated, supporting further development of zuranolone in the treatment of PPD. Trial Registration ClinicalTrials.gov Identifier: NCT02978326.
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Affiliation(s)
- Kristina M. Deligiannidis
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, New York
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | | | | | | | | | - Sigui Li
- Sage Therapeutics, Inc, Cambridge, Massachusetts
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17
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Schweizer-Schubert S, Gordon JL, Eisenlohr-Moul TA, Meltzer-Brody S, Schmalenberger KM, Slopien R, Zietlow AL, Ehlert U, Ditzen B. Steroid Hormone Sensitivity in Reproductive Mood Disorders: On the Role of the GABA A Receptor Complex and Stress During Hormonal Transitions. Front Med (Lausanne) 2021; 7:479646. [PMID: 33585496 PMCID: PMC7873927 DOI: 10.3389/fmed.2020.479646] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Women worldwide are two to three times more likely to suffer from depression in their lifetime than are men. Female risk for depressive symptoms is particularly high during the reproductive years between menarche and menopause. The term “Reproductive Mood Disorders” refers to depressive disorders triggered by hormonal fluctuations during reproductive transitions including the perimenarchal phase, the pre-menstrual phase, pregnancy, the peripartum period and the perimenopausal transition. Here we focus on reproductive mood disorders manifesting in adult life. We propose a research agenda that draws together several reproductive mood disorders and investigates which genetic, endocrinological, neural, and psychosocial factors can explain depressive symptoms during phases of hormonal transitions in women. Based on current research it is assumed that some women experience an increased sensitivity to not only fluctuations in reproductive steroids (estrogen and progesterone), but also stress-related steroids. We integrate both dynamics into the concept of “steroid hormone sensitivity,” expanding on the concept of “reproductive hormone sensitivity.” We suggest that a differential response of the stress steroid system including corticosteroids, neurosteroids, like allopregnanolone and the GABA-A Receptor complex, as well as a differential (epi)genetic risk in serotonergic and GABAergic signaling, are moderators or mediators between changes in the reproductive steroid system and the physiological, affective, and cognitive outcomes manifesting in reproductive mood disorders. We point to the lack of research on the role of psychosocial factors in increasing a woman's stress level and at some point also the sensitivity of her stress steroid system within the etiology of Reproductive Mood Disorders. Drawing together the evidence on various reproductive mood disorders we seek to present a basis for the development of more effective pharmacological, social, and psychological treatment interventions and prevention strategies for women susceptible to these disorders. This could pave the way for new research as well as medical and psychological teaching and practice- such as a new type of Practice for Gynecological Psychoneuroendocrinology- with the aim of working on and ultimately offering more integrative forms of support not yet available to women suffering from depression during hormonal transitions. In medical history women have been left alone with this integrative challenge.
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Affiliation(s)
- Sophie Schweizer-Schubert
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany.,Practice for Psychoendocrinology and Psychotherapy, Heilbronn, Germany
| | | | - Tory A Eisenlohr-Moul
- Women's Mental Health Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Katja M Schmalenberger
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Radoslaw Slopien
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna-Lena Zietlow
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Ehlert
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
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18
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Kakanakova A, Popov S, Maes M. Immunological Disturbances and Neuroimaging Findings in Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) Comorbid Patients. Curr Top Med Chem 2021; 20:759-769. [PMID: 32108009 DOI: 10.2174/1568026620666200228093935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 01/02/2023]
Abstract
Mood disorders and Major Depressive Disorder, in particular, appear to be some of the most common psychiatric disorders with a high rate of comorbidity most frequently of anxiety or substance abuse disorders (alcohol use disorder). In both cases - MDD and AUD, a number of immunological disturbances are observed, such as chronic mild inflammation response, increased level of cytokines, hypercortisolaemia, which lead to specific changes in brain neurotransmitter functions. Some of the contemporary brain imaging techniques are functional magnetic resonance imaging (fMRI) and magnetic spectroscopy which are most commonly used to assess the brain metabolism and functional connectivity changes such as altered responses to emotional stimuli in MDD or overactivation of ventromedial prefrontal areas during delayed and underactivation of dorsolateral prefrontal regions during impulsive reward decisions in AUD and dysfunction of gamma-aminobutyric acid (GABA) and/or glutamate neurotransmitter systems, low NAA and myo-Inositol in both MDD and AUD.
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Affiliation(s)
- Andriana Kakanakova
- Department of Psychiatry and Medical Psychology, Medical University Plovdiv, Faculty of Medicine, Plovdiv, Bulgaria
| | - Stefan Popov
- Department of Psychiatry and Medical Psychology, Medical University Plovdiv, Faculty of Medicine, Plovdiv, Bulgaria
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19
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Thippeswamy H, Davies W. A new molecular risk pathway for postpartum mood disorders: clues from steroid sulfatase-deficient individuals. Arch Womens Ment Health 2021; 24:391-401. [PMID: 33219387 PMCID: PMC8116278 DOI: 10.1007/s00737-020-01093-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
Postpartum mood disorders develop shortly after childbirth in a significant proportion of women. These conditions are associated with a range of symptoms including abnormally high or low mood, irritability, cognitive disorganisation, disrupted sleep, hallucinations/delusions, and occasionally suicidal or infanticidal ideation; if not treated promptly, they can substantially impact upon the mother's health, mother-infant bonding, and family dynamics. The biological precipitants of such disorders remain unclear, although large changes in maternal immune and hormonal physiology following childbirth are likely to play a role. Pharmacological therapies for postpartum mood disorders can be effective, but may be associated with side effects, concerns relating to breastfeeding, and teratogenicity risks when used prophylactically. Furthermore, most of the drugs that are used to treat postpartum mood disorders are the same ones that are used to treat mood episodes during non-postpartum periods. A better understanding of the biological factors predisposing to postpartum mood disorders would allow for rational drug development, and the identification of predictive biomarkers to ensure that 'at risk' mothers receive earlier and more effective clinical management. We describe new findings relating to the role of the enzyme steroid sulfatase in maternal postpartum behavioural processes, and discuss how these point to a novel molecular risk pathway underlying postpartum mood disorders. Specifically, we suggest that aberrant steroid hormone-dependent regulation of neuronal calcium influx via extracellular matrix proteins and membrane receptors involved in responding to the cell's microenvironment might be important. Testing of this hypothesis might identify novel therapeutic targets and predictive biomarkers.
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Affiliation(s)
- Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - William Davies
- Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK. .,School of Psychology, Cardiff University, Tower Building, 70, Park Place, Cardiff, CF10 3AT, UK. .,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.
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20
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Abstract
At least one in seven pregnant or recently postpartum women will experience a mental illness such as an anxiety disorder, depressive disorder, or substance use disorder. These mental illnesses have detrimental effects on the health of the mother, child, and family, but little is known about the hypothalamic and other neural correlates of maternal mental health concerns. The transition to parenthood alone is a time of remarkable neural plasticity, so it is perhaps not surprising that current research is showing that maternal mental illness has unique neural profiles. Furthermore, the neural systems affected by peripartum mental illness overlap and interact with the systems involved in maternal caregiving behaviors, and mother-infant interactions are, therefore, highly susceptible to disruption. This review discusses what we know about the unique neural changes occurring during peripartum mental illness and the role of the hypothalamus in these illnesses. With an improved understanding of the neural correlates of maternal mental health and disease, we will be better equipped to predict risk, develop effective treatments, and ultimately prevent suffering for millions of parents during this critical time in life.
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Affiliation(s)
- Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR S 1085, Rennes, France.
| | - James E Swain
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI, United States
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21
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Maternal Separation Model of Postpartum Depression: Potential Role for Nucleus Accumbens Dopamine D1-D2 Receptor Heteromer. Neurochem Res 2020; 45:2978-2990. [PMID: 33057844 DOI: 10.1007/s11064-020-03145-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
Postpartum depression is a mood disorder with a distinct neurobiological and behavioural profile occurring during and after the postpartum period. Dopamine pathways in the limbic regions of the brain such as the nucleus accumbens (NAc) have been shown to be involved in the etiology of depressive disorders. Selective activation of the dopamine D1-D2 receptor heteromer has been demonsrated to cause depressive- and anxiogenic-like behaviours in rats. The maternal separation model involving three hour daily maternal separation (MS) from pups on PPD 2-15 on anxiety-, depression- and anhedonia-like behaviors in the dams was investigated, together with plasma corticosterone, oxytocin and D1-D2 heteromer expression in the NAc core and shell in non-MS and MS dams. Depression, anxiety and anhedonia-like behaviours were measured using the forced swim test, elevated plus maze and sucrose preference test, respectively. In comparison to non-MS controls, MS dams displayed slightly higher depressive and anxiety-like behaviours with no difference in anhedonia-like behaviours. The MS dams displayed significantly increased care of pups after their retrieval with higher bouts of nursing, lower latency to nurse, lower bouts of out nest behaviour and decreased self-care. There was no significant alteration in D1-D2 heteromer expression in NAc core and shell between mothers of either group (MS, non-MS) or between postpartum rats and nonpregnant female rats, remaining higher than in male rats. This data provides evidence for the maternal separation model in producing a postpartum depression-like profile, but with maternal resilience able to modify behaviours to counteract any potential deleterious consequences to the pups.
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22
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Sacher J, Chechko N, Dannlowski U, Walter M, Derntl B. The peripartum human brain: Current understanding and future perspectives. Front Neuroendocrinol 2020; 59:100859. [PMID: 32771399 DOI: 10.1016/j.yfrne.2020.100859] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
The peripartum period offers a unique opportunity to improve our understanding of how dramatic fluctuations in endogenous ovarian hormones affect the human brain and behavior. This notwithstanding, peripartum depression remains an underdiagnosed and undertreated disorder. Here, we review recent neuroimaging findings with respect to the neuroplastic changes in the maternal brain during pregnancy and the postpartum period. We seek to provide an overview of multimodal neuroimaging designs of current peripartum depression models of hormone withdrawal, changes in monoaminergic signaling, and maladaptive neuroplasticity, which likely lead to the development of a condition that puts the lives of mother and infant at risk. We discuss the need to effectively integrate the available information on psychosocial and neurobiological risk factors contributing to individual vulnerability. Finally, we propose a systematic approach to neuroimaging the peripartum brain that acknowledges important co-morbidities and variation in disease onset.
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Affiliation(s)
- Julia Sacher
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103 Leipzig, Germany; Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103 Leipzig, Germany; Clinic of Cognitive Neurology, University of Leipzig, Liebigstr. 16, 04103 Leipzig, Germany.
| | - Natalia Chechko
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Pauwelsstr. 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Forschungszentrum Jülich, Wilhelm-Johnen-Str., 52428 Jülich, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert Schweitzer-Campus 1, G 9A, 48149 Muenster, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Medical School, University of Tübingen, Osianderstr. 24, 72076 Tübingen, Germany; LEAD Graduate Training & Research Network, University of Tübingen, Walter-Simon-Str. 12, 72072 Tübingen, Germany
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23
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Che K, Mao N, Li Y, Liu M, Ma H, Bai W, Xu X, Dong J, Li Y, Shi Y, Xie H. Altered Spontaneous Neural Activity in Peripartum Depression: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychol 2020; 11:656. [PMID: 32346374 PMCID: PMC7172032 DOI: 10.3389/fpsyg.2020.00656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023] Open
Abstract
Abnormalities related to peripartum depression (PPD) have been detected in several brain regions through tasking-state functional magnetic resonance imaging (fMRI). In this study, we used the two markers of resting-state fMRI (rs-fMRI) to investigate changes in spontaneous neural activity of PPD and their correlation with depression severity. A total of 16 individuals with PPD were compared with 16 age- and education-matched healthy controls (HCs) by using rs-fMRI. Two-sample t-test was used to compare the fractional amplitudes of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) values between groups. Pearson correlation analysis was used to determine the correlation between the fALFF and ReHo of the abnormal brain region and the Hamilton Depression Scale (HAMD) and Edinburgh Postnatal Depression Scale scores. The spontaneous neural activity of the PPD group significantly increased mainly in the left middle frontal gyrus, left precuneus, left inferior parietal lobule, and left dorsolateral prefrontal cortex (DLPFC) and decreased mainly in the bilateral precentral gyrus and right inferior occipital gyrus compared with those of the HCs. The fALFF value of the left DLPFC was negatively correlated with the HAMD score in PPD. This rs-fMRI study suggests that changes in the spontaneous neural activity of these regions are related to emotional responses. PPD cases with low fALFF values in the left DLPFC have severe depression.
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Affiliation(s)
- Kaili Che
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuna Li
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Meijie Liu
- Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Bai
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xiao Xu
- Medical Imaging Department, Weifang Medical University, Weifang, China
| | - Jianjun Dong
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ying Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Rincón-Cortés M, Grace AA. Adaptations in reward-related behaviors and mesolimbic dopamine function during motherhood and the postpartum period. Front Neuroendocrinol 2020; 57:100839. [PMID: 32305528 PMCID: PMC7531575 DOI: 10.1016/j.yfrne.2020.100839] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/15/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Initiation and maintenance of maternal behavior is driven by a complex interaction between the physiology of parturition and offspring stimulation, causing functional changes in maternal brain and behavior. Maternal behaviors are among the most robust and rewarding motivated behaviors. Mesolimbic dopamine (DA) system alterations during pregnancy and the postpartum enable enhanced reward-related responses to offspring stimuli. Here, we review behavioral evidence demonstrating postpartum rodents exhibit a bias towards pups and pup-related stimuli in reward-related tasks. Next, we provide an overview of normative adaptations in the mesolimbic DA system induced by parturition and the postpartum, which likely mediate shifts in offspring valence. We also discuss a causal link between dopaminergic dysfunction and disrupted maternal behaviors, which are recapitulated in postpartum depression (PPD) and relevant rodent models. In sum, mesolimbic DA system activation drives infant-seeking behavior and strengthens the mother-infant bond, potentially representing a therapeutic target for reward-related deficits in PPD.
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Affiliation(s)
- Millie Rincón-Cortés
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States.
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States
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25
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Vigod SN, Murphy KE, Dennis CL, Oberlander TF, Ray JG, Daskalakis ZJ, Blumberger DM. Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial. Brain Stimul 2019; 12:1475-1483. [DOI: 10.1016/j.brs.2019.06.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022] Open
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26
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Nguyen AJ, Hoyer E, Rajhans P, Strathearn L, Kim S. A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression. J Neuroendocrinol 2019; 31:e12794. [PMID: 31520440 DOI: 10.1111/jne.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/19/2022]
Abstract
Postpartum depression (PPD) is a common but complex condition that is poorly understood and multifactorial in aetiology. It is a condition that can compromise the mother's care for her infant, which may pose challenges to the formation of the mother-infant bond and the infant's overall development. Past research has looked at abnormalities in the brain circuitry and hormonal profiles of mothers with PPD compared to non-depressed mothers. However, abnormalities in PPD that may specifically affect the mother's care of her infant have not been clearly assessed. Thus, the present review aims to synthesise studies of altered brain and hormonal responses in mothers with PPD in relation to their care of their infant. First, we review maternal brain responses and their relation to PPD symptomatology, focusing on the salience/fear network, reward/attachment network and default mode network. Next, we discuss oxytocin and hypothalamic-pituitary-adrenal axis hormones in the context of maternal behaviour and PPD. Finally, we synthesise these findings and propose how future studies may benefit from the combined study of both neural and hormonal activity to better understand the underlying neurobiology of maternal care in PPD.
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Affiliation(s)
- Amanda J Nguyen
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elisabeth Hoyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Purva Rajhans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Sohye Kim
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Center for Reproductive Psychiatry, Pavilion for Women, Texas Children's Hospital, Houston, TX, USA
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27
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Unternaehrer E, Cost KT, Bouvette-Turcot AA, Gaudreau H, Massicotte R, Dhir SK, Hari Dass SA, O'Donnell KJ, Gordon-Green C, Atkinson L, Levitan RD, Wazana A, Steiner M, Lydon JE, Clark R, Fleming AS, Meaney MJ. Dissecting maternal care: Patterns of maternal parenting in a prospective cohort study. J Neuroendocrinol 2019; 31:e12784. [PMID: 31442354 DOI: 10.1111/jne.12784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/19/2019] [Accepted: 08/21/2019] [Indexed: 01/23/2023]
Abstract
Parental care has a strong impact on neurodevelopment and mental health in the offspring. Although numerous animal studies have revealed that the parental brain is a highly complex system involving many brain structures and neuroendocrine systems, human maternal parenting as a multidimensional construct with cognitive, emotional, and behavioural components has not been characterised comprehensively. This unique multi-method analysis aimed to examine patterns of self-reported and observed parenting from 6 to 60 months postpartum in a cohort of 496 mothers (mean maternal age = 32 years). Self-report questionnaires assessed motivational components of mothering, parenting stress, parenting-related mood, maternal investment, maternal parenting style, mother-child relationship satisfaction, and mother-child bonding at multiple time points. Observed parenting variables included the Ainsworth Sensitivity Scales at 6 and 18 months, the Behavioral Evaluation Strategies Taxonomies at 6 months, an Etch-A-Sketch cooperation task at 48 months, and the Parent-Child Early Relationship Assessment at 60 months. To examine whether different latent constructs underlie these measures of maternal parenting, we conducted an exploratory factor analysis. Self-report measures of parenting correlated only weakly with behavioural observations. Factor analysis on a subsample (n = 197) revealed four latent factors that each explained from 7% to 11% of the variance in the data (32% total variance explained). Based on the loadings of the instruments, the factors were interpreted as: Supportive Parenting, Self-Enjoyment Parenting, Overwhelmed Parenting, and Affectionate Parenting. These factor scores showed specific associations with maternal education and depressive symptoms, as well as with child outcomes, including maternally reported internalising and externalising behavioural problems, school readiness, and child-reported symptoms of mental health. These findings parallel the complexity of the parental brain, suggesting that maternal parenting consists of multiple components, each of which is associated with different maternal characteristics and child outcomes.
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Affiliation(s)
- Eva Unternaehrer
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada
- Department of Psychology, University of Constance, Constance, Germany
| | | | - Andrée-Anne Bouvette-Turcot
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada
| | - Hélène Gaudreau
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
| | - Rachel Massicotte
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - Sabine K Dhir
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - Shantala A Hari Dass
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada
| | | | | | - Robert D Levitan
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Ashley Wazana
- Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | - John E Lydon
- Department of Psychology, McGill University, Montréal, QC, Canada
| | - Roseanne Clark
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alison S Fleming
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Michael J Meaney
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada
- Singapore Institute for Clinical Sciences, Singapore, Singapore
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28
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Post C, Leuner B. The maternal reward system in postpartum depression. Arch Womens Ment Health 2019; 22:417-429. [PMID: 30554286 PMCID: PMC6784840 DOI: 10.1007/s00737-018-0926-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022]
Abstract
The experience of motherhood is most often emotionally positive and rewarding, but for many new mothers suffering from postpartum depression (PPD), this is not the case. Preclinical and clinical research has sought to uncover brain changes underlying PPD in order to gain a better understanding of how this disorder develops. This review focuses on the mesolimbic dopamine system, particularly the ventral tegmental area-nucleus accumbens pathway which has been implicated in the regulation of critical functions disrupted in PPD including mood, motivation, and mothering. Specifically, we discuss normative changes in the mesolimbic system during motherhood in both rodents and humans and how these are impacted in PPD. We also consider modulation of mesolimbic dopamine by the hypothalamic neuropeptide oxytocin and how oxytocin-dopamine interactions regulate mood and mothering during the postpartum period. In addition to providing an overview of reward mechanisms in PPD, our goal is to highlight open questions which warrant further research.
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Affiliation(s)
- Caitlin Post
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, USA
| | - Benedetta Leuner
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, USA.
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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29
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Duan C, Hare M, Staring M, Deligiannidis KM. Examining the relationship between perinatal depression and neurodevelopment in infants and children through structural and functional neuroimaging research. Int Rev Psychiatry 2019; 31:264-279. [PMID: 30701993 PMCID: PMC6594877 DOI: 10.1080/09540261.2018.1527759] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression is the most common perinatal psychiatric disorder, but little is known about how it may impact offspring neurodevelopment, as well as the mechanisms by which it may confer transgenerational psychiatric risk. This review presents imaging studies conducted to evaluate the relationship between perinatal depression (PND) and infant and child neurodevelopment. Altered structural and functional connectivity is implicated in children exposed to PND and anxiety. Overall, there are changes in connectivity between amygdala and the prefrontal cortex. Studies suggest decreased hippocampal growth in the first 6 months after birth, decreased cortical thickness in children, and increased amygdala volumes, that are more pronounced in female offspring. Future research is needed to understand the impact of PND on development so that early interventions which promote mother-infant bonding and cognitive development may improve developmental outcomes in children exposed to PND, reducing later risk of psychopathology.
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Affiliation(s)
- Christy Duan
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, USA
| | - Megan Hare
- Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Morganne Staring
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Kristina M. Deligiannidis
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, USA,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA,Departments of Psychiatry and Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA,Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
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30
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Resting-state functional connectivity, cortical GABA, and neuroactive steroids in peripartum and peripartum depressed women: a functional magnetic resonance imaging and spectroscopy study. Neuropsychopharmacology 2019; 44:546-554. [PMID: 30327498 PMCID: PMC6333815 DOI: 10.1038/s41386-018-0242-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/24/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023]
Abstract
Postpartum depression (PPD) is associated with abnormalities in resting-state functional connectivity (RSFC) but the underlying neurochemistry is unclear. We hypothesized that peripartum GABAergic neuroactive steroids (NAS) are related to cortical GABA concentrations and RSFC in PPD as compared to healthy comparison women (HCW). To test this, we measured RSFC with fMRI and GABA+/Creatine (Cr) concentrations with proton magnetic resonance spectroscopy (1H MRS) in the pregenual anterior cingulate (pgACC) and occipital cortices (OCC) and quantified peripartum plasma NAS. We examined between-group differences in RSFC and the relationship between cortical GABA+/Cr concentrations with RSFC. We investigated the relationship between NAS, RSFC and cortical GABA+/Cr concentrations. Within the default mode network (DMN) an area of the dorsomedial prefrontal cortex (DMPFC) had greater connectivity with the rest of the DMN in PPD (peak voxel: MNI coordinates (2, 58, 32), p = 0.002) and was correlated to depression scores (peak HAM-D17 voxel: MNI coordinates (0, 60, 34), p = 0.008). pgACC GABA+/Cr correlated positively with DMPFC RSFC in a region spanning the right anterior/posterior insula and right temporal pole (r = +0.661, p = 0.000). OCC GABA+/Cr correlated positively with regions spanning both amygdalae (right amygdala: r = +0.522, p = 0.000; left amygdala: r = +0.651, p = 0.000) as well as superior parietal areas. Plasma allopregnanolone was higher in PPD (p = 0.03) and positively correlated with intra DMPFC connectivity (r = +0.548, p = 0.000) but not GABA+/Cr. These results provide initial evidence that PPD is associated with altered DMN connectivity; cortical GABA+/Cr concentrations are associated with postpartum RSFC and allopregnanolone is associated with postpartum intra-DMPFC connectivity.
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31
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Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol 2019; 52:165-180. [PMID: 30552910 PMCID: PMC6370514 DOI: 10.1016/j.yfrne.2018.12.001] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.
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Affiliation(s)
- Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, USA.
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32
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Glynn LM, Howland MA, Fox M. Maternal programming: Application of a developmental psychopathology perspective. Dev Psychopathol 2018; 30:905-919. [PMID: 30068423 PMCID: PMC6274636 DOI: 10.1017/s0954579418000524] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The fetal phase of life has long been recognized as a sensitive period of development. Here we posit that pregnancy represents a simultaneous sensitive period for the adult female with broad and persisting consequences for her health and development, including risk for psychopathology. In this review, we examine the transition to motherhood through the lens of developmental psychopathology. Specifically, we summarize the typical and atypical changes in brain and behavior that characterize the perinatal period. We highlight how the exceptional neuroplasticity exhibited by women during this life phase may account for increased vulnerability for psychopathology. Further, we discuss several modes of signaling that are available to the fetus to affect maternal phenotypes (hormones, motor activity, and gene transfer) and also illustrate how evolutionary perspectives can help explain how and why fetal functions may contribute to maternal psychopathology. The developmental psychopathology perspective has spurred advances in understanding risk and resilience for mental health in many domains. As such, it is surprising that this major epoch in the female life span has yet to benefit fully from similar applications.
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Affiliation(s)
| | | | - Molly Fox
- University of California,Los Angeles
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33
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White matter integrity in medication-free women with peripartum depression: a tract-based spatial statistics study. Neuropsychopharmacology 2018; 43:1573-1580. [PMID: 29453442 PMCID: PMC5983547 DOI: 10.1038/s41386-018-0023-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 01/03/2023]
Abstract
Diffusion tensor imaging (DTI) studies in depression show decreased structural connectivity in the left anterior limb of the internal capsule and the genu of the corpus callosum but no such studies exist in peripartum depression (PPD), which affects 1 in 8 women. We analyzed fractional anisotropy (FA) as a measure of white matter integrity of these two tracts using tract-based spatial statistics (TBSS). We then conducted an exploratory whole-brain analysis to identify additional regions implicated in PPD. Seventy-five pregnant, medication-free women were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) and Structured Clinical Interview (SCID) for DSM-IV-TR in pregnancy and in the postpartum. Structural MRI and DTI sequences were acquired in forty-four women within 2-8 weeks postpartum. TBSS data were analyzed between healthy comparison postpartum women (HCW) and women who developed PPD to determine differences in white matter integrity within the left anterior limb of the internal capsule and the genu of the corpus callosum, then analyzed across participants to explore correlation between FA and the EPDS score. An exploratory whole-brain analysis was also conducted to identify other potential regions showing differences in white matter integrity between groups, as well as correlation between EPDS and FA across groups. All results were corrected for multiple comparisons and analyses conducted using FSL, p < 0.05, K > 10. In comparison to HCW, women with PPD had significantly lower FA in left anterior limb of the internal capsule (p = 0.010). FA was negatively correlated with EPDS scores in the left anterior limb of the internal capsule (p = 0.019). In the whole-brain analysis, FA in the right retrolenticular internal capsule (p = 0.03) and two clusters within the body of the corpus callosum (p = 0.044, p = 0.050) were negatively correlated with EPDS; there were no between-group differences in FA. Reduced FA in the left anterior limb of the internal capsule suggests disruption of fronto-subcortical circuits in PPD. A negative correlation between FA within the body of the corpus callosum and EPDS total score could additionally reflect disrupted interhemispheric structural connectivity in women with depressive symptoms.
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