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Niu L, Du Z, Xie Z, Liu X, Wang Q, Zhao Y, Wang H, Hao C, Xue D, Wang L. Total testosterone plays a crucial role in the pathway from hypothyroidism to broad depression in women. J Affect Disord 2024; 359:164-170. [PMID: 38768827 DOI: 10.1016/j.jad.2024.05.085] [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] [Received: 11/16/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Depression tends to develop in correlation with hypothyroidism, however it's unclear how testosterone traits contribute to this association. We examined the causal association between depression, testosterone traits, and hypothyroidism using Mendelian randomization (MR). METHOD We conducted univariable and multivariable MR studies using summary-level statistics from genome-wide association studies (GWAS) of Hypothyroidism (n = 213,990), broad depression (n = 322,580), probable major depressive disorder (probable MDD) (n = 174,519), and International Classification of Diseases (ICD)-9 or ICD-10-coded MDD (n = 217,584) from European ancestry. The inverse variance weighted (IVW) method was used as the main MR analysis. RESULTS In univariate MR analysis, there is a positive causal relationship between hypothyroidism and broad depression (P = 0.0074; OR = 1.0066; 95%CI: 1.0018-1.0114) and probable MDD (P = 0.0242; OR = 1.0056; 95%CI: 1.0007-1.0105). In females, there is a causal relationship between hypothyroidism and decreased total testosterone (P < 0.001; OR = 0.9747; 95%CI: 0.9612-0.9885) and sex hormone binding globulin (SHBG) levels (P = 0.0418; OR = 0.9858; 95%CI: 0.9723-0.9995). In females, there is an inverse causal relationship between total testosterone and broad depression (P = 0.0349; OR = 0.9898; 95%CI: 0.9804-0.9993). Furthermore, in multivariate MR analysis, after adjusting for total testosterone in females, hypothyroidism only has a positive causal relationship with probable MDD, and the relationship with broad depression is no longer significant. Most notably, after adjusting for hypothyroidism, the inverse causal effect of female total testosterone levels on broad depression becomes more significant (P = 0.0154; OR = 0.9878; 95%CI: 0.9780-0.9977). CONCLUSION Hypothyroidism increases the risk of broad depression and probable MDD development. Total Testosterone appears to play an important role in the relationship between hypothyroidism and broad depression in female.
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Affiliation(s)
- Le Niu
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiwei Du
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhihong Xie
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuxu Liu
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiang Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Yong Zhao
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hao Wang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chenjun Hao
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongbo Xue
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Liyi Wang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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2
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Kotov DA, Corpuz R. No evidence for relationship between paternal post-partum depressive symptoms and testosterone or cortisol in first-time fathers. Front Psychol 2024; 15:1348031. [PMID: 38425562 PMCID: PMC10902172 DOI: 10.3389/fpsyg.2024.1348031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Male life history strategies are regulated by the neuroendocrine system. Testosterone (T) and cortisol regulate male behaviors including parenting and facilitate managing tradeoffs at key transitions in development such as first-time fatherhood. Both hormones demonstrate marked fluctuations in the postnatal period, and this presents an opportunity to investigate the role of T and cortisol in postpartum depressive symptoms-comparably less studied in fathers than in mothers in the evolutionary literature. Prior work on depressive symptoms has yet to integrate insights from the "dual hormone hypothesis (DHH)" which has focused on how T and cortisol interact to jointly regulate traits associated with dominance and status-seeking (i.e., mating effort) but has yet to be included in models of parenting effort. In this research, we use secondary data to investigate the relationship between DHH and traits ostensibly opposed to status seeking (i.e., depressive symptoms). First-time fathers (n = 193) provided morning saliva samples 10 months following parturition and reported on the presence of depressive symptoms (BDI-II). Responses were decomposed into three factors: cognitive, affective, and somatic. Using hybrid latent variable structural equation modeling, we did not find evidence that T predicted variability in cognitive, affective, or somatic depressive symptom factors. We found a null effect for cortisol as well. Finally, we could not find evidence that the DHH variable (T × cortisol interaction) predicted any variability in cognitive, affective, or somatic depressive symptoms. While we did not find evidence to support our hypotheses using a secondary data set, this study contributes to research on the neuroendocrinology of depression in fathers. Discussion focuses on the limitations of sample demographics, timing of saliva and self-report collection, and the lack of extant theory specific to paternal postpartum depression.
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Affiliation(s)
| | - Randy Corpuz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
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3
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Dukic J, Ehlert U. Longitudinal Course of Sex Steroids From Pregnancy to Postpartum. Endocrinology 2023; 164:bqad108. [PMID: 37450580 PMCID: PMC10499333 DOI: 10.1210/endocr/bqad108] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
CONTEXT Sex steroids (SS) typically rise during pregnancy and decline after birth, but no consistent reference values exist for these hormonal courses. We aimed to establish an overview of SS secretion patterns during the peripartum and to better understand how SS contribute to maternal and fetal pathologies. EVIDENCE ACQUISITION A systematic literature search was conducted in accordance with the PRISMA guidelines using PubMed, Cochrane Library, and PsycINFO. Additionally, we conducted a supplementary manual search of references. Observational studies published in English and assessing estradiol, progesterone, and testosterone over the course of the peripartum in physically healthy female subjects were included, without restrictions on year of publication. Extracted data were analyzed descriptively and visually. EVIDENCE SYNTHESIS SS increase progressively during pregnancy, with an extremely wide range of reported concentrations, especially in the third trimester. In fact, reported concentrations varied up to 5000-fold at comparable measurement time points. CONCLUSIONS A comprehensive understanding of the influence of SS levels on associated maternal and fetal pathologies is currently hindered by 2 main factors. First, reported SS levels vary widely during the peripartum period. Second, the current state of knowledge on how SS are associated with pathologies in mothers and babies is largely based on correlational studies, and causality thus remains unclear. Consequently, we recommend the development of a systematic reference framework that follows the suggestions presented in this review. This would enable the establishment of SS reference values for a healthy population, resulting in the possibility to draw conclusions about deviations and related pathologies.
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Affiliation(s)
- Jelena Dukic
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland
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4
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Gongolli J, Vanderschaegen A, Prahlow JA. A Case of Spontaneous Coronary Artery Dissection in the Setting of Exogenous Testosterone. Am J Forensic Med Pathol 2023; 44:122-125. [PMID: 36943719 DOI: 10.1097/paf.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, occurring when there is separation of the coronary artery walls by intramural hemorrhage creating a false lumen. This compresses the arterial lumen, compromising the ability of the coronary artery to perfuse the myocardial tissue. Spontaneous coronary artery dissection is usually fatal, with risk factors including pregnancy, young age, and female sex, birth control, and other hormonal therapies.In this case report, we describe the case of a 31-year-old biological female transitioning to male with exogenous testosterone who experienced a SCAD. Given the known risk factors for SCAD, such as pregnancy and exogenous hormone therapy, this case raises additional considerations regarding rare unintended consequences of testosterone therapy.
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Affiliation(s)
- Julita Gongolli
- From the Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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Ahmadpour P, Faroughi F, Mirghafourvand M. The relationship of childbirth experience with postpartum depression and anxiety: a cross-sectional study. BMC Psychol 2023; 11:58. [PMID: 36869373 PMCID: PMC9983514 DOI: 10.1186/s40359-023-01105-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The childbirth experience is a personal life event that is influenced by physiologic and mental-psychological processes. Due to the prevalence of psychiatric problems after childbirth, it is important to recognize the factors affecting women's emotional reactions. This study was conducted to define the relationship of childbirth experience with postpartum anxiety and depression. METHODS This cross-sectional study was conducted on 399 women from 1 to 4 months after their childbirth who were referred to health centers in Tabriz-Iran from January 2021 to September 2021. Socio-demographic and obstetric characteristics questionnaire, Childbirth Experience Questionnaire (CEQ 2.0), Edinburgh Postpartum Depression Scale (EPDS), and Postpartum Specific Anxiety Scale (PSAS) were used to collect the data. The general linear modeling was used along with adjustment of socio-demographic characteristics to determine the relationship between the childbirth experience with depression and anxiety. RESULTS The mean (SD) of the overall score for childbirth experience, anxiety, and depression were 2.9 (0.2) (score range: 1 to 4), 91.6 (4.8) (score range: 0 to153), and 9.4 (0.7) (score range: 0 to 30), respectively. There was a significant inverse correlation between the overall score of childbirth experiences, the depression score (r= -0.36, p < 0.001), and the anxiety score (r= -0.12, p = 0.028) based on the Pearson correlation test. According to the general linear modeling and with adjustment of socio-demographic characteristics, with the increasing score of the childbirth experience, the depression score decreased (B= -0.2; 95%CI: -0.3 to -0.1). Moreover, the variable of control during pregnancy was a predictor for postpartum depression and anxiety, so in women with the control during pregnancy, the mean score of postpartum depression (B= -1.8; CI 95%: -3.0 to -0.5; P = 0.004) and anxiety (B=-6.0; CI 95%: -10.1 to -1.6; P = 0.007) was less. CONCLUSION Based on the study results, postpartum depression and anxiety are related to childbirth experiences, therefore considering the effects of mothers' mental health on other aspects of a woman and her family's life, the core role of health care providers and policymakers in creating positive childbirth experiences is determined.
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Affiliation(s)
- Parivash Ahmadpour
- Midwifery Department, Faculty of Nursing and Midwifery, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farnaz Faroughi
- Midwifery Department, Faculty of Nursing and Midwifery, Maragheh Branch, Islamic azad University, Maragheh, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing & Midwifery, Tabriz University of Medical sciences, Tabriz, Iran. .,Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Social Determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
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6
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Zito S, Nosari G, Pigoni A, Moltrasio C, Delvecchio G. Association between testosterone levels and mood disorders: A minireview. J Affect Disord 2023; 330:48-56. [PMID: 36841309 DOI: 10.1016/j.jad.2023.02.108] [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: 08/23/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Although many studies reported the neuropsychiatric involvement of testosterone (T) levels in the development of mood disorders, its role in this disabling disorder is still not well understood. Therefore, in this review, we aim to summarize the current literature exploring serum testosterone levels in both major depressive disorder (MDD) and bipolar disorder (BD), with particular attention given to the possible causal relationship between pathological mood alterations and T levels. METHODS We selected 9 original studies from a bibliographic search on PubMed, excluding studies on hormonal therapy and other psychiatric disorders other than mood disorders. RESULTS The results reported by the reviewed studies were conflicting especially with regards to the presence of dysfunctional levels of T in patients with BD. Specifically, while MDD was found to be associated with low levels of T compared to healthy controls (HC), in BD the results were highly heterogeneous, with a mixed picture of reduced, increased or no difference in T levels in BD patients compared to HC. LIMITATIONS Studies were highly heterogeneous in terms of samples employed, psychometric scales used for assessing depressive symptoms, T assay methods and therapeutic regimens. CONCLUSIONS Overall, T levels were shown to be reduced in both MDD and BD patients, ultimately suggesting that T could be useful as a biomarker in mood disorders and provide guidance for future research.
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Affiliation(s)
- Silvana Zito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Attention deficit in children with attention deficit hyperactivity disorder at primary school age measured with the attention network test (ANT): A protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0275599. [PMID: 36282809 PMCID: PMC9595530 DOI: 10.1371/journal.pone.0275599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Attentional deficits are among the most bothersome symptoms of attention deficit hyperactivity disorder (ADHD). To date, the neurological basis of attentional deficits has not been fully described according to the diagnostic criteria. ADHD may result from deficits in various attributes of attention. There is no specialist neuropsychological diagnostic method that allows reliable distinction between primary attention disorders in the etiology of ADHD and secondary problems that may arise due to co-morbidities. This protocol aims to systematically review the literature to evaluate patterns of attention common to school-age children either diagnosed with ADHD or at high risk of ADHD, as measured by the neuropsychological attention network test (ANT). Methods Our search strategy will consist of electronic databases (PubMed, PsychInfo, Web of Science, EMBASE, and Cochrane Library) and hand searching. Both prospective cohort studies and prospective studies of intervention effects will be included, provided they used the ANT. The primary output variable will be attention deficits. Screening and eligibility will be done independently by two reviewers based on pre-specified eligibility criteria. Data extraction will be based on a pre-pilot data extraction form and conducted by two authors independently. The risk of bias will be assessed by two authors independently. The rating of the certainty of the entire body of evidence will be evaluated using the GRADE approach. Any discrepancies identified at any stage of the review will be resolved by discussion or/and consultation with another reviewer. We plan a narrative synthesis of findings and a quantitative meta-analysis if the data allow. Discussion The research will identify patterns of neuropsychological ANT results characteristic of both school-age children diagnosed with ADHD and those at high risk of having ADHD. Our results could be used to check whether the pattern of a child’s performance in the ANT corresponds to the characteristic pattern of the results of children with ADHD. At present, the ANT is used only in research; the results of this review will serve as a useful benchmark. Hopefully, in the future, it will be possible to use the ANT in the wider diagnosis of ADHD. Systematic review registration PROSPERO: CRD42021249768.
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8
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Clephane K, Lorenz TK. Putative Mental, Physical, and Social Mechanisms of Hormonal Influences on Postpartum Sexuality. CURRENT SEXUAL HEALTH REPORTS 2021; 13:136-148. [PMID: 35707497 PMCID: PMC9191849 DOI: 10.1007/s11930-021-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Much research has documented changes in postpartum sexuality, including changes in sexual functioning and satisfaction for both the birthing parent and their partner(s). These changes are often linked to postpartum changes in hormonal and immune responses, which can have both direct and indirect effects on sexuality. Recent Findings Here, we review how postpartum sexuality may be changed via mental, physical, and social/relationship effects of a variety of hormones, including estrogens, progestogens, androgens, cortisol, and oxytocin. We also review the ways in which inflammation may act alongside hormones to influence postpartum sexuality. Summary We argue that, as each of these factors strongly influence the action of others, the next phase of research in postpartum sexuality must examine the bidirectional interactions of hormones and their effects on behavior, cognition, and social relationships.
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Affiliation(s)
- Kirstin Clephane
- Department of Psychology & Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Stadium East C69, Lincoln, NE 68588-0156, USA
| | - Tierney K. Lorenz
- Department of Psychology & Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Stadium East C69, Lincoln, NE 68588-0156, USA
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9
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Rizzo A, Bruno A, Torre G, Mento C, Pandolfo G, Cedro C, Laganà AS, Granese R, Zoccali RA, Muscatello MRA. Subthreshold psychiatric symptoms as potential predictors of postpartum depression. Health Care Women Int 2021; 43:129-141. [PMID: 34652261 DOI: 10.1080/07399332.2021.1963730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors' purpose in the present study is to examine the role of subthreshold mental disorders as predictors of Postpartum Depression (PPD). 110 pregnancy women were evaluated as follow: the General 5-Spectrum Measure at 26 weeks of gestation; the Edinburgh Postnatal Depression Scale at 3/6 months after delivery. Only 4.5% of the sample developed PPD at 3/6 months after delivery. Agoraphobia/panic, depressed mood, social anxiety and eating problems relate positively to PPD at 3/6 months. Early identification of symptoms that could indicate the development of future mood problems in the mother is of crucial importance for mental health and prevention.
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Affiliation(s)
- Amelia Rizzo
- Psychiatry Unit, Hospital University of Messina, Messina, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanna Torre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Roberta Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy
| | - Rocco Antonio Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Maharjan DT, Syed AAS, Lin GN, Ying W. Testosterone in Female Depression: A Meta-Analysis and Mendelian Randomization Study. Biomolecules 2021; 11:409. [PMID: 33802106 PMCID: PMC7999217 DOI: 10.3390/biom11030409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/19/2021] [Accepted: 03/07/2021] [Indexed: 11/16/2022] Open
Abstract
Testosterone's role in female depression is not well understood, with studies reporting conflicting results. Here, we use meta-analytical and Mendelian randomization techniques to determine whether serum testosterone levels differ between depressed and healthy women and whether such a relationship is casual. Our meta-analysis shows a significant association between absolute serum testosterone levels and female depression, which remains true for the premenopausal group while achieving borderline significance in the postmenopausal group. The results from our Mendelian randomization analysis failed to show any causal relationship between testosterone and depression. Our results show that women with depression do indeed display significantly different serum levels of testosterone. However, the directions of the effect of this relationship are conflicting and may be due to menopausal status. Since our Mendelian randomization analysis was insignificant, the difference in testosterone levels between healthy and depressed women is most likely a manifestation of the disease itself. Further studies could be carried out to leverage this newfound insight into better diagnostic capabilities culminating in early intervention in female depression.
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Affiliation(s)
- Dhruba Tara Maharjan
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China; (D.T.M.); (G.N.L.)
| | - Ali Alamdar Shah Syed
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Guan Ning Lin
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China; (D.T.M.); (G.N.L.)
| | - Weihai Ying
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China; (D.T.M.); (G.N.L.)
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Transcriptome Sequencing in the Preoptic Region of Rat Dams Reveals a Role of Androgen Receptor in the Control of Maternal Behavior. Int J Mol Sci 2021; 22:ijms22041517. [PMID: 33546359 PMCID: PMC7913516 DOI: 10.3390/ijms22041517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 01/17/2023] Open
Abstract
(1) Background: Preoptic region of hypothalamus is responsible to control maternal behavior, which was hypothesized to be associated with gene expressional changes. (2) Methods: Transcriptome sequencing was first applied in the preoptic region of rat dams in comparison to a control group of mothers whose pups were taken away immediately after parturition and did not exhibit caring behavior 10 days later. (3) Results: Differentially expressed genes were found and validated by quantitative RT-PCR, among them NACHT and WD repeat domain containing 1 (Nwd1) is known to control androgen receptor (AR) protein levels. The distribution of Nwd1 mRNA and AR was similar in the preoptic area. Therefore, we focused on this steroid hormone receptor and found its reduced protein level in rat dams. To establish the function of AR in maternal behavior, its antagonist was administered intracerebroventricularly into mother rats and increased pup-directed behavior of the animals. (4) Conclusions: AR levels are suppressed in the preoptic area of mothers possibly mediated by altered Nwd1 expression in order to allow sustained high-level care for the pups. Thus, our study first implicated the AR in the control of maternal behaviors.
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Yu Y, Liang HF, Chen J, Li ZB, Han YS, Chen JX, Li JC. Postpartum Depression: Current Status and Possible Identification Using Biomarkers. Front Psychiatry 2021; 12:620371. [PMID: 34211407 PMCID: PMC8240635 DOI: 10.3389/fpsyt.2021.620371] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Postpartum depression (PPD) is a serious health issue that can affect about 15% of the female population within after giving birth. It often conveys significant negative consequences to the offsprings. The symptoms and risk factors are somewhat similar to those found in non-postpartum depression. The main difference resides in the fact that PPD is triggered by postpartum specific factors, including especially biological changes in the hormone levels. Patients are usually diagnosed using a questionnaire onsite or in a clinic. Treatment of PPD often involves psychotherapy and antidepressant medications. In recent years, there have been more researches on the identification of biological markers for PPD. In this review, we will focus on the current research status of PPD, with an emphasis on the recent progress made on the identification of PPD biomarkers.
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Affiliation(s)
- Yi Yu
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Center for Analyses and Measurements, College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Hong-Feng Liang
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China
| | - Jing Chen
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Zhi-Bin Li
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Yu-Shuai Han
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Jia-Xi Chen
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Ji-Cheng Li
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
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Tobore TO. On maternal Post-Partum/Natal depression. A global underrecognized problem and the need for better Treatment strategies. Psychiatry Res 2020; 290:113163. [PMID: 32505925 DOI: 10.1016/j.psychres.2020.113163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Maternal Postpartum (PPD) or Postnatal Depression (PND) is believed to be the commonest medical complication postpartum. Evidence suggests a significantly higher prevalence of the disease compared to the often reported 10-15%. METHOD Studies were identified by accessing several databases including PubMed/Medline, PubMed Central, EBSCO, and PsycINFO. RESULTS Vitamin D (VD) deficiency, hormonal levels alteration (estrogen, progesterone, testosterone, oxytocin, and prolactin), thyroid dysfunction, and increased oxidative stress, play a critical role in PPD etiopathogenesis and pathophysiology. CONCLUSIONS Treatment strategies should include an integrated approach of antidepressants and psychotherapy, melatonin, diet, sleep improvement, exercise, VD and antioxidants supplementation, and economic and social support.
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Lutkiewicz K, Bieleninik Ł, Cieślak M, Bidzan M. Maternal-Infant Bonding and Its Relationships with Maternal Depressive Symptoms, Stress and Anxiety in the Early Postpartum Period in a Polish Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5427. [PMID: 32731490 PMCID: PMC7432717 DOI: 10.3390/ijerph17155427] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023]
Abstract
A large body of literature indicates that there is a relationship between maternal psychological well-being and the early maternal-infant bond. However, this relationship is not fully understood, due to the different theoretical frameworks of maternal-infant bonding and different data collections points. Thus, the aim of this study was to examine the relationship between the maternal bond and the maternal psychological state including anxiety, stress, and maternal depressive symptoms. In this cohort study, 150 women who gave birth after 37 weeks of pregnancy completed the following self-reports 1-3 days post-delivery: Socio-demographic questionnaire, Postpartum Bonding Questionnaire (PBQ), Edinburgh Postpartum Depression Scale (EPDS), Postpartum Depression Screening Scale (PDSS), Generalized Anxiety Disorder Assessment (GAD-7), and Parental Stress Scale (PSS). The obtained results showed that the maternal level of stress, anxiety and postnatal depressive symptoms are significantly correlated with the maternal-infant bond in Polish mothers. In addition, regression analysis shows that postpartum depressive symptoms and maternal stress are significantly associated with the maternal-infant bonding process in the early postpartum period. This finding emphasizes the importance of identifying maternal mental state difficulties in the early postpartum period in order to provide interventions to help build healthy maternal-infant bonding.
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Affiliation(s)
- Karolina Lutkiewicz
- Institute of Psychology, University of Gdansk, 80-309 Gdańsk, Poland; (Ł.B.); (M.C.); (M.B.)
| | - Łucja Bieleninik
- Institute of Psychology, University of Gdansk, 80-309 Gdańsk, Poland; (Ł.B.); (M.C.); (M.B.)
- GAMUT—The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, 5029 Bergen, Norway
| | - Mariusz Cieślak
- Institute of Psychology, University of Gdansk, 80-309 Gdańsk, Poland; (Ł.B.); (M.C.); (M.B.)
| | - Mariola Bidzan
- Institute of Psychology, University of Gdansk, 80-309 Gdańsk, Poland; (Ł.B.); (M.C.); (M.B.)
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15
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Peñalver Bernabé B, Maki PM, Dowty SM, Salas M, Cralle L, Shah Z, Gilbert JA. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology (Berl) 2020; 237:915-941. [PMID: 32065252 DOI: 10.1007/s00213-019-05436-4] [Citation(s) in RCA: 11] [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: 10/16/2018] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
Perinatal depression is the most common complication of pregnancy and affects the mother, fetus, and infant. Recent preclinical studies and a limited number of clinical studies have suggested an influence of the gut microbiome on the onset and course of mental health disorders. In this review, we examine the current state of knowledge regarding genetics, epigenetics, heritability, and neuro-immuno-endocrine systems biology in perinatal mood disorders, with a particular focus on the interaction between these factors and the gut microbiome, which is mediated via the gut-brain axis. We also provide an overview of experimental and analytical methods that are currently available to researchers interested in elucidating the influence of the gut microbiome on mental health disorders during pregnancy and postpartum.
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Affiliation(s)
- Beatriz Peñalver Bernabé
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shannon M Dowty
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariana Salas
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Lauren Cralle
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Zainab Shah
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jack A Gilbert
- Scripts Oceanographic Institute, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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16
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Gust K, Caccese C, Larosa A, Nguyen TV. Neuroendocrine Effects of Lactation and Hormone-Gene-Environment Interactions. Mol Neurobiol 2020; 57:2074-2084. [PMID: 31927723 DOI: 10.1007/s12035-019-01855-8] [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: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
While correlational studies suggest that lactation may confer a certain level of protection from mental illness, this benefit is not uniformly expressed in all women who choose to breastfeed. We propose here that the neuroendocrine "resetting" induced by lactation may predispose toward positive affect states in a subset of hormone-sensitive mothers, with hormone-gene and hormone-environment interactions determining the ultimate psychological outcome. We find evidence to suggest that higher secretion of prolactin/oxytocin as well as lower secretion of vasopression/androgens in lactating mothers may protect against postpartum depression and anxiety, decrease levels of irritability, and optimize stress responses. On the other hand, while the abrupt withdrawal of estradiol/progesterone in the immediate postpartum period tends to be associated with adverse psychological outcomes, the chronic suppression of estrogens/progestogens induced by lactation may have antidepressant and anxiolytic effects over time. Finally, the hypo-cortisolemic state seen in lactating mothers appears to be associated with improved stress reactivity and circadian rhythms. We also discuss hormone-gene and hormone-environment interactions likely to modulate any potential psychological benefits related to lactation and focus on those factors that are either easy to screen for or known to be modifiable. In sum, neuroendocrine alterations induced by lactation may play a key role in determining reproductive psychiatric risk in a subset of hormone-sensitive women. Using these neuroendocrine factors as an individualized index of risk can help in devising targeted programs to support these women in pursuing lactation or, for those not able or willing, accessing psychological interventions in a timely manner.
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Affiliation(s)
- Kirsten Gust
- Reproductive Psychiatry Program, Departments of Psychiatry and Obstetrics-Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Christina Caccese
- Department of Psychiatry, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Amanda Larosa
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Neuroscience Division, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Reproductive Psychiatry Program, Departments of Psychiatry and Obstetrics-Gynecology, McGill University Health Centre, Montreal, QC, Canada.
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17
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Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
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Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
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18
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Trifu S, Vladuti A, Popescu A. THE NEUROENDOCRINOLOGICAL ASPECTS OF PREGNANCY AND POSTPARTUM DEPRESSION. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:410-415. [PMID: 32010366 DOI: 10.4183/aeb.2019.410] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Ties between the endocrine system and mental health are undeniably a consistent point of interest in modern day medicine. Furthermore, mental disturbances due to hormonal changes following childbirth have been mentioned in medical literature since Hippocrates. Considering the dramatic endocrine, paracrine and autocrine changes that occur during gestation, labour and postnatal phase, hormonal theories are not to be ignored in the treatment of postpartum disorders. Results Reproductive hormones are known to modulate behavioural, emotional and cognitive response, therefore rapid changes in estradiol and progesterone plasma concentrations during pregnancy and labour create a vulnerable terrain leading towards postpartum disorders. New research shows that women suffering from postpartum disorders have abnormal neural responses, suggesting a neuroendocrine explanation for postpartum syndromes. Conclusion To facilitate further research in this area, we present new information on several hormonal interactions and the psychiatric response involved in pregnancy and labour, offering an interdisciplinary outlook on pregnancy and postpartum disorders. There is enough evidence to suggest that estradiol, progesterone, oxytocin, cortisol and thyroid hormones are some of many hormones involved in postpartum syndromes and tackling their perinatal imbalance with pharmacological substituents or antagonists could be useful as an adjuvant form of treatment in future patients.
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Affiliation(s)
- S Trifu
- "Carol Davila" University of Medicine and Pharmacy - Dept. of Neurosciences, Bucharest, Romania
| | - A Vladuti
- University of Bucharest Faculty of Psychology and Educational Sciences - Dept. of Psychology, Bucharest, Romania
| | - A Popescu
- "Alex. Obregia" Clinical Hospital for Psychiatry - Dept. of Psychiatry, Bucharest, Romania
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19
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a theoretical explanation and a review of the recent literature concerning the role of neuroactive steroids in perinatal depression, and to use this information to suggest future directions of research. RECENT FINDINGS The bulk of the evidence on neuroactive steroids in perinatal depression concerns allopregnanolone. Recent studies have been mixed, with some studies finding a direct correlation between lower levels of allopregnanolone and increased depressive symptoms but other studies finding no relationship. Evidence concerning other neuroactive steroids and perinatal depression is sparse. Additional research is needed with larger sample sizes and better characterization across the perinatal period (rather than cross-sectionally). Because some studies point to a lag between neuroactive steroid dysregulation and subsequent symptoms, future research should consider interactions with other aspects of neuroactive steroid physiology, such as synthetic enzymes or receptor plasticity.
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Affiliation(s)
- Katherine McEvoy
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Jennifer L Payne
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Lauren M Osborne
- Women's Mood Disorders Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.
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20
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Abdul Rahman I, Yaqoob U, Bhatti TA. Post partum depression-It's time to pay attention. Asian J Psychiatr 2018; 31:111. [PMID: 29476950 DOI: 10.1016/j.ajp.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | - Uzair Yaqoob
- Sindh Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Tariq Ali Bhatti
- Sindh Medical College, Dow University of Health Sciences, Karachi, Pakistan.
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21
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Kimmel M, Clive M, Gispen F, Guintivano J, Brown T, Cox O, Beckmann MW, Kornhuber J, Fasching PA, Osborne LM, Binder E, Payne JL, Kaminsky Z. Oxytocin receptor DNA methylation in postpartum depression. Psychoneuroendocrinology 2016; 69:150-60. [PMID: 27108164 PMCID: PMC7152506 DOI: 10.1016/j.psyneuen.2016.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
Abstract
The oxytocin receptor (OXTR) is a key regulator of stress and anxiety and may be regulated by both psychosocial risk factors and gonadal hormones, making it an attractive candidate for study in postpartum depression (PPD). The objective of this study was to investigate both serum hormone and PPD specific DNA methylation variation in the OXTR. Illumina HM450 microarray data generated in a prospective PPD cohort identified significant associations (P=0.014) with PPD in an intronic region in the OXTR located 4bp proximal to an estrogen receptor (ER) binding region. Pyrosequencing confirmed moderate evidence for an interaction of CpGs in the region with childhood abuse status to mediate PPD. These CpGs located on chr3 at positions 8810078 and 8810069 exhibited significant associations with postpartum depression scores from an independent cohort of 240 women with no prior psychiatric history. Hormone analysis suggested a PPD specific negative correlation of DNA methylation in the region with serum estradiol levels. Estradiol levels and OXTR DNA methylation exhibited a significant interaction to associate with the ratio of allopregnanolone to progesterone. Cumulatively, the data corroborate our previous hypotheses of a PPD specific increased sensitivity of epigenetic reprogramming at estrogen target genes and suggests that OXTR epigenetic variation may be an important mediator of mood relevant neuroactive steroid production.
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Affiliation(s)
- Mary Kimmel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA,Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Makena Clive
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Fiona Gispen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jerry Guintivano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tori Brown
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Olivia Cox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Lauren M. Osborne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Elisabeth Binder
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, 80804 Munich, Germany
| | - Jennifer L. Payne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Zachary Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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