Oxytocin and postpartum depression: A systematic review

Exogenous oxytocin administered to induce or augment labour is positively associated with quality of observed mother-infant bonding

Oxytocin is a key hormone in the transition to motherhood. The maternal endogenous oxytocin system facilitates many physiological and biological adaptations, including breastfeeding, maternal wellbeing, and brain plasticity. Additionally, maternal endogenous oxytocin works as a finetuned orchestrator prior to, during, and after the birth of a child to support birth progression and mother-infant bonding. Exogenous oxytocin may be administered to induce or augment labour when this is not progressing naturally and is a common obstetric intervention worldwide. However, the lasting impact of these widely varying levels of systemic exogenous oxytocin on mother-infant bonding is currently unknown. This study aimed to investigate the association between exogenous oxytocin administered to induce or augment labour and quality of observed mother-infant bonding. Thirty-eight mother and infant dyads participated (mothers aged 24-48 years; infants aged 2-5 months). Mother-infant bonding quality was assessed via the Recorded Interaction Task and hospital birth records were consulted to obtain exogenous oxytocin administration data. Demographic information and possible confounding factors were collected from dyads, and salivary oxytocin concentration was measured for both mother and infant. Mother's perception of infant sleep difficulty was identified as a confounding factor for quality of mother-infant bonding. After controlling for the confounding factor, receiving exogenous oxytocin to induce or augment labour, as opposed to not, was found to be significantly positively associated with higher quality of observed mother-infant bonding (p = 0.029). These novel findings highlight the need for further exploration, both of the impact of the treatment and of the mechanisms of action of intrapartum exogenous oxytocin on the endogenous oxytocin system. It is argued that particular focus be given to investigate action on the central oxytocin receptors, and if this may play a role in subsequent mother-infant bonding outcomes. It is vital to understand the full breadth and the clinical implications of this commonplace procedure.

Non-biological factors associated with postpartum depression among women in Shenzhen: a case-control study

Background

Postpartum depression (PPD) presents a significant public health challenge. While PPD's impact extends from maternal health to child development, cultural stigma and a lack of public awareness, particularly in developing countries, contribute to its underestimation and under diagnosed. This study investigated the non-biological associated factors for PPD in Shenzhen city due to its unique socioeconomic landscape, where rapid urbanization and migrant influx could uniquely impact maternal mental health. By identifying local PPD determinants, the research aimed to contribute to targeted mental health interventions in the region.

Method

Data were collected from May to December 2019 at the Luohu Maternal and Child Health Medical Center, Shenzhen. Inclusion criteria were postpartum women without psychiatric histories who live within the locality. The Chinese Edinburgh Postnatal Depression Scale was utilized to confirm PPD diagnosis. Participant information including demographics, economic status and postnatal factors were collected via structured questionnaires. Statistical analyses of t-tests, Wilcoxon rank-sum tests, chi-square tests, and logistic regression, were performed using SPSS 20.0, with significance set at p ≤ 0.05.

Results

The study included 430 healthy mothers and 73 PPD mothers. Several factors were found to significantly influence the onset of PPD (p < 0.05): age (OR = 0.921, 95% CI: 0.864-0.981); living with in-laws (OR = 2.133, 95% CI: 1.108-4.106); bottle feeding (OR = 3.757, 95% CI: 1.567-9.006); prenatal depression (OR = 3.515, 95% CI: 1.61-7.675); prenatal anxiety (OR = 6.072, 95% CI: 3.209-11.49); and adverse life events during pregnancy (OR = 3.287, 95% CI: 1.165-9.269). Other factors were not found to have a significant effect.

Conclusion

Our study found that in the developed city of Shenzhen in Southern China, living with in-laws, exclusive bottle feeding, prenatal anxiety, depression, and adverse life events are non-biological associated factors for postpartum depression. The findings emphasize the importance of considering a range of factors when addressing maternal mental health within a specific local regions. It calls for targeted interventions or prevention program that take into considering the specific cultural, social, and individual factors.

Effect of esketamine on serum neurotransmitters in patients with postpartum depression: a randomized controlled trial

BACKGROUND

The development of postpartum depression has been linked to fluctuations in the levels of neurotransmitters in the human body, such as 5-hydroxytryptamine (5-HT), dopamine (DA), noradrenaline (Norepinephrine, NE), and brain derived neurotrophic factor (BDNF). Research has indicated that the antidepressant effect of esketamine are mediated by monoamine transmitters and neurotrophic factors. Therefore, we postulate that intravenous administration of esketamine in patients with postpartum depression may alter the serum concentrations of these neurotransmitters.

METHODS

Three hundred fifteen patients with postpartum depression were selected and divided into two groups based on randomized numerical expression: esketamine (E) group (0. 25 mg/kg esketamine) and control (C) group (a same volume of 0.9% saline), all the drugs were pumped for 40 min. After the end of drug pumping, all patients were continuously observed for 2 h. Changes in serum levels of 5-HT, DA, NE, BDNF were recorded before drug administration and on the 3rd day after drug administration. The scores of Edinburgh Postnatal Depression Scale (EPDS) were calculated before drug administration, and on the 3rd day and on the 30th day after drug administration. Dizziness, headache, nausea, vomiting, drowsiness, and feeling of detachment occurred were recorded within 2 h after drug administration.

RESULTS

Before drug administration, the serum concentrations of 5-HT,DA,BDNF,NE in Group E and Group C were namely (0. 91 ± 0. 19 vs. 0. 98 ± 0. 21, P = 0. 181), (2. 38 ± 0. 35 vs. 2. 32 ± 0. 32, P = 0. 491), (3. 07 ± 0. 89 vs 3. 02 ± 0. 88, P = 0. 828), (39. 79 ± 7. 78 vs 41. 34 ± 10. 03, P = 0. 506). On the third day post-medication, the serum concentrations of 5-HT,DA,BDNF,NE in Group E and Group C were namely (1. 42 ± 0. 35 vs. 0. 96 ± 0. 24, P < 0. 001), (3. 99 ± 0. 17 vs. 2. 41 ± 0. 28, P < 0. 001),(5. 45 ± 0. 81 vs 3. 22 ± 0. 76, P < 0. 001),(44. 36 ± 9. 98 vs 40. 69 ± 11. 75, P = 0. 198). Before medication, the EPDS scores were (16. 15 ± 3. 02 vs 17. 85 ± 3. 89, P = 0. 064). on the third day after medication, the Group E had significantly reduced scores (12. 98 ± 2. 39 vs 16. 73 ± 3. 52, P < 0. 001). On the 30rd day after medication, EPDS scores between the two groups were (16. 34 ± 3. 43 vs 16. 91 ± 4. 02, p = 0. 203). Within 2 h of medication, the rate of adverse events was similar between the two groups.

CONCLUSIONS

Small doses of esketamine can increase the serum concentration of 5-HT,DA,BDNF, and in the short term, decrease EPDS scores, and improve postpartum depressive symptoms.

TRIAL REGISTRATION

Retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2300078343, 2023/12/05).

Loss of transient receptor potential channel 5 causes obesity and postpartum depression

Hypothalamic neural circuits regulate instinctive behaviors such as food seeking, the fight/flight response, socialization, and maternal care. Here, we identified microdeletions on chromosome Xq23 disrupting the brain-expressed transient receptor potential (TRP) channel 5 (TRPC5). This family of channels detects sensory stimuli and converts them into electrical signals interpretable by the brain. Male TRPC5 deletion carriers exhibited food seeking, obesity, anxiety, and autism, which were recapitulated in knockin male mice harboring a human loss-of-function TRPC5 mutation. Women carrying TRPC5 deletions had severe postpartum depression. As mothers, female knockin mice exhibited anhedonia and depression-like behavior with impaired care of offspring. Deletion of Trpc5 from oxytocin neurons in the hypothalamic paraventricular nucleus caused obesity in both sexes and postpartum depressive behavior in females, while Trpc5 overexpression in oxytocin neurons in knock-in mice reversed these phenotypes. We demonstrate that TRPC5 plays a pivotal role in mediating innate human behaviors fundamental to survival, including food seeking and maternal care.

Maternal antenatal depression, oxytocin, and infant temperament: The roles of ethnicity and adult attachment avoidance

This study examined the associations between maternal depression and oxytocin in pregnancy, caregiving sensitivity and adult attachment style, and infant temperament. One hundred and six women recruited from a public hospital antenatal clinic in Australia, and their infants completed assessments at three time points (Time 1: pregnancy; Time 2: 3-month postpartum; Time 3: 12-month postpartum). Mothers completed self-report questionnaires assessing maternal depression symptom severity at Time 1-3, adult attachment style at Time 2, and infant temperament at Time 3. At Time 1, they also provided a blood sample to assess peripheral oxytocin levels, and at Time 2, participated in a parent-child interaction session, which was later coded for caregiving behavior (sensitivity). Neither maternal depression nor lower levels of oxytocin during pregnancy predicted difficult infant temperament; rather, it was predicted by non-Caucasian ethnicity. When all other variables were free to vary, adult attachment avoidance mediated an association between maternal depression during pregnancy and difficult infant temperament. Results highlight the potential value of interventions focusing on adult attachment insecurity for pregnant women and raise questions about associations between culture/ethnicity and infant temperament.

Moxie begets MOXI: The journey to a novel hypothesis about Mu-opioid and OXytocin system Interactions

This narrative review summarizes the early life of the author, Khalin E. Nisbett, and highlights the factors that led to her career in research and her development of two novel research hypotheses: the Mu-opioid and OXytocin system Interaction (MOXI) hypothesis and Mu-Opioid receptor antagonist and OXytocin receptor Agonist In Combination (MOXAIC) treatment hypothesis. Notably, Nisbett's career began in the era after countless studies demonstrated that oxytocin is not just a female neurotransmitter and not just a female reproductive hormone, an era in which researchers are exploring the role of oxytocin in emotion regulation, social interaction, and cognitive processing across both sexes. As such, the previously held perspective that oxytocin is "just a female hormone" did not impede Nisbett's ideas. Intrigued by science, emotion regulation, and social interaction, she began to explore the role of oxytocin and opioids in emotion regulation. On the heels of earlier theories, such as the Tend-and-Befriend theory and Opioid Theory of Social Attachment, she began to develop the MOXI hypothesis, which postulates that the μ-opioid receptor and oxytocin systems interact to mediate social interaction and emotion regulation. In this narrative review, Nisbett summarizes two studies that explored (i) the role of oxytocin in anxiety- and depression-like behavior and (ii) the effect of opioid receptor blockade on the anxiolytic-like effect of oxytocin, which led to a revision of the MOXI hypothesis and postulation of the Mu-Opioid receptor antagonist and OXytocin receptor Agonist In Combination (MOXAIC) treatment hypothesis. Nisbett also discusses several limitations of these hypotheses and her current research interests and aspirations.

From Breastfeeding to Support in Mothers' Feeding Choices: A Key Role in the Prevention of Postpartum Depression?

The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10-15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother's emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers' compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother's self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother's emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers' breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP.

Neuropeptides affecting social behavior in mammals: Oxytocin

Oxytocin (OXT), a neuropeptide consisting of only nine amino acids, is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Although OXT is best known for its role in lactation and parturition, recent research has shown that it also has a significant impact on social behaviors in mammals. However, a comprehensive review of this topic is still lacking. In this paper, we systematically reviewed the effects of OXT on social behavior in mammals. These effects of OXT from the perspective of five key behavioral dimensions were summarized: parental behavior, anxiety, aggression, attachment, and empathy. To date, researchers have agreed that OXT plays a positive regulatory role in a wide range of social behaviors, but there have been controversially reported results. In this review, we have provided a detailed panorama of the role of OXT in social behavior and, for the first time, delved into the underlying regulatory mechanisms, which may help better understand the multifaceted role of OXT. Levels of OXT in previous human studies were also summarized to provide insights for diagnosis of mental disorders.

Elucidating the influence of familial interactions on geriatric depression: A comprehensive nationwide multi-center investigation leveraging machine learning

OBJECTIVE

A plethora of studies have unequivocally established the profound significance of harmonious familial relationships on the psychological well-being of the elderly. In this study, we elucidate the intergenerational relationships, probing the association between frequent interactions or encounters with their children and the incidence of depression in old age.

METHODOLOGY

We employed a retrospective cross-sectional study design, sourcing our data from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). To identify cases of depression, we utilized the 10-item Center for Epidemiologic Studies Depression Scale (CESD). Employing a five-fold cross-validation methodology, we endeavored to fashion five distinct machine learning models. Subsequently, we crafted learning curves to facilitate the refinement of hyperparameters, assessing model classification performance through metrics such as accuracy and the Area Under the Receiver Operating Characteristic (AUROC) curve. To further elucidate the relationship between variables and geriatric depression, logistic regression was subsequently applied.

RESULTS

Our findings accentuated that sleep patterns emerged as the paramount determinants influencing the onset of depression in the elderly. Relationships with offspring ranked as the second most significant determinant, only surpassed by sleep habits. A negative correlation was observed between sleep patterns (Odds Ratio [OR]: 0.78, 95 % Confidence Interval [CI]: 0.75-0.81, P < 0.01), communication with offspring (OR: 0.86, 95 % CI: 0.82-0.90, P < 0.01), and the prevalence of depressive symptoms. Among the evaluated models, the k-Near Neighbor algorithm demonstrated commendable discriminative power. However, it was the Random Forest algorithm that manifested unparalleled discriminative prowess and precision, establishing itself as the most efficacious classifier.

CONCLUSION

Prolonging the duration of nocturnal sleep, and elevating the frequency of communication with offspring have been identified as measures conducive to mitigating the onset of geriatric depression.

Investigation and Analysis of Emotional State and Oxytocin Level in Patients with Postpartum Depression

BACKGROUND

Postpartum depression (PPD) is a common mental disorder in postpartum women, negatively impacting physical and mental health. Correlation analysis can predict the relationship between variables. By detecting the abnormal level of oxytocin, clinicians can timely know the emotional states of parturients to guide clinical practice. This study aimed to investigate the relationship between emotional states and oxytocin (OT) levels in patients with PPD.

MATERIALS AND METHODS

The medical records of 166 PPD patients admitted to Cangzhou Central Hospital from May 2020 to March 2023 were retrospectively analyzed. After excluding 9 patients who did not meet the inclusion criteria, the remaining 157 patients were included in this study. The 7-item Generalized Anxiety Disorder Scale and Patient Health Questionaire-9 items were used to evaluate the emotional states of 157 patients, and the included subjects were grouped according to the results of the scale. The serum OT levels of patients was measured, and the relationship between the OT levels and emotional states was analyzed.

RESULTS

In this study, 75 patients were included in the mild anxiety group, and 82 patients were included in the moderate and severe anxiety group. Seventy-nine patients were selected as the mild depression group, and 78 patients were included in the moderate and severe depression group. The mild anxiety group had a higher OT level than the moderate and severe anxiety group (Z = -10.121, p < 0.001). The mild depression group had a higher OT level than the moderate and severe depression group (Z = -9.758, p < 0.001). OT level was negatively correlated with anxiety and depression scores (r = -0.676, r = -0.665, p < 0.001).

CONCLUSION

There is a specific relationship between the emotional states of PPD patients and the OT levels in the body, and active clinical management strategies need to be implemented.

Environmental enrichment attenuates depressive-like behavior in maternal rats by inhibiting neuroinflammation and apoptosis and promoting neuroplasticity

Gestational stress can exacerbate postpartum depression (PPD), for which treatment options remain limited. Environmental enrichment (EE) may be a therapeutic intervention for neuropsychiatric disorders, including depression, but the specific mechanisms by which EE might impact PPD remain unknown. Here we examined the behavioral, molecular, and cellular impact of EE in a stable PPD model in rats developed through maternal separation (MS). Maternal rats subjected to MS developed depression-like behavior and cognitive dysfunction together with evidence of significant neuroinflammation including microglia activation, neuronal apoptosis, and impaired synaptic plasticity. Expanding the duration of EE to throughout pregnancy and lactation, we observed an EE-associated reversal of MS-induced depressive phenotypes, inhibition of neuroinflammation and neuronal apoptosis, and improvement in synaptic plasticity in maternal rats. Thus, EE effectively alleviates neuroinflammation, neuronal apoptosis, damage to synaptic plasticity, and consequent depression-like behavior in mother rats experiencing MS-induced PPD, paving the way for new preventive and therapeutic strategies for PPD.

Analysis of the correlation between general postpartum well-being and depression in primiparas: A cross-sectional study

To investigate the status quo and influencing factors of general postpartum well-being in primiparas, analyze its correlation with postpartum depression, and provide a theoretical foundation for enhancing the postpartum well-being of primiparas. From the start of November 2021 to the end of December 2021, the General Information Questionnaire, General Well-Being Scale, and the Edinburgh Postpartum Depression Scale were used to survey primiparas in a tertiary hospital, and the correlation between general well-being and postpartum depression was analyzed. We surveyed a total of 225 primiparas. The average score for general well-being in primiparas was 77.84 ± 6.83, and the total score for postpartum depression was 9.11 ± 2.51. Confinement location, planned pregnancy, pregnancy complications, neonatal sex, medical expenses, etc, had statistically significant effects on the general well-being scores (P < .05), whereas per capita monthly income, pregnancy complications, maternal and infant care skills, and medical expenses had statistically significant effects on postpartum depression scores (P < .05). Postpartum depression scores were negatively correlated with general well-being, health anxiety, energy, sad or happy mood, relaxation, and tension. There is a negative correlation between the general well-being of primiparas and postpartum depression, suggesting that in clinical care, the focus should be on primiparas with pregnancy complications, and psychological counseling should be provided in advance to prevent postpartum depression and the resulting decrease in well-being.

Prevalence and risk factors for postpartum depression 2 months after a vaginal delivery: a prospective multicenter study

BACKGROUND

Very little is known about the prevalence and risk factors of postpartum depression among women with vaginal births without major pregnancy complications.

OBJECTIVE

This study aimed to assess the prevalence of postpartum depression and identify its characteristics 2 months after singleton vaginal delivery at or near term.

STUDY DESIGN

This was an ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery randomized controlled trial, which was conducted in 15 French hospitals in 2015-2016 and enrolled women with singleton vaginal deliveries after 35 weeks of gestation. After randomization, the characteristics of labor, delivery, and the immediate postpartum experience, including the experience of childbirth, were prospectively collected. Medical records provided women's other characteristics, particularly any psychiatric history. Of note, 2 months after childbirth, provisional postpartum depression diagnosis was defined as a score of ≥13 on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Associations between potential risk factors and postpartum depression were analyzed by multivariate logistic regression. Moreover, an Edinburgh Postnatal Depression Scale cutoff value of ≥11 was selected to perform a sensitivity analysis.

RESULTS

The questionnaire was returned by 2811 of 3891 women (72.2% response rate). The prevalence rates of the provisional diagnosis were 9.9% (95% confidence interval, 8.6%-11.3%) defined by an Edinburgh Postnatal Depression Scale score of ≥13 and 15.5% (95% confidence interval, 14.0%-17.1%) with a cutoff value of ≥11. The characteristics associated with higher risks of postpartum depression in multivariate analysis were mostly related to prepregnancy characteristics, specifically age of <25 years (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.9) and advanced age (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), migration from North Africa (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.4), previous abortion (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), and psychiatric history (adjusted odds ratio, 2.9; 95% confidence interval, 1.8-4.8). Some characteristics of labor and delivery, such as induced labor (adjusted odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and operative vaginal delivery (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), seemed to be associated with postpartum depression. In addition, bad memories of childbirth in the immediate postpartum were strongly associated with postpartum depression symptoms at 2 months after giving birth (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.2).

CONCLUSION

Approximately 10% of women with vaginal deliveries have postpartum depression symptoms, assessed by a score of ≥13 on the depression scale that was used at 2 months. Prepregnancy vulnerability factors; obstetrical characteristics, such as induced labor and operative vaginal delivery; and bad memories of childbirth 2 days after delivery were the main factors associated with this provisional diagnosis. A screening approach that targets risk factors may help to identify women at risk of postpartum depression who could benefit from early intervention.

Oxytocin: physiology, pharmacology, and clinical application for labor management

Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.

Intestinal microbiome and maternal mental health: preventing parental stress and enhancing resilience in mothers

The number of mothers suffering from mental illness is increasing steadily, particularly under conditions of the coronavirus pandemic. The identification of factors that contribute to resilience in mothers is urgently needed to decrease the risks of poor physical and psychological health. We focused on the risk of parenting stress and psychological resilience in healthy mothers with no psychiatric and physical disorders and conducted two studies to examine the relationships between intestinal microbiota, physical condition, and psychological state. Our results showed that alpha diversity and beta diversity of the microbiome are related to high parenting stress risk. Psychological resilience and physical conditions were associated with relative abundances of the genera Blautia, Clostridium, and Eggerthella. This study helps further understand the gut-brain axis mechanisms and supports proposals for enhancing resilience in mothers.

The Impact of Postpartum Depression on the Early Mother-Infant Relationship during the COVID-19 Pandemic: Perception versus Reality

Postpartum depression (PPD) can interfere with the establishment of affective bonds between infant and mother, which is important for the cognitive, social-emotional, and physical development of the child. Rates of PPD have increased during the COVID-19 pandemic, likely due to the added stress and limited support available to new parents. The present study examined whether parenting-related stress, perceived bonding impairments, the quality of observed mother-infant interactions, and salivary oxytocin levels differ between depressed and non-depressed mothers, along with differential impacts of COVID-19 on depressed mothers. Participants included 70 mothers (45 depressed, 25 controls) with infants aged 2-6 months. All data were collected remotely to ease participant burden during the pandemic. Depression was associated with experiences of heightened parenting-related stress and bonding difficulties. These differences were not observed during mother-infant interactions or in salivary oxytocin levels. Differences in COVID-19-related experiences were minimal, though depressed mothers rated slightly higher stress associated with returning to work and financial impacts of the pandemic. Findings highlight the importance of early intervention for PPD to mitigate long-term effects on mothers, children, and families. Additionally, they underscore the need for early intervention to support the developing mother-infant dyad relationship during this crucial time.

Endocrinological Treatment Targets for Depressive Disorder

Depressive disorder exhibits heterogeneity in clinical presentation, progression, and treatment outcomes. While conventional antidepressants based on the monoamine hypothesis benefit many patients, a significant proportion remains unresponsive or fails to fully recover. An individualized integrative treatment approach, considering diverse pathophysiologies, holds promise for these individuals. The endocrine system, governing physiological regulation and organ homeostasis, plays a pivotal role in central nervous system functions. Dysregulations in endocrine system are major cause of depressive disorder due to other medical conditions. Subtle endocrine abnormalities, such as subclinical hypothyroidism, are associated with depression. Conversely, depressive disorder correlates with endocrine-related biomarkers. Fluctuations in sex hormone levels related to female reproduction, elevate depression risk in susceptible subjects. Consequently, extensive research has explored treatment strategies involving the endocrine system. Treatment guidelines recommend tri-iodothyronine augmentation for resistant depression, while allopregnanolone analogs have gained approval for postpartum depression, with ongoing investigations for broader depressive disorders. This book chapter will introduce the relationship between the endocrine system and depressive disorders, presenting clinical findings on neuroendocrinological treatments for depression.

Intranasal oxytocin alleviates comorbid depressive symptoms in neuropathic pain via elevating hippocampal BDNF production in both female and male mice

The comorbidity of pain and depression is frequently observed in patients suffering from chronic pain and depression. However, the comorbid mechanism is not well elucidated and the therapeutic medication is still inadequate. Oxytocin is a neuropeptide synthesized in the hypothalamus. It has been reported to relieve chronic pain and depressive symptoms. However, the analgesic action and mechanisms of oxytocin have mainly been investigated using peripheral or spinal administration. Because of the advantage of intranasal delivery of oxytocin in crossing the blood-brain barrier, we investigated the effect of intranasal application of oxytocin on neuropathic pain and comorbid depressive symptoms in both female and male mice. In female and male mice receiving spared nerve injury (SNI) surgery, intranasal oxytocin (2.4 μg, daily for 28 days) attenuated depression-like behavior, but did not alleviate mechanical hyperalgesia. Intranasal oxytocin not only inhibited the activation of microglia and astrocytes, but also increased the downregulated oxytocin receptor (OTR) expression, reversed the elevated GluN2A, and restored the decreased BDNF expression in the hippocampus. SNI also decreased OTR expression in the spinal cord and increased spinal GluN2A and BDNF. However, intranasal oxytocin treatment did not change the expression levels of OTR, GluN2A, or BDNF in the spinal cord of neuropathic mice. The results suggest that the oxytocin signaling in the hippocampus is involved in the comorbidity of pain and depression, and intranasal oxytocin may have the potential to treat depressive symptoms in neuropathic pain patients.

Mitochondrial might: powering the peripartum for risk and resilience

The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.

Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms

PURPOSE OF REVIEW

Postpartum depression (PPD) and breastfeeding are important, interrelated health factors. It is established that women who breastfeed exclusively have lowered likelihood of developing significant PPD. Yet, many questions remain around what factors are involved. The purpose of this review is to provide updated information about the relationship between PPD and breastfeeding.

RECENT FINDINGS

Both psychological and physiological factors have emerged as important moderators and mechanisms of the relationship between postpartum depression and breastfeeding. Breastfeeding self-efficacy, self-compassion, and engagement with the infant during feeding all modify or mediate the relationship, and a complex dynamic relationship among cortisol, oxytocin, progesterone, and estrogen is involved. Importantly, recent intervention studies suggest psychosocial interventions may impact both breastfeeding and mood. Providers and researchers should recognize the interrelationship between the breastfeeding and PPD and apply this understanding to patient care through integrated education and care for both mood and breastfeeding enhancement.

Association between mitochondrial DNA levels and depression: a systematic review and meta-analysis

BACKGROUND

Mitochondrial dysfunction leading to disturbances in energy metabolism has emerged as one of the risk factors in the pathogenesis of depression. Numerous studies have identified alterations in the content of mitochondrial DNA (mtDNA) in peripheral blood and cerebrospinal fluid of individuals with depression. Researchers have sought to establish a clear association between mtDNA and depression. Consequently, we conducted a comprehensive meta-analysis to assess the existing evidence regarding the impact of mtDNA on depression.

METHODS

This study conducted a thorough search of the following databases up to March 13, 2023: PubMed, Embase, the Cochrane Library, the Web of Science, Wanfang Database, SINOMED, the China Science and Technology Journal Database, and China National Knowledge Infrastructure. The meta-analysis was carried out using RevMan (version 5.4) and Stata (version 16.0) software. In addition, publication bias was assessed with funnel plots, Begg's test and Egger's test.

RESULTS

Our analysis included data from 10 articles, including 12 studies for further examination. A total of 1400 participants were included in this study, comprising 709 (including 300 males and 409 females) patients with depression and 691 (including 303 males and 388 females) healthy controls. The average age of depressed patients was (42.98 ± 2.55) years, and the average age of healthy people was (41.71 ± 2.6) years. The scales used to assess outcomes are Hamilton-rating scale for Depression(4 articles), Montgomery-Asberg Depression Rating Scale(3 articles), and Mini-Internatioal Neuropsychiatric Interview (1 articles). The meta-analysis revealed significantly higher levels of mtDNA in circulating blood samples and skin fibroblasts of individuals with depression in comparison to healthy controls [standardized mean difference(SMD) = 0.42, 95% confidence intervals(CI): 0.16, 0.67].

CONCLUSIONS

Our study concludes that there is a significant (p < 0.05) increase in mtDNA levels in serum, plasma, and cerebrospinal fluid in individuals with depression. These findings suggest that mtDNA could serve as a potential biomarker for diagnosing depression.

REGISTRATION NUMBER

PROSPERO CRD42023414285.

Assessment of Tissue Expression of the Oxytocin-Vasopressin Pathway in the Placenta of Women with a First-Episode Psychosis during Pregnancy

Psychosis refers to a mental health condition characterized by a loss of touch with reality, comprising delusions, hallucinations, disorganized thought, disorganized behavior, catatonia, and negative symptoms. A first-episode psychosis (FEP) is a rare condition that can trigger adverse outcomes both for the mother and newborn. Previously, we demonstrated the existence of histopathological changes in the placenta of pregnant women who suffer an FEP in pregnancy. Altered levels of oxytocin (OXT) and vasopressin (AVP) have been detected in patients who manifested an FEP, whereas abnormal placental expression of these hormones and their receptors (OXTR and AVPR1A) has been proven in different obstetric complications. However, the precise role and expression of these components in the placenta of women after an FEP have not been studied yet. Thus, the purpose of the present study was to analyze the gene and protein expression, using RT-qPCR and immunohistochemistry (IHC), of OXT, OXTR, AVP, and AVPR1a in the placental tissue of pregnant women after an FEP in comparison to pregnant women without any health complication (HC-PW). Our results showed increased gene and protein expression of OXT, AVP, OXTR, and AVPR1A in the placental tissue of pregnant women who suffer an FEP. Therefore, our study suggests that an FEP during pregnancy may be associated with an abnormal paracrine/endocrine activity of the placenta, which can negatively affect the maternofetal wellbeing. Nevertheless, additional research is required to validate our findings and ascertain any potential implications of the observed alterations.

Association between serum oxytocin levels and depressive state in community-dwelling older adults: A cross-sectional study

Aim

Identifying peripheral biomarkers related to the prevention or modification of unhealthy mental conditions in older adults would be extremely beneficial. This study aimed to evaluate serum oxytocin levels in older adults living in a rural community and their association with cognitive function, anxiety, depressive state, and well-being.

Methods

This survey was conducted between November 2016 and September 2017 in Kurokawa-cho, Imari, Saga Prefecture, Japan, among people aged ≥65 years. Blood samples were collected from the participants for serum oxytocin level analysis, which was performed using peptide enzyme immunoassay. Participants underwent neuropsychological assessments, including the Mini-Mental State Examination, Clinical Dementia Rating, Frontal Assessment Battery, State-Trait Anxiety Inventory, 15-item Geriatric Depression Scale, and 17-item Philadelphia Geriatric Center Morale Scale. We examined the association between serum oxytocin levels and neuropsychological assessment results.

Results

Out of 94 participants, 25 were men and 69 were women, with mean ages of 78.24 ± 3.85 years and 78.10 ± 5.43 years, respectively. Serum oxytocin levels were negatively associated with 15-item Geriatric Depression Scale scores. Additionally, nondepressive state/depressive state was classified by the 15-item Geriatric Depression Scale (cut-off 5/6). Logistic regression analysis showed that higher serum oxytocin levels tended to be associated with a less depressive state at that time.

Conclusions

Serum oxytocin levels may be associated with depressive state in adults aged ≥65 years.

A unified model of the biology of peripartum depression

Peripartum depression (PPD) is a prevalent and debilitating disorder that adversely affects the development of mothers and infants. Recently, there has been a plea for increased mental health screening during the peripartum period; however, currently, there is no accurate screening tool to identify women at risk of PPD. In addition, some women do not respond to current treatment schemes and develop treatment-resistant depression. The current perspective aims to propose a unified understanding of the biological underpinnings of PPD (UmPPD) that considers the heterogeneity in the onset, symptoms cluster, and severity of PPD. Such a model could promote basic and applied research on PPD and suggest new treatment avenues. The central hub of the model is the kynurenine pathway (KP) and the KP-serotonin ratio. The forces and specific processes at play that cause an imbalance within the KP and between KP and serotonin are inflammation, stress, reproductive hormones (especially estradiol and progesterone), and oxytocin. UmPPD predicts that the most severe PPD would comprise prolonged inflammation, ongoing or multiple stressors, excessive estrogen, progesterone resistance, and avoidance of breastfeeding, skin-to-skin contact, and social proximity. These factors would be associated with a higher likelihood of developing PPD, early onset, and more significant symptom severity. In addition, subtypes of PPD would consist of different compositions and expressions of these components, with one central common factor. UmPPD could aid in directing future research and possibly detecting critical processes that could help discover, develop, and utilize novel treatments for PPD.

Adverse childhood experiences mediate the negative association between borderline personality disorder symptoms and plasma oxytocin

Background Interpersonal dysfunction is a core symptom of borderline personality disorder (BPD) and may be closely linked to adverse childhood experiences. According to a recent model on the pathology of BPD, the neuropeptide oxytocin might play an important role in the development and maintenance of the disorder. However, so far, only few studies with small adult samples have reported reduced baseline oxytocin levels in BPD that may be linked to adverse childhood experiences. Methods We examined baseline plasma oxytocin levels in 131 female patients with BPD and 124 non-BPD female controls across a large age span (12-50 years). Additionally, 113 female patients with less than five DSM-IV BPD features were included to examine the association between plasma oxytocin levels and the number of fulfilled BPD criteria. We also explored associations between plasma oxytocin and adverse childhood experiences as well as depressive symptoms in BPD. Results Patients with BPD had reduced plasma oxytocin levels compared to non-BPD controls and this was independent of age. Plasma oxytocin was negatively associated with the number of fulfilled BPD criteria. The exploratory regression model revealed no association between plasma oxytocin and depressive symptoms but an association between plasma oxytocin and adverse childhood experiences, which in fact mediated the relationship between BPD criteria und plasma oxytocin. Conclusion In a large sample of individuals with BPD across a large age span, our results replicate and extend previous reports of reduced plasma oxytocin levels that might be related to adverse childhood experiences thus providing further evidence for a prominent role of oxytocin in BPD.

Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system

BACKGROUND

The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding.

AIM

To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems.

METHODS

Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables.

RESULTS

Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.

CONCLUSIONS

Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.

Mothers' breastfeeding six weeks postpartum and factors influencing exclusive breastfeeding during the first six months

We aimed to assess the feeding pattern and influencing factors within six weeks postpartum on exclusive breastfeeding duration among Chinese mothers. This study was conducted using 2:1 matched case-control study. Cases and controls were matched for maternal age, parity and mode of birth. A total of 210 women were included. Approximately 67.9% of women stopped exclusive breastfeeding within the first six weeks postpartum. Maternal non-exclusive breastfeeding intention, lower maternal educational level, mother-infant skin to skin contact over one hour, unsatisfied breastfeeding self-evaluation and maternal unhealthy condition within the first six weeks were risk factors for ceasing exclusive breastfeeding early.

Serum oxytocin and corticotropin-releasing hormone levels in the third trimester of pregnancy for predicting postpartum depression in Thai women

PURPOSE

This prospective observational study aimed to determine whether serum oxytocin (OT) or corticotrophin-releasing hormone (CRH) levels in the third trimester of pregnancy (or late pregnancy) could prospectively predict postpartum depression (PPD) at six weeks after childbirth.

METHODS

We measured late pregnancy OT and CRH levels in Thai women, assessed depression using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), and collected mothers, labor, and newborn data. At six weeks postpartum, an EPDS score ≥ 11 or PHQ-9 score ≥ 10 was defined as the presence of PPD. Multivariable binary logistic regression analysis was performed to determine the predictors of PPD.

RESULTS

Of 200 participants, 136 (68.0%) were reassessed at six weeks postpartum, and 19 of them (14.0%) had PPD. Of the 19 participants with PPD, 9 met the EPDS criterion only, 3 met the PHQ-9 criterion only, and 7 met both criteria. OT levels were not significantly different between those with and without PPD (p = 0.35). CRH levels (aOR = 1.011, 95% CI = 1.001-1.023, p = 0.041), DASS-21 stress (aOR = 1.259, 95% CI = 1.132-1.400, p < 0.001), and APGAR at 1 min (aOR = 0.425, 95% CI = 0.240-0.752, p = 0.003) were significant predictors of PPD.

CONCLUSIONS

Only high CRH but not OT levels in late pregnancy may predict 6-week PPD. However, combining these CRH levels, late pregnancy stress, and newborn well-being immediately after birth seems to increase the accuracy of PPD prediction.

Epidemiology of Caesarean section on maternal request in Australia: A population-based study

OBJECTIVE

To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR).

DESIGN

Population-based record linkage study.

SETTING

Birth registry data for all births in Queensland, Australia, from 2008 to 2017.

PARTICIPANTS

Pregnancies resulting in live or intrapartum stillbirth with >=20 gestational weeks and/or >=400 gm birth weight were the study population. The analytic sample was restricted to low-risk pregnancies by excluding preterm, non-cephalic pregnancies with medical risk factors.

MEASUREMENTS

CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI).

FINDINGS

Of total C-sections (n = 204,863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1-6.7%, p<0.01) for the total pregnancies (N=613,375) Of the analytic sample (N=365568), nulliparous women with age ≥35 years (OR: 2.32,95% CI: 2.09-2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65-5.18); with mood disorders (OR: 2.15; 95% CI: 1.88-2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95-32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06-0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1-2.59) and special care admission (OR:2.15; 95% CI:1.03-4.5) were higher after CSMR in comparison to SVBs CONCLUSION: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR increased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate information, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.

Oxytocin and Women Postpartum Depression: A Systematic Review of Randomized Controlled Trials

Previous studies have demonstrated that oxytocin was a viable therapy option for postpartum depression. However, the role remains controversial. To evaluate the efficacy of oxytocin on women postpartum depression, we searched PubMed, Web of Science, Cochrane Library, and EmBase for literatures from inception of the database to April 18th, 2022. Randomized controlled trials (RCTs) that investigated the effects of oxytocin on postpartum depression were selected for this study. Six RCTs (195 women) were gathered. The effects of oxytocin were roughly divided into emotion and cognition. The modulation of oxytocin to women's emotion was demonstrated in four of the trials. The results were conflicting: One trial showed that oxytocin alleviated the depressive mood; two trials showed that oxytocin had no effect (but reduce negative thoughts in healthy mothers, or decrease the narcissistic trait); another trial showed that oxytocin aggravated depression. Women's cognition was shown to be regulated by oxytocin in four of the trials. In general, oxytocin enhanced postpartum depressive women's perception of their relationship with the infants. This systematic review showed that the effect of oxytocin on postpartum depression is still uncertain. We partly support that exogenous oxytocin might improve the cognition of women with postpartum depression to their infants, while the effect on emotion is still controversial. Further RCTs with larger samples and more diversified evaluation criteria are needed to better reveal its efficacy on postpartum depression.

Single low-dose ketamine infusion for women with prenatal depressive symptoms undergoing cesarean delivery: A pilot randomized trial

Background

Ketamine is approved for antidepressant therapy, but evidence regarding its use in women with perinatal depression is lacking. Herein, we investigated the effects of low-dose ketamine in women with prenatal depressive symptoms and tested the feasibility of a future large randomized trial.

Methods

This was a randomized, double-blind, placebo-controlled pilot trial. Sixty-six women with prenatal depressive symptoms who were scheduled for elective cesarean delivery were randomized to receive either low-dose ketamine (0.5 mg/kg) or placebo (normal saline). The study drugs were intravenously infused over a 40-minute period after clamping the umbilical cord. The primary outcome was depression score assessed with the Edinburgh Postnatal Depression Scale at 48 h postpartum. Among other and safety outcomes, occurrence of nausea or vomiting was observed, pain intensity was assessed with the numeric rating scale. The feasibility of implementing the protocol was also evaluated.

Results

A total of 64 parturients were included in the intention-to-treat analysis. The depression score at 48 h did not differ between groups: median 9 (interquartile range 6 to 13) with ketamine vs. 8 (6 to 10) with placebo; median difference 1, 95% CI -1 to 3; P = 0.608. The pain intensity at 4 h postpartum was less severe in the ketamine group (median difference -1, 95% CI -1 to 0, P = 0.002). Among safety outcomes, intraoperative nausea or vomiting was less common in patients given ketamine (0.0% [0/33] with ketamine vs. 21.2% [7/33] with placebo, P = 0.011). Recruitment was satisfactory and the protocol was acceptable to participants and clinicians.

Conclusions

A single low-dose ketamine infusion did not decrease the depression score at 2 days, but reduced intraoperative nausea and vomiting and lowered pain intensity at 4 h after cesarean delivery among women with prenatal depressive symptoms. The study protocol is feasible for a large randomized trial.

Clinical Trial Registration

The study was registered with ClinicalTrials.gov (identifier: NCT03336541; 08/11/2017).

Cortisol, Maternal Stress, and Breastfeeding Rate at Hospital Discharge: A Systematic Review

Introduction: Breastfeeding is considered the best way to provide essential and necessary nutrients to the newborn, intervening in its growth and development. However, early abandonment of this method is quite common, due to various factors such as stress. Objectives: To determine whether the level of postpartum cortisol can serve as an indicator of maternal stress and whether there is a relationship between the level of cortisol and the rate of exclusive breastfeeding (EBF) at hospital discharge. Methodology: Systematic review of the literature under the PRISMA guidelines. PubMed, Web of Science, CINAHL, and Scopus databases were used. Original articles published from 2017 to 2022 in English, French, Portuguese, and Spanish were included. All study designs were eligible. Of the 3,712 records initially identified, 15 studies were included in this review. Results: Elevated cortisol levels, due to immediate postpartum stressors, have direct effects on the performance of the essential hormones in breast milk production. The EBF rates are negatively influenced by perceived maternal stress. Conclusion: Cortisol levels may be a good indicator of the level of stress to which the mother is subjected during the immediate postpartum period.

Potential of Heterogeneous Compounds as Antidepressants: A Narrative Review

Depression is a globally widespread disorder caused by a complicated interplay of social, psychological, and biological factors. Approximately 280 million people are suffering from depression worldwide. Traditional frontline antidepressants targeting monoamine neurotransmitters show unsatisfactory effects. The development and application of novel antidepressants for dissimilar targets are on the agenda. This review characterizes the antidepressant effects of multiple endogenous compounds and/or their targets to provide new insight into the working mechanism of antidepressants. We also discuss perspectives and challenges for the generation of novel antidepressants.

Exploring associations between postpartum depression and oxytocin levels in cerebrospinal fluid, plasma and saliva

BACKGROUND

Postpartum depression (PPD) is a serious mental health concern affecting approximately 17.22 % of new mothers worldwide. In addition to its obstetric effects, oxytocin (OXT) has also been considered to play a role in PPD. However, most previous studies exploring associations between PPD and OXT levels focus on easier accessible compartments such as blood or saliva.

STUDY AIM

To explore the possible association between PPD and OXT levels, and to assess the interaction between peripheral secretion and central release of OXT.

METHODS

In this study, we prospectively measured OXT concentrations in cerebrospinal fluid (CSF), plasma and saliva of 94 women with elective cesarean section by enzyme-linked immunosorbent assay (ELISA) kits. The participants were divided into the PPD group if the score of Edinburgh Postpartum Depression Scale (EPDS) ≥ 10 at 3 months postpartum, otherwise into the non-PPD (nPPD) group.

RESULTS

The incidence of PPD was 30.85 %. OXT concentrations in CSF (r = -0.518, p < 0.001), plasma (r = -0.240, p = 0.020) and saliva (r = -0.263, p = 0.010) were negatively correlated with EPDS score, and were valuable for the prediction of PPD, with AUC and 95%CI of 0.890 (0.809-0.945), 0.683 (0.579-0.775) and 0.699 (0.596-0.790), respectively. Moreover, OXT concentrations in plasma (r = 0.407, p < 0.001) and saliva (r = 0.624, p < 0.001) were positively correlated with CSF OXT concentrations.

LIMITATIONS

Only full-term pregnant women undergoing elective cesarean section were included in this study, which may affect study generalizability.

CONCLUSIONS

The central and peripheral release of OXT is coordinated, and OXT level measured prenatally in CSF, plasma, or saliva is valuable for the prediction of PPD.

Regulatory Role of PFC Corticotropin-Releasing Factor System in Stress-Associated Depression Disorders: A Systematic Review

Stress has a substantial role in formation of psychiatric disorders especially depression. Meanwhile, impairment of the prefrontal cortex (PFC) is connected to the executive and cognitive deficits induced by the stress. Given the involvement of the corticotropin-releasing factor (CRF) in stress-related processes and knowing the fact that PFC hosts a lot of CRF receptors and CRF neurotransmissions, it can worth to look at the CRF as a potential treatment for the regulation of depression disorders induced by stress within PFC region. Here, for the first time we aimed to systematically review the effectiveness of intra-PFC CRF system in the modulation of depression dysfunction caused by the stress in clinical and preclinical models/studies. Qualified researches were combined utilizing a comprehensive search of six databases including Scopus, Pubmed, Web of Science, Sciencedirect, APA PsycNet, and Embase in April 2021 and were evaluated through proper methodological quality assessment tools. Results indicate that PFC has a remarkable role in the modulation for stress-induced depression and intra-PFC CRF receptors agonist and antagonist are very considerable for regulating these types of impairments. Specifically, elevation of both CRF immunoreactivity and gene expression were observed in human studies. In the animal studies, mostly immunoreactivity or excitatory/inhibitory currents of CRF within the PFC regulated depression dysfunction. In conclusion, reviewed studies show a positive attitude toward the CRF system in regulation of the stress-induced depression; however, obviously further investigations are required to get closer to the best treatment. Prefrontal cortex corticotropin-releasing factor system regulates stress-induced depression. CRFR1, Corticotropin-releasing factor receptor of type1; PFC, Prefrontal cortex; Minus (-) and Plus (+) signs, dysregulation and upregulation, respectively.

Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown

The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.

Pro-lactation cesarean section: Immediate skin-to-skin contact and its influence on prolonged breastfeeding

Mexico has a high rate of cesarean sections and one of the lowest prevalences of exclusive breastfeeding in all of Latin America. There are known factors that can compensate for the disadvantages and drawbacks of cesarean delivery over breastfeeding. In terms of studying the variations of breastfeeding experiences, this work specifically concentrates on exploring different changes in the technique of cesarean section, related to immediate Skin-to-Skin Contact for women with high and low risk pregnancies, which may in turn influence Maternal Satisfaction and the choice of Prolonged Breastfeeding. A convenience sample of (n = 150) women who underwent cesarean section in a private hospital in Mexico between the years 2015-2020 participated in this study, the participants answered a structured interview protocol designed for the specific purposes of this study. The analysis was guided grounded theory. The majority of these participants (n = 121, 82.3%) were in labor before entering a cesarean section. The most common indications for cesarean section were those of active-phase arrest and regarding maternal complications, previous cesarean sections (n = 59) and hypertensive complications (n = 15) were the most frequent. For fetal complications, non-cephalic fetal positions (n = 12) were reported as the most common. Despite the different conditions of their cesarean sections, almost all the women experienced Skin-to-Skin Contact during the cesarean section. Almost all of them managed to breastfeed for more than 6 months and many of them breastfed their babies for up to 2 years. The main factors associated to prolonged breastfeeding and satisfaction were higher education degrees, immediate skin-to-skin contact during surgery and counseling on breastfeeding after the baby was born. Our findings highlight the importance of considering adjustments during and after a cesarean section, making it more focused on women and toward better probabilities of achieving prolonged breastfeeding in Mexican women. This being a first step for future studies of direct interventions in the breastfeeding process, such as the management of skin-to-skin contact and professional support after birth for guided breastfeeding.

Infant Stimulation Induced a Rapid Increase in Maternal Salivary Oxytocin

Oxytocin (OT) is a neuropeptide involved in human social behaviors and reproduction. Non-invasive OT levels in saliva have recently roused interest as it does not require a specialized medical setting. Here, we observed one woman’s basal serum and saliva OT from pregnancy to 1 year postpartum to track OT concentration changes over this period. We examined the changes in salivary OT levels over time in response to maternal physiological and behavioral responses. The fluctuation of saliva OT levels is well correlated with serum OT during pregnancy and breastfeeding. However, while salivary OT increased rapidly during direct interaction (social interaction tests) with the infant and/or when the mother was watching her own infant’s video (video tests), no increase was observed in serum. We used social interaction and video tests on a group of mothers (nine mothers for social interaction and six for the video test) to clarify these single-subject results. In both tests, the mothers had increased OT in their saliva but not serum. Our study may suggest that salivary samples reflect not only the physical but also the emotional state and that saliva samples may be useful for monitoring women’s OT levels during pre- and postpartum periods. Further studies with larger sample numbers are necessary to confirm the rapid changes in salivary OT levels in response to maternal physiological and behavioral responses.

Oxytocin and microglia in the development of social behaviour

Oxytocin is a well-established regulator of social behaviour. Microglia, the resident immune cells of the central nervous system, regulate brain development and maintenance in health and disease. Oxytocin and microglia interact: microglia appear to regulate the oxytocin system and are, in turn, regulated by oxytocin, which appears to have anti-inflammatory effects. Both microglia and oxytocin are regulated in sex-specific ways. Oxytocin and microglia may work together to promote experience-dependent circuit refinement through multiple developmental-sensitive periods contributing to individual differences in social behaviour. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.

Gut microbiota: Linking nutrition and perinatal depression

Perinatal depression is a mood disorder that is reported in women during pregnancy (prenatal) and after childbirth (postnatal). The onset of perinatal depression is associated with changes in reproductive hormones, stress hormones and neurosteroids. These chemical compounds can be modulated by the gut microbiota, which may affect maternal mental health during the perinatal period via the gut-brain-axis. Recent studies suggest that nutritional and dietary interventions (vitamin D, ω-3 fatty acids, iron, and fiber) effectively prevent or mitigate maternal depression and anxiety, but their efficacy is confounded by various factors, including the gut microbiota. Probiotics are efficacious in maintaining microbiota homeostasis, and thus, have the potential to modulate the development of perinatal mood disorders, despite no evidence in human. Therefore, clinical trials are warranted to investigate the role of probiotic supplementation in perinatal depression and behavioral changes. This article reviews the interplay between nutrition, gut microbiota and mood and cognition, and the evidence suggesting that probiotics affect the onset and development of perinatal depression.

Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03−2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30−3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47−0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34−0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29−0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85−25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80−30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.

Possible oxytocin-related biomarkers in anxiety and mood disorders

Anxiety and mood disorders are prevalent, disabling, and frequently difficult to treat. Such disorders are often comorbid and share similar characteristics. For more accurate diagnosis and improved treatment, a deeper understanding of the pathophysiology of anxiety and mood disorders is important. Oxytocin, a neuropeptide synthesized in the hypothalamus, affects human psychology and behaviors such as social and affiliative behaviors, fear and emotion processing, and stress regulation. Thus, oxytocin is believed to exert anxiolytic and antidepressant-like effects. This review article provides an overview of clinical studies on relationships between the oxytocin system and anxiety and mood disorders, focusing on oxytocin-related biomarker findings. Biomarkers used in such studies include central and peripheral oxytocin levels, analysis of oxytocin-related genes, and expression levels of oxytocin and oxytocin receptor genes in postmortem brains. Although a growing number of studies support the presence of oxytocinergic effects on anxiety and mood disorders, study results are heterogeneous and inconclusive. Moderating factors such as the characteristics of study populations, including sex, age, context, early life adversity, and attachment styles in patient cohorts, might affect the heterogeneity of the study results. Limitations in existing research such as small sample sizes, large dependence on peripheral sources of oxytocin, and inconsistent results between immunoassay methods complicate the interpretation of existing findings.

Receptor for advanced glycation end-products and child neglect in mice: A possible link to postpartum depression

The receptor for advanced glycation end-products (RAGE), a pattern recognition molecule, has a role in the remodeling of vascular endothelial cells mainly in lungs, kidney and brain under pathological conditions. We recently discovered that RAGE binds oxytocin (OT) and transports it to the brain from circulation on neurovascular endothelial cells. We produced knockout mice of the mouse homologue of the human RAGE gene, Ager, designated RAGE KO mice. In RAGE KO mice, while hyperactivity has been reported in male mice, maternal behavior was impaired in female mice. After an additional stress, deficits in pup care were observed in RAGE KO mother mice. This resulted in pup death within 1–2 days, suggesting that RAGE plays a critical role during the postpartum period. Thus, RAGE seems to be important in the manifestation of normal maternal behavior in dams. In this review, we summarize the significance of brain OT transport by RAGE and propose that RAGE-dependent OT can dampen stress signals during pregnancy, delivery and early postpartum periods. To the best of our knowledge, there have been no previous articles on these RAGE-dependent results. Based on these results in mice, we discuss a potential critical role of RAGE in emotion swings at the puerperium (peripartum) and postpartum periods in women.

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RAGE play a role in oxytocin transport via the blood-brain barrier into the brain.

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RAGE KO dams had maternal behavior impairment after stress exposure that is in line with the two-hit theory. The first hit is RAGE signaling absence, the second hit is a stress event occurred in the postpartum period.

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We can hypothesize that RAGE signaling can affect maternal depression development through oxytocin transportation into the brain.

Dysfunctions of brain oxytocin signaling: Implications for poor mothering

Good mothering has profound impact on both the mother's and the young's well-being. Consequently, experiencing inadequate maternal care - or even neglect - in the first stages of life is a major risk factor for the development of psychiatric disorders, and even for poor parenting towards the future offspring. Thus, understanding the neurobiological basis of maternal neglect becomes crucial. Along with other neurotransmitters and neuropeptides, oxytocin (OXT) has long been known as one of the main modulators of maternal behavior. In rodents, disruptions of central OXT transmission have been associated with poor maternal responses, like impaired onset of nursing behaviors, and reduced care and defense of the pups. Importantly, such behavioral and molecular deficits can be transmitted through generations, creating a vicious circle of low-quality maternal behavior. Similarly, evidence from human studies shows that OXT signaling is defective in conditions of inadequate mothering and child neglect. On those premises, this review aims at providing a comprehensive overview of animal and human studies linking perturbed OXT transmission to poor maternal behavior. Considering the important fallouts of inadequate maternal responses, we believe that unraveling the alterations in OXT transmission might provide useful insights for a better understanding of maternal neglect and, ultimately, for future intervention approaches.

Experience-Regulated Neuronal Signaling in Maternal Behavior

Maternal behavior is shaped and challenged by the changing developmental needs of offspring and a broad range of environmental factors, with evidence indicating that the maternal brain exhibits a high degree of plasticity. This plasticity is displayed within cellular and molecular systems, including both intra- and intercellular signaling processes as well as transcriptional profiles. This experience-associated plasticity may have significant overlap with the mechanisms controlling memory processes, in particular those that are activity-dependent. While a significant body of work has identified various molecules and intracellular processes regulating maternal care, the role of activity- and experience-dependent processes remains unclear. We discuss recent progress in studying activity-dependent changes occurring at the synapse, in the nucleus, and during the transport between these two structures in relation to maternal behavior. Several pre- and postsynaptic molecules as well as transcription factors have been found to be critical in these processes. This role reflects the principal importance of the molecular and cellular mechanisms of memory formation to maternal and other behavioral adaptations.

Labor induction with oxytocin in pregnant rats is not associated with oxidative stress in the fetal brain

Despite the widespread use of oxytocin for induction of labor, mechanistic insights into fetal/neonatal wellbeing are lacking because of the absence of an animal model that recapitulates modern obstetric practice. Here, we create and validate a hi-fidelity pregnant rat model that mirrors labor induction with oxytocin in laboring women. The model consists of an implantable preprogrammed microprocessor-controlled infusion pump that delivers a gradually escalating dose of intravenous oxytocin to induce birth at term gestation. We validated the model with molecular biological experiments on the uterine myometrium and telemetry-supported assessment of changes in intrauterine pressure. Finally, we applied this model to test the hypothesis that labor induction with oxytocin would be associated with oxidative stress in the newborn brain. Analysis of biomarkers of oxidative stress and changes in the expression of associated genes were no different between oxytocin-exposed and saline-treated pups, suggesting that oxytocin-induced labor was not associated with oxidative stress in the developing brain. Collectively, we provide a viable and realistic animal model for labor induction and augmentation with oxytocin that would enable new lines of investigation related to the impact of perinatal oxytocin exposure on the mother-infant dyad.

The Association between Late Third-Trimester Oxytocin Level and Early-Onset Postpartum Depression Symptoms among Jordanian Mothers: A Cross-sectional Study

PURPOSE

Oxytocin has been suggested to play a vital role in modulating maternal behavior and stress-related disorders. However, the relationship between antenatal oxytocin and postpartum depression is not well established. We aim to investigate the association between serum oxytocin level in the late third-trimester and early-onset postpartum depression symptoms.

MATERIALS AND METHODS

A total of 172 healthy pregnant women participated in this cross-sectional descriptive study. The serum oxytocin level was measured between 34 and 37 weeks. A validated Edinburgh Postnatal Depression Scale (EPDS) was used to assess symptoms of depression four to six weeks postpartum. Participants who scored more than 12 on the EPDS were considered having depressive symptoms. Independent sample t-test and Pearson r were used to examine differences in depression scores. The level of significance was set at α = 0.05.

RESULTS

30.8% of the participants experienced depressive symptoms. There was no association between EPDS scores and oxytocin level r(170) = 0.10, p = 0.23. The association also did not exist even among women with a lifetime history of depression r(43) = -0.13, p = 0.37. Participants with low education, low income, previous history of depression, positive family history of depression, positive family issues, and absent emotional family support have scored significantly higher on EPDS scores than their counterparts. The strongest association was with previous lifetime history of depression t(170) = -4.40, p < 0.001.

CONCLUSIONS

Postpartum depression is a major public health problem in Jordan. Late trimester serum oxytocin level has no association with early-onset postpartum depression.

The Role of OXT, OXTR, AVP, and AVPR1a Gene Expression in the Course of Schizophrenia

Schizophrenia is a serious and chronic mental illness, the symptoms of which usually appear for the first time in late adolescence or early adulthood. To date, much research has been conducted on the etiology of schizophrenia; however, it is still not fully understood. Oxytocin and vasopressin as neuromodulators that regulate social and emotional behavior are promising candidates for determining the vulnerability to schizophrenia. The aim of this study was to evaluate the expression of OXT, OXTR, AVP, and AVPR1a genes at the mRNA and protein levels in patients with schizophrenia. Due to the neurodegenerative nature of schizophrenia, the study group was divided into two subgroups, namely, G1 with a diagnosis that was made between 10 and 15 years after the onset of the illness, and G2 with a diagnosis made up to two years after the onset of the illness. Moreover, the relationship between the examined genes and the severity of schizophrenia symptoms, assessed using PANSS (Positive and Negative Syndrome Scale) and CDSS scales (Clinical Depression Scale for Schizophrenia) was evaluated. The analysis of the expression of the studied genes at the mRNA and protein levels showed statistically significant differences in the expression of all the investigated genes. OXT and AVPR1a gene expression at both the mRNA and protein levels were significantly lower in the schizophrenia group, and OXTR and AVP gene expression at both the mRNA and protein levels was higher in the schizophrenia subjects than in the controls. Furthermore, a significant correlation of OXT gene expression at the mRNA and protein levels with the severity of depressive symptoms in schizophrenia as assessed by CDSS was found.

The Relationship Between 5-Hydroxytryptamine and Its Metabolite Changes With Post-stroke Depression

Post-stroke depression (PSD) is the most common and serious sequelae of stroke. Approximately 33% of stroke survivors were affected by PSD. However, many issues (e.g., incidence, diagnostic marker, and risk factor) related to PSD remained unclear. The "monoamine hypothesis" is a significant hypothesis for depression, which suggests that three monoamines play a key role in depression. Therefore, most current antidepressants are developed to modulate the monoamines on PSD treatment, and these antidepressants have good effects on patients with PSD. However, the potential mechanisms of three monoamines in PSD are still unclear. Previously, we proposed "three primary emotions," which suggested a new model of basic emotions based on the three monoamines. It may provide a new way for PSD treatment. In addition, recent studies have found that monoamine-related emotional intervention also showed potential effects in the treatment and prevention of PSD. This study discusses these issues and attempts to provide a prospect for future research on PSD.

Roles of Oxytocin in Stress Responses, Allostasis and Resilience

Oxytocin has been revealed to work for anxiety suppression and anti-stress as well as for psychosocial behavior and reproductive functions. Oxytocin neurons are activated by various stressful stimuli. The oxytocin receptor is widely distributed within the brain, and oxytocin that is released or diffused affects behavioral and neuroendocrine stress responses. On the other hand, there has been an increasing number of reports on the role of oxytocin in allostasis and resilience. It has been shown that oxytocin maintains homeostasis, shifts the set point for adaptation to a changing environment (allostasis) and contributes to recovery from the shifted set point by inducing active coping responses to stressful stimuli (resilience). Recent studies have suggested that oxytocin is also involved in stress-related disorders, and it has been shown in clinical trials that oxytocin provides therapeutic benefits for patients diagnosed with stress-related disorders. This review includes the latest information on the role of oxytocin in stress responses and adaptation.