A systematic review of cortisol, thyroid-stimulating hormone, and prolactin in peripartum women with major depression

Abstract

Pregnancy and postpartum are periods of high susceptibility to major depression (MD) and other mood disorders. The peripartum period is also a time of considerable changes in the levels of hormones, including cortisol, thyroid-stimulating hormone (TSH), prolactin, gonadotropins, and gonadal steroids. To investigate the relationship between mood and hormonal changes during and after pregnancy, we reviewed published reports of hormonal measures during this time frame, searched via PubMed and Web of Science. Studies were included if women in the antepartum or postpartum periods were clinically diagnosed with MD, and if there were repeated measures of cortisol, TSH, or prolactin. For these three hormones, the numbers of human studies that met these criteria were 15, 7, and 3, respectively. Convergent findings suggest that morning cortisol is reduced in pregnant and postpartum women with MD. Evidence did not support changes in TSH as a marker of MD during the peripartum period, and evidence for changes in prolactin in peripartum MD was equivocal. Aside from reduced morning cortisol in peripartum women with MD, definitive evidence for an association between specific hormonal fluctuations and mood disorders in the peripartum period remains elusive.

Functional Status of Hypothalamic–Pituitary–Thyroid and Hypothalamic–Pituitary–Adrenal Axes in Hospitalized Schizophrenics in Shanghai

“…have examined HPAA and HPTA in samples of patients with schizophrenia and psychosis. Findings from these studies have been examined in meta-analyses and systematic reviews (29)(30)(31). However, many of these markers have not been examined in the same samples.…”

A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression

“…Cortisol, a major end product of the HPA axis, has also received significant attention. To date, no conclusive association has been reported between prenatal cortisol levels at rest and subsequent development of PPD, although cortisol levels at rest are documented to be lower starting 1 month postpartum in mothers with PPD compared to non‐depressed mothers . As for cortisol reactivity, there is some evidence suggesting that mothers who subsequently developed PPD show increased cortisol reactivity during pregnancy.…”

“…77 Interestingly, some research groups have not been able to replicate these results with larger sample sizes and, instead, found no relationship between higher levels of mid- reported between prenatal cortisol levels at rest and subsequent development of PPD, 76,77 although cortisol levels at rest are documented to be lower starting 1 month postpartum in mothers with PPD compared to non-depressed mothers. 75,[80][81][82] As for cortisol reactivity, there is some evidence suggesting that mothers who subsequently developed PPD show increased cortisol reactivity during pregnancy. One study that used the Trier Social Stress Test reported that pregnant mothers who later developed PPD demonstrated increased cortisol response to psychosocial stress.…”

“…PPD may be moderated by a range of individual and contextual factors. Not surprisingly, given the diurnal variation of cortisol, the timing of cortisol measurement appears to play a role in this relationship, with some studies reporting reduced cortisol levels in mothers with PPD in the morning 81,87,88 but not at other times of the day. 89 It is important to observe here that this is in contrast to the link established between elevated morning cortisol and non-postpartum MDD.…”

Postpartale psychische Störungen und ihre Bedeutung für die Wochenbettbetreuung

“…Dabei schien zunächst der abrupte Entzug von Östrogenen und Progesteron nach der Geburt und Ablösung der Plazenta für die Entstehung postpartaler Depressionen verantwortlich zu sein. Trotz intensiver Bemühungen konnte jedoch der ätiologische Einfluss hormoneller Faktoren noch nicht in ausreichendem Maße geklärt werden [4].…”