The role of reproductive hormones in postpartum depression

Abstract

Despite decades of research aimed at identifying the causes of postpartum depression (PPD), PPD remains common, and the causes are poorly understood. Many have attributed the onset of PPD to the rapid perinatal change in reproductive hormones. Although a number of human and non-human animal studies support the role of reproductive hormones in PPD, several studies have failed to detect an association between hormone concentrations and PPD. The purpose of this review is to examine the hypothesis that fluctuations in reproductive hormone levels during pregnancy and the postpartum period trigger PPD in susceptible women. We discuss and integrate the literature on animal models of PPD and human studies of reproductive hormones and PPD. We also discuss alternative biological models of PPD to demonstrate the potential for multiple PPD phenotypes and to describe the complex interplay of changing reproductive hormones and alterations in thyroid function, immune function, HPA axis function, lactogenic hormones, and genetic expression that may contribute to affective dysfunction. There are three primary lines of inquiry that have addressed the role of reproductive hormones in PPD: non-human animal studies, correlational studies of postpartum hormone levels and mood symptoms, and hormone manipulation studies. Reproductive hormones influence virtually every biological system implicated in PPD, and a subgroup of women seem to be particularly sensitive to the effects of perinatal changes in hormone levels. We propose that these women constitute a “hormone-sensitive” PPD phenotype, which should be studied independent of other PPD phenotypes to identify underlying pathophysiology and develop novel treatment targets.

Management of Peripartum Depression: Better, Prevent Than Treat!.

“…This study also delineates the differences between PPD and antenatal depression continuing after childbirth. Further, a study has suggested "hormone sensitive postpartum depression" to be a subgroup who are sensitive to hormonal changes of childbirth (Schiller et al 2015).…”

Brexanolone: an allosteric modulator of GABA-A receptors in the rapid treatment of postpartum depression

“…Findings from several studies implicate peripartum fluctuations in reproductive hormones (particularly, the major progesterone metabolite allopregnanolone) having pivotal pathophysiological roles in PPD [3]. The rapid decline in the levels of reproductive hormones that occurs after delivery is believed to contribute to the development of depression in susceptible women.…”

Overlap of Postnatal Depression and Postcoital Dysphoria in Women- Implications for Common Underlying Mechanisms

“…Replication of these results in larger, independent cohorts is warranted. Understanding of the pathways by assessing biological markers such as longitudinal changes in gene expression and DNA methylation would be useful [15].…”