Understanding Peripartum Depression Through Neuroimaging: a Review of Structural and Functional Connectivity and Molecular Imaging Research

Abstract

Purpose of review Imaging research has sought to uncover brain structure, function and metabolism in women with postpartum depression (PPD) as little is known about its underlying pathophysiology. This review discusses the imaging modalities used to date to evaluate postpartum depression and highlights recent findings. Recent findings Altered functional connectivity and activity changes in brain areas implicated in executive functioning and emotion and reward processing have been identified in PPD. Metabolism changes involving monoamine oxidase A, gamma-aminobutyric acid, glutamate, serotonin, and dopamine have additionally been reported. To date, no studies have evaluated grey matter morphometry, voxel-based morphometry, surface area, cortical thickness, or white matter tract integrity in PPD. Summary Recent imaging studies report changes in functional connectivity and metabolism in women with PPD vs. healthy comparison women. Future research is needed to extend these findings as they have important implications for the prevention and treatment of postpartum mood disorders.

Dissecting maternal care: Patterns of maternal parenting in a prospective cohort study

“…For example, Supportive Parenting might be linked to cortical brain structures involved in executive functions, such as attention, decision‐making and planning, and may involve dopaminergic and oxytocinergic systems . At the same time, the strong association between depression and the Self‐Enjoyment Parenting score could indicate an overlapping involvement of the dopaminergic reward pathway, which has been associated with complex maternal behaviours, as well as symptoms of depression, and might thus be an important neurobiological determinant of this particular component of maternal parenting . Also, the anterior cingulate cortex and amygdala may be involved both in the depressive symptoms and in the self‐monitoring of socially desirable responses in the Self‐Enjoyment Parenting score .…”

“…59 At the same time, the strong association between depression and the Self-Enjoyment Parenting score could indicate an overlapping involvement of the dopaminergic reward pathway, which has been associated with complex maternal behaviours, as well as symptoms of depression, and might thus be an important neurobiological determinant of this particular component of maternal parenting. 60 Also, the anterior cingulate cortex and amygdala may be involved both in the depressive symptoms and in the self-monitoring of socially desirable responses in the Self-Enjoyment Parenting score. 61 Maternal symptoms of depression were also linked with Overwhelmed Parenting, which might indicate that feeling stressed and depressed could lead to higher levels of cortisol, which affects multiple brain regions and hormones, including oxytocin-and dopamine-related pathways.…”

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

“…The most commonly used modality to assess changes in neural activity and connectivity is blood‐oxygen‐level dependent (BOLD) functional magnetic resonance imaging (fMRI), allowing for the indirect and non‐invasive study of mothers’ neural response to various stimuli via BOLD activity. These studies have primarily focused on mothers’ BOLD responses to emotionally salient cues in areas of the brain implicated in executive functioning, reward processing and emotional processes because these areas have often been identified as showing altered responses in mothers with PPD . Along with changes in brain activity, a woman experiences significant changes in her hormonal profile during pregnancy and in the postpartum period.…”

“…These studies have primarily focused on mothers' BOLD responses to emotionally salient cues in areas of the brain implicated in executive functioning, reward processing and emotional processes because these areas have often been identified as showing altered responses in mothers with PPD. 10 Along with changes in brain activity, a woman experiences significant changes in her hormonal profile during pregnancy and in the postpartum period. PPD is understood to be at least partially mediated by the dysregulation of key hormones involved in this process.…”

Resting-state functional connectivity, cortical GABA and neuroactive steroids in peripartum and peripartum depressed women: a functional magnetic imaging and resonance study

“…Studies have established network dysfunction in non-peripartum major depressive disorder (MDD) [7]. fMRI studies using a small number of predefined regions point to reduced functional connectivity between regions of the default mode (DMN) [8] and salience networks (SN) [9] in PPD [10]. The DMN is a network of connected brain regions most active at rest and involved in monitoring of the external environment and internal mentation.…”