Posts tagged postpartum depression
Articles and news from the latest research reports.
Breastfeeding linked to lower risk of postnatal depression
A new study of over 10,000 mothers has shown that women who breastfed their babies were at significantly lower risk of postnatal depression than those who did not.
The study, by researchers in the UK and Spain, and published today in the journal Maternal and Child Health, shows that mothers who planned to breastfeed and who actually went on to breastfeed were around 50% less likely to become depressed than mothers who had not planned to, and who did not, breastfeed. Mothers who planned to breastfeed, but who did not go on to breastfeed, were over twice as likely to become depressed as mothers who had not planned to, and who did not, breastfeed.
The relationship between breastfeeding and depression was most pronounced when babies were 8 weeks old, but much smaller when babies were 8 months or older.
The research, funded by the Economic and Social Research Council, used data drawn from the Avon Longitudinal Survey of Parents and Children (ALSPAC), a study of 13,998 births in the Bristol area in the early 1990s. Maternal depression was measured using the Edinburgh Postnatal Depression Scale when babies were 8 weeks, and 8, 21 and 33 months old. Depression was also assessed at two points during pregnancy, enabling the researchers to take into account mothers’ pre-existing mental health conditions.
This is one of the largest studies of its kind; as well as being one of the few studies taking into account mothers’ previous mental health, it also controls for socioeconomic factors such as income and relationship status, and for other potential confounders such as how babies were delivered, and whether they were premature.
“Breastfeeding has well-established benefits to babies, in terms of their physical health and cognitive development; our study shows that it also benefits the mental health of mothers,” says Dr Maria Iacovou, from the University of Cambridge’s Department of Sociology and a Bye Fellow at Fitzwilliam College.
“In fact, the effects on mothers’ mental health that we report in this study are also likely to have an impact on babies, since maternal depression has previously been shown to have negative effects on many aspects of children’s development.”
Dr Iacovou believes that health authorities should not only be encouraging women to breastfeed, but should also provide a level of support that will help mothers who want to breastfeed succeed.
“Lots of mothers and babies take to breastfeeding pretty easily. But for many others, it doesn’t come naturally at all; for these mothers, having someone with the training, the skills, and perhaps most importantly the time to help them get it right, can make all the difference,” she adds.
“However good the level of support that’s provided, there will be some mothers who wanted to breastfeed and who don’t manage to. It’s clear that these mothers need a great deal of understanding and support; there is currently hardly any skilled specialist help for these mothers, and this is something else that health providers should be thinking about.”
Around one in 12 women in the sample experienced depressive symptoms during pregnancy, while one in eight experienced depression at one or more of the four measurement points after giving birth.
According to figures from the UK’s Department of Health, almost three-quarters of mothers initiated breastfeeding in 2012/13; by the time of the 6-8 week check, only 47% of babies were being breastfed. This is one of the lowest rates of breastfeeding in Europe.
(Image caption: Positron-Emission-Tomography (PET) of a depressive patient without medication (left) with elevated monoamine-oxidase-A-levels (green, yellow, red) and after a six-week-treatment with the monoamine-oxidase-A-inhibitor moclobemid (right). Credit: © Sacher et al., 2011, J Psy Neurosci.)
Monoamine oxidase A: biomarker for postpartum depression
Many women suffer from baby blues after giving birth. Some even develop full-blown postpartum depression in the weeks that follow. Monoamine oxidase A, an enzyme responsible for the breakdown of neurotransmitters like dopamine and serotonin, plays an important role in this condition. In comparison to healthy women, women who experience postpartum depression present strongly elevated levels of the enzyme in their brains. This was discovered by a Canadian-German research team including Julia Sacher from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig. Their findings could help in the prevention of postpartum depression and in the development of new drugs for its treatment.
For most women, the birth of their baby is one of the most strenuous but also happiest days in their lives. However, joy and happiness are often followed by fatigue and exhaustion. The vast majority of women experience a temporary drop in mood for a few days after birth. These symptoms of “baby blues” are not an illness; however, in some cases they can represent early signs of an imminent episode of depression: in 13 percent of mothers, the emotional turmoil experienced after childbirth leads to the development of a full-blown postpartum depression. Postpartum depression is harmful not only to the mother, but also to the baby. It is difficult to treat this condition effectively, as its precise neurobiological causes have remained unidentified to date.
The new study shows that postpartum depression is accompanied by strongly elevated monoamine oxidase A in the brain, particularly in the prefrontal cortex and in the anterior cingulate cortex. In women with postpartum depression, the values recorded were 21 percent higher than those of women who were not plagued by negative feelings after giving birth. Women who did not develop full-blown depression but found themselves crying more often than usual due to depressed mood also presented moderately elevated values.
“Therefore, we should promote strategies that help to reduce monoamine oxidase A levels in the brain, and avoid everything that makes these values rise,” explains Sacher. Such factors include heavy smoking, alcohol consumption and chronic stress, for example when the mother feels neglected and abandoned by her partner and family. “My ultimate goal is to provide women and their families with very concrete lifestyle recommendations that will enable them to prevent postpartum depression,” explains the psychiatrist.
A new generation of long-established drugs could also play an important role in the treatment of postpartum depression in future. Up to now, depressed mothers are mainly given drugs that increase the concentration of serotonin in the brain. However, because monoamine oxidase A breaks down not only serotonin but also other monoamines like dopamine and noradrenaline, a treatment that directly targets monoamine oxidase A could have a higher success rate, particularly in very serious cases: this alternative is provided by selective and reversible monoamine-oxidase- A inhibitors. “The first monoamine oxidase inhibitors often had severe side effects, for example hypertensive crises, which necessitated adherence to a strict diet,” explains Sacher. “However, the new selective and reversible drugs are better tolerated,” she adds. In the next stage of this research involving clinical trials, the scientists intend to test the effectiveness of these reversible monoamine oxidase A inhibitors in the treatment of postpartum depression.
Because the measurement of this enzyme in the brain requires complex technology, it is not suitable for routine testing. Thus, the researchers are also looking for a peripheral marker of this enzyme that can be detected in saliva or blood.
Four years ago, Julia Sacher and her colleagues at the Centre for Addiction and Mental Health CAMH in Toronto already succeeded in showing that, in the first week postpartum, the concentration of the enzyme monoamine oxidase A in the brain is on average 40 percent higher than in women who had not recently given birth. “The monoamine oxidase A values behave in the opposite way to oestrogen levels. When oestrogen levels drop acutely after childbirth, the concentration of monoamine oxidase A rises. This drastic change also influences serotonin levels, known as the happiness hormone,” explains Dr. Sacher. In most women, the values quickly return to normal. In others, they remain raised – and thereby promote the development of depression.
Genetic Predictors of Postpartum Depression Uncovered
Alteration of two genes, detectable by simple blood test during pregnancy, foretold illness with 85 percent certainty in small study
Johns Hopkins researchers say they have discovered specific chemical alterations in two genes that, when present during pregnancy, reliably predict whether a woman will develop postpartum depression.
The epigenetic modifications, which alter the way genes function without changing the underlying DNA sequence, can apparently be detected in the blood of pregnant women during any trimester, potentially providing a simple way to foretell depression in the weeks after giving birth, and an opportunity to intervene before symptoms become debilitating.
The findings of the small study involving 52 pregnant women are described online in the journal Molecular Psychiatry.
“Postpartum depression can be harmful to both mother and child,” says study leader Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “But we don’t have a reliable way to screen for the condition before it causes harm, and a test like this could be that way.”
It is not clear what causes postpartum depression, a condition marked by persistent feelings of sadness, hopelessness, exhaustion and anxiety that begins within four weeks of childbirth and can last weeks, several months or up to a year. An estimated 10 to 18 percent of all new mothers develop the condition, and the rate rises to 30 to 35 percent among women with previously diagnosed mood disorders. Scientists long believed the symptoms were related to the large drop-off in the mother’s estrogen levels following childbirth, but studies have shown that both depressed and nondepressed women have similar estrogen levels.
By studying mice, the Johns Hopkins researchers suspected that estrogen induced epigenetic changes in cells in the hippocampus, a part of the brain that governs mood. Kaminsky and his team then created a complicated statistical model to find the candidate genes most likely undergoing those epigenetic changes, which could be potential predictors for postpartum depression. That process resulted in the identification of two genes, known as TTC9B and HP1BP3, about which little is known save for their involvement in hippocampal activity.
Kaminsky says the genes in question may have something to do with the creation of new cells in the hippocampus and the ability of the brain to reorganize and adapt in the face of new environments — two elements important in mood. In some ways, he says, estrogen can behave like an antidepressant, so that when inhibited, it adversely affects mood.
The researchers later confirmed their findings in humans by looking for epigenetic changes to thousands of genes in blood samples from 52 pregnant women with mood disorders. Jennifer L. Payne, M.D., director of the Johns Hopkins Women’s Mood Disorders Center, collected the blood samples. The women were followed both during and after pregnancy to see who developed postpartum depression.
The researchers noticed that women who developed postpartum depression exhibited stronger epigenetic changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, two genes were most highly correlated with the development of postpartum depression. TTC9B and HP1BP3 predicted with 85 percent certainty which women became ill.
“We were pretty surprised by how well the genes were correlated with postpartum depression,” Kaminsky says. “With more research, this could prove to be a powerful tool.”
Kaminsky says the next step in research would be to collect blood samples from a larger group of pregnant women and follow them for a longer period of time. He also says it would be useful to examine whether the same epigenetic changes are present in the offspring of women who develop postpartum depression.
Evidence suggests that early identification and treatment of postpartum depression can limit or prevent debilitating effects. Alerting women to the condition’s risk factors — as well as determining whether they have a previous history of the disorder, other mental illness and unusual stress — is key to preventing long-term problems.
Research also shows, Kaminsky says, that postpartum depression not only affects the health and safety of the mother, but also her child’s mental, physical and behavioral health.
Kaminsky says that if his preliminary work pans out, he hopes a blood test for the epigenetic biomarkers could be added to the battery of tests women undergo during pregnancy, and inform decisions about the use of antidepressants during pregnancy. There are concerns, he says, about the effects of these drugs on the fetus and their use must be weighed against the potentially debilitating consequences to both the mother and child of foregoing them.
“If you knew you were likely to develop postpartum depression, your decisions about managing your care could be made more clearly,” he says.
(Source: hopkinsmedicine.org)