postpartum depression and anxiety affect 1 in 10 women, they are often
overlooked and under-reported.
- They are treated as extensions of major depression and
generalized anxiety disorder.
- A new
study states that despite the common symptoms of PPD and other forms of
depression the underlying mechanisms are different.
- Neural activity in women with PPD involves distinct pattern in
comparison with those who suffer from depression but have not given birth.
neurobiology of both postpartum depression and anxiety were explored by
Despite the increased frequency of postpartum
and postpartum anxiety, it is often overlooked and goes under-diagnosed. Psychologists have
underestimated the uniqueness of mood and emotional disorders that arise during
pregnancy or shortly after giving birth.
Postpartum depression is depression that
occurs after having a baby
and affects 1 out of 10
developed countries, at least 10%-15% of women are faced with PPD. In
developing countries, the rates of postpartum anxiety appear to be at least as
high as those in developed nations and PPD can be two to three times higher
than in industrialized countries.
New mothers struggling with PPD are often detached
or withdrawn from family and friends, lose their appetite, feel sad, angry and irritable
much of the time.
It is different from "baby blues "
which most new mothers
experience. "Baby blues" are characterized by symptoms of worry,
sadness, and tiredness. It usually resolves on its own.
Postpartum depression is more intense and
longer than those of "baby blues."
Postpartum mood disorders not only affect
mothers but also their infants because new and depressed mothers are often
irritated by their infants, ignore their
needs, breastfeed less, lack in maternal emotions and may have
trouble forming a bond.
These early interactions with the
newborns are important and can
lead to long-term behavioral problems for the children when
they are older.
Medical claims by children of depressed
mothers are higher compared to children of healthy women because they bear a
higher burden of illness, use health care services more frequently, and have
more medical office and emergency department visits than do children of
The annual cost of not treating a mother
with depression, is estimated to be $7,200.
Despite the increased prevalence of both
PPD and postpartum anxiety and pervasive costs for the mother and developing
child, very few clinical studies offer an understanding of the neural bases of
postpartum emotional and mood disorders.
Differences in Neural Activity
depression does not have any diagnostic criteria and its symptoms often resemble other forms of depression or mood disorders.
is difficult to assess the precise rates of postpartum anxiety and depressive
disorders due to the heterogeneity of the disorders, differences among studies
in their research populations, and an overall lack of screening for psychiatric
symptoms in postpartum women.
the research, psychologists explore the neurobiology of
postpartum depression and anxiety.
"Motherhood really can change the
mother, which is something we often overlook. And we forget about examining the
neurobiology of maternal mental health and maternal mental illness,
particularly anxiety," says behavioral neuroscientist Jodi Pawluski of
University of Rennes 1 in France, who co-authored the paper with Joseph
Lonstein of Michigan State University and Alison Fleming of the University of
Toronto at Mississauga.
To study the brain systems involved in
affective disorders in women during late pregnancy through to 18 months
postpartum, two general research strategies involving the safe and non-invasive
functional magnetic resonance
(fMRI) approach have been used.
The first strategy
involves analysis of women's brain
resting state, or the brain activity that occurs in the absence of any
specific external stimulation.
These analysis focus on brain
systems that characterize depression, including those involved in
self-awareness, emotional regulation, and cognitive functioning in the absence
It was noted that at rest, women who had
both PPD and postpartum anxiety had decreased neural connectivity.
These women with PPD showed significantly
weaker connectivity between the amygdala (AMG), anterior cingulate cortex (ACC), dorsal lateral
prefrontal cortex (DLPFC), and the hippocampus compared with non-depressed postpartum
Analyzing Brain Response to Infant and
The second strategy
fMRI to investigate differences in mothers' brain in response to infant and
The goal was to understand both the
neurobiology of PPD and postpartum anxiety and how they alter neurobiological
correlates of maternal response to infants.
The analysis revealed that neural
activation between depressed and non-depressed mothers also differs in response
to infant and non-infant related cues.
The activity in a specific brain region
will increase in response to a non-infant emotional cue, but decrease in
response to an infant-related emotional cue.
For instance, the amygdala is usually
hyperactive in anxious and depressed people, but for the women with PPD, the
amygdala can actually be less activated.
These results collectively suggest that
mood disorders during the postpartum period are neurobiologically distinct from these
disorders at other times in one's life.
PPD is now listed as perinatal
, a subset of major depression in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5). DSM-5 is the text which sets industry
standards for diagnosing mental conditions.
But postpartum anxiety, though as
prevalent as PPD is not included at all in the DSM-5. Despite affecting 1 in 7
new mothers postpartum anxiety receives far less attention in the literature.
"When we talk about the neurobiology
of postpartum depression and anxiety, our information from the studies done on
humans is only comprised of about 20 papers," says Pawluski.
"If you think that 10%-20% of women
during pregnancy and the postpartum period will suffer from depression and/or
anxiety, and then you realize there are only 20 publications looking at the
neurobiology of these illnesses, it's quite shocking." Pawluski added.
Pawluski described new parenthood as,
"It's a life changer. It's fantastic, terrifying, amazing, frustrating,
exhausting, thrilling, and everything in between. It is not always a happy
time, and we need to understand that, talk about it, and figure why it can
trigger mental illnesses in so many women. If we can improve the health and
well-being of the mother, we will improve the health and well-being of the
child and family."
Though PPD and postpartum anxiety affect nearly 1 in 10 women, they
are often treated as extensions of major depression and generalized anxiety
The condition can be further complicated
by the reality and expectations
where women are expected to
enthusiastically embrace their new motherhood, but they are unable to.
Another major problem is that sometimes
the social stigma
associated with mental disorders prevent many women with postpartum
mood disorders from discussing their issues openly with health care providers
and hence their condition remains largely under-addressed.
Though information on changes in activation
in brain regions can be studied using fMRI, which helps in detecting changes in blood flow, continued research
is needed for postpartum anxiety and depression to determine the mechanisms
behind the neurobiological patterns.
The understanding of neurobiological
pattern of maternal mood disorders will help in developing effective and safe
treatment approaches, thus improving the health and well-being of the mother
The review is
published in Trends in Neurosciences
- Jodi Pawluski et al. The Neurobiology of Postpartum Anxiety and Depression. Trends in Neurosciences ; (2017) doi.org/10.1016/j.tins.2016.11.009
- Depression Among Women - (https://www.cdc.gov/reproductivehealth/depression/)