As they bred the mice, the team ran into trouble. Pregnancy is a time of great change and little is known about how the brain shifts as a result. The troubled mice launched experiments that helped Maguire triangulate depression, stress, and pregnancy, leading to the first FDA approved treatment for postpartum depression.
Later experiments conducted after Maguire established her lab at Tufts University in showed that disabling another critical player in the GABA system — a protein transporter called potassium-chloride cotransporter 2 KCC2 — produced similarly stressed-out mother mice.
Maguire now believes pregnancy puts the brain in a precarious position. It ramps up the production of neurosteroid chemicals, which encourage the calming effects of the GABA system and limit stress by making a circuit known as the hypothalamic—pituitary—adrenal axis, or HPA axis, less responsive. At the same time, however, the number of GABA A receptors plummets to keep the brain from growing too lethargic.
Keeping stress in check requires the brain to carefully balance neurosteroid production with the number of GABA A receptors. Immediately after a mouse mother gives birth, neurosteroid levels plummet. Similar events may leave humans in a more fragile state too. Clinical trials backed up her theory. Women on properly supervised medication for depression during pregnancy are less likely to develop PPD after. Antidepressant medications definitely have a necessary role for some PPD patients, but medication alone is not as effective as when used in combination with therapy.
It is not uncommon for an obstetrician to write the initial prescription for an antidepressant. Being prepared and having a plan of action is essential. Beyond the clinical setting, Kim is conducting research for new ways to treat perinatal depression, including a National Institute of Mental Health-funded study focusing on the use of a novel non-pharmacologic treatment for depression during pregnancy.
Subscribe to our mailing list to receive an e-mail notification when new content goes live! Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department s , University of Pennsylvania Health System Penn Medicine , or the University of Pennsylvania, unless explicitly stated with the authority to do so. Health information is provided for educational purposes and should not be used as a source of personal medical advice.
His most recent work applying this approach to postpartum depression is outlined in a paper recently published in the Journal of Neuroendocrinology. One specific neurosteroid, allopregnanolone, is produced in increasing amounts during pregnancy.
However, after childbirth, the neurosteroid levels drop, leading to chemical imbalances in the brain that can cause postpartum depression. This medication, which was then renamed as brexanalone, was approved in as the first drug for postpartum depression.
Postpartum depression is unique in that there is a small window of time during which it can be treated; it varies from person to person, but the critical period is the first four weeks after the baby is born. Neurosteroids, on the other hand, work immediately as antidepressants because they have a rapid mechanism of action.
Younger fathers, those with a history of depression and fathers with financial difficulties are at increased risk of experiencing depression. Many women may suffer in silence, dismissing their struggles as a normal part of pregnancy and childbirth and fail to seek care. Treatment for depression during pregnancy is essential.
Greater awareness and understanding can lead to better outcomes for women and their babies. Like other types of depression, peripartum depression can be managed with psychotherapy talk therapy , medication, lifestyle changes and supportive environment or a combination of these. Women who are pregnant or nursing should discuss the risks and benefits of medication with their doctors. In general, the risk of birth defects to the unborn baby are low.
APA guidelines for treating women with major depressive disorder who are pregnant or breastfeeding recommend psychotherapy without medication as a first-line treatment when the depression or anxiety is mild. For women with moderate or severe depression or anxiety, antidepressant medication should be considered as a primary treatment.
With proper treatment, most new mothers find relief from their symptoms. Women who are treated for peripartum depression should continue treatment even after they feel better. If treatment is stopped too soon, symptoms can recur. Other suggestions for helping to cope with peripartum depression include resting as much as you can sleep when your baby sleeps and make time to go out or visit friends. Strong support from partners, family and friends is very important. National Suicide Prevention Lifeline at TALK for free and confidential emotional support—they talk about more than just suicide.
Feeling guilty and blaming oneself when things go wrong, and worrying and feeling panicky for no good reason are signs of anxiety in the peripartum period. Bipolar illness can emerge during pregnancy or the postpartum period. Risk factors include a previous mood disorder and family history of mood disorders. Treatment can include mood stabilizers and antipsychotic medications 9 along with therapy.
Peripartum Psychosis — Peripartum psychosis is an extremely rare but serious condition — it occurs in only one or two out of every 1, deliveries. The symptoms of peripartum psychosis are extreme and may include insomnia, excessive energy, agitation, hearing voices, and extreme paranoia or suspiciousness. Many women with peripartum psychosis have a personal or family history of bipolar disorder. Symptoms of peripartum psychosis can be a serious medical emergency and require immediate attention.
0コメント