Failed Lactation and Perinatal Depression: Common Problems with Shared Neuroendocrine Mechanisms?

Abstract

In the early postpartum period, mother and infant navigate a critical neuroendocrine transition from pregnancy to lactation. Two major clinical problems that occur during this transition are failed lactation and perinatal mood disorders. These disorders often overlap in clinical settings. Failed lactation is common. Although all major medical organizations recommend 6 months of exclusive breastfeeding, only 13% of women in the United States achieve this recommendation. Perinatal mood disorders affect 10% of mothers, with substantial morbidity for mother and child. We hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders. In this hypothesis article, we discuss data from both animal models and clinical studies that suggest neuroendocrine mechanisms that may underlie these two disorders. Research to elucidate the role of these underlying mechanisms may identify treatment strategies both to relieve perinatal depression and to enable women to achieve their infant feeding goals.

Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

“…Postpartum depression is associated with reduced breastfeeding duration, 15,16,[33][34][35][36] and neuroendocrine mechanisms may underlie this association. 12,21 Moreover, reduced maternal sensitivity 37 in the setting of depression may also contribute to breastfeeding difficulties.…”

“…However, successful breastfeeding also depends on the integrated psychology and physiology of mother and child. 12 The prevalence of early, undesired weaning that mothers attribute to disrupted physiology is unknown.…”

“…20 With respect to depression and lactation, women with symptoms of depression and anxiety had lower oxytocin levels during feeding in a recent study, 21 and several other neuroendocrine mechanisms may link maternal mood disorders with breastfeeding difficulties. 12 Furthermore, in animal models, disruption of oxytocin physiology results in dysregulated stress responses and poor feeding. 22 Thus, maternal health conditions may disrupt lactation, leading to early, undesired weaning.…”

Genetic variation in oxytocin rs2740210 and early adversity associated with postpartum depression and breastfeeding duration

“…However, the reverse is also true: breastfeeding is protective for postpartum depression (Henderson et al 2003) and contributes to the improvement of maternal mood [ (Heinrichs et al 2001;Jonas et al 2008;Lonstein 2007;Mezzacappa & Katlin 2002;Neppl et al 2009;Uvnäs-Moberg et al 1990;Virden 1988), but see (Taveras et al 2003)]. Here, too, the underlying mechanisms may be related to the oxytocin system (Cyranowski et al 2008;Frasch et al 1995;Scantamburlo et al 2007;Skrundz et al 2011;Stuebe et al 2012) and to its effects on other endocrine systems such as the hypothalamic-pituitary-adrenal 'stress' system (Altemus et al 1995;Amico et al 1994;Chiodera et al 1991;Handlin et al 2009;Heinrichs et al 2001;Tu et al 2006;Walker et al 2004). Also, there is a growing body of evidence indicating that depressed mothers have lower oxytocin levels (Heim et al 2004(Heim et al , 2009Skrundz et al 2011) and that they tend to respond less contingently to the baby and to spend less time with them (Field 2010;Fleming et al 1988;Herrera et al 2004).…”

Behavioral Roles of Oxytocin and Vasopressin

“…The advantage of targeting clinical studies of OXT and depression at postpartum depression is that improvements in these patients is also beneficial to the rest of the family, and may represent a preventative target for the offspring of depressed mothers. Furthermore, there has been recent speculation that failed lactation and perinatal depression have related neuroendocrine mechanisms [121]. Failed lactation is common in depressed mothers, and in many cases can exacerbate symptoms of depression in mothers.…”