The aetiology of postpartum psychosis: Why are there no answers?

Abstract

Little progress has been made towards an understanding of the aetiology of postpartum psychosis, despite the longstanding assumption that it is precipitated by biological factors. Methodological problems in this area of research may be responsible for this failure, as outlined here using the example of the relevant research into the role of oestrogens. A solution to these problems is discussed, i.e. the use of a homogeneous high-risk subject sample, which would satisfy the requirements of future research and offer several advantages over previous work.

Loss, happiness and postpartum depression: The ultimate paradox.

“…For example, it is unclear why, if postpartum depression is brought about because of hormone changes at the time of birth (Harris, 1994) as some suggest, significant numbers of women do not get depressed at that stage. Further, it is unclear whether psychological problems following childbirth, from psychosis to mild depression, form part of a continuum or a series of different unrelated conditions (Appleby, 1990), or if there are any qualitative differences between depression at this time and other times in a woman’s life (Stoppard, 1998; Green, 1998) or, indeed, between postpartum and depression suffered by men on entering fatherhood (Richman, Raskin, & Gaines, 1991).…”

Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

“…Both oestrogen and progesterone are known to interact with monoaminergic functioning, with oestrogen having an overall facilitatory effect on dopaminergic systems [61]. Given that monoamines are well evidenced to play a role in mood and psychotic disorders outside of the perinatal period [62][63][64], researchers have postulated that the precipitous drop in hormones following childbirth may result in dopaminergic hypersensitivity in some women vulnerable to the childbirth trigger [65]. There is also evidence to suggest that prolactin may be implicated in this potential mechanism.…”

“…Absolute levels of steroid hormones do not appear to differ between women affected by postpartum mood disorders and those who remain well [71]. For this reason, the assumption that the abrupt withdrawal of hormones is a direct causal factor in postpartum psychosis has been criticised for being overly simplistic [65]. Nonetheless, it remains possible that some women are differentially sensitive to normal endocrine changes that occur in relation to pregnancy and childbirth [72].…”

Selected issues in women's reproductive health: Psychological perspectives.

“…Stressful life events have not been shown to constitute a risk factor (e.g., . Most researchers assume a biological etiology (Appleby, 1990;Brockington, Oates, & Rose, 1990), with a leading hypothesis involving the exposure of sensitive dopamine receptors when chorionic steroids decrease in the first few days postpartum (Brockington et al, 1990;Wieck et al, 1991). However, no strong evidence for an endocrine or biochemical etiology has emerged (Appleby, 1990; George & Sandler, 1988).…”