The role of steroids in the development of post-partum mental disorders

Abstract

aBackground. Unfavorable post-partum changes to mental well-being affect more than half of all women, and are a risk to the health of both mother and baby. Their effects place strains on health and social systems. Currently, no generally accepted theory exists of the causes and mechanisms of post-partum mental disorders. Methods. Literature search up to 2012, using PubMed and search words: neuroactive steroids, post-partum mental disorders, depression, corticotropin-releasing hormone and estrogens.Results. There are several theories for post-partum depression. One is that autoimmune diseases are involved. Others revolve around genes responsible or that lead to increased disposition to the disorder. It is likely however that the process is associated with the separation of the placenta and the fetal zone of fetal adrenal gland, the main sources of corticotropin-releasing hormone and sexual and neuroactive steroids during pregnancy, and the ability of the receptor system to adapt to these changes. The central nervous system is able to produce neurosteroids, but the drop in levels of peripheral steroids likely leads to a sudden deficit in neuroinhibitory steroids modulating ionotropic receptors in the brain. Conclusions. Post-partum depression is a multifactorial disease with unknown etiology. It is probably associated with sudden changes in the production of hormones influencing the nervous system, and on the other hand the ability of the receptor system to adapt to these changes. When the relative changes in concentrations of hormones, rather than their absolute levels, is likely more important.

Postpartum depression: psychoneuroimmunological underpinnings and treatment

“…Within 48 hours of parturition, maternal levels of cortisol, estrogen, progesterone, and neurosteroids fall dramatically, which has been suggested to contribute to PPD,17,18 perhaps paralleling varying depression sensitivity to hormonal changes in menses and menopause. However, other work suggests that hormonal changes are not the major determinant of PPD,19 although a decrease in allopregnanolone is correlated with decreased mood in the “baby blues” period postnatally 20.…”

Neuroactive Molecules in the Etiology of Postpartum Depression. An overview

“…During the first 48 hours after birth, new mothers experience a dramatic fall in estrogen, progesterone, cortisol and neurosteroid levels. Although some studies argued against the involvement of hormonal fluctuations in the etiology of PPD [7,8], more recent evidence supports the link between steroid withdrawal and the presence of PPD [8,9].…”