The Value of HPA Axis Hormones as Biomarkers for Screening and Early Diagnosis of Postpartum Depression: Updated Information About Methodology

Abstract

Because of the high prevalence of postpartum depression (PPD) and the suffering involved, early diagnosis is urgent; however, current screening tools and diagnosis are inadequate. In addition to conventional methods such as the Edinburgh Postnatal Depression Scale and clinical interviews, several hormones in the hypothalamic–pituitary–adrenal (HPA) axis, such as corticotrophin-releasing hormone, adrenocorticotropic hormone, and cortisol, have been considered because of their critical roles in stress regulation in the mothers. The study designs are complicated, however, and so the effectiveness of these hormones as biomarkers for PPD is still controversial. Such inconsistency may have resulted from the variation in methodology between studies. The methodology problems in the investigation of PPD and HPA axis hormones have not been reported extensively. We therefore sought to summarize the methodological problems of studies published in the past decade, including the strengths and weaknesses of the examinations and the technological difficulties involved. Our findings suggest that (a) suitable samples and appropriate detection methods would reduce heterogeneity among trials; (b) the cutoff value of the scale test should be carefully selected for determining the performance of biomarker tests; (c) evaluation methods and criteria should be chosen with consideration of the tools feasible for use in local hospitals and population; and (d) the cost of diagnosis should be reduced. We hope that these findings provide insight for future investigations of HPA axis hormones as biomarkers for screening and early diagnosis of PPD.

Stress biomarkers in individuals with fibromyalgia syndrome: a systematic review with meta-analysis

“…41 The measurement is usually done by radioimmunoassay (RIA) or enzyme-linked immunoassay (ELISA), with RIA being highly sensitive, but prone to operation procedures, and ELISA generally producing more reliable measurements. 9,41,53…”

Postpartum Depression and Its Biological Biomarkers

“…Pregnancy, childbirth, and lactation all significantly modify how the HPA axis and circulating cortisol operate. Placental CRH (pCRH), to some extent, is in charge of important pregnancy phases like nursing, pregnancy, and birthing, which result in high cortisol levels and numerous essential basic and unique functional overlaps between the HPA hormones (Figure 1 ) [ 27 ]. Although there is a lot of individual variation, the last few weeks of pregnancy are when cortisol levels rise the steepest, reaching levels that are three times higher than those of non-pregnant women [ 28 ].…”