Pathophysiological mechanisms implicated in postpartum depression

• Published in: Frontiers in neuroendocrinology Vol. 52; pp. 165 - 180
• Main Authors: Payne, Jennifer L., Maguire, Jamie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019
• Subjects: Allopregnanolone; Animals; Circuit dysfunction; Depression, Postpartum - etiology; Depression, Postpartum - genetics; Depression, Postpartum - immunology; Depression, Postpartum - metabolism; Epigenesis, Genetic - genetics; Epigenetics; Female; GABA; HPA axis; Humans; Hypothalamo-Hypophyseal System - metabolism; Inflammation - complications; Inflammation - immunology; Inflammation - metabolism; Neuroinflammation; Oscillations; Pituitary-Adrenal System - metabolism; Postpartum depression; Stress; GABA; Epigenetics; Circuit dysfunction; Oscillations; Neuroinflammation; Postpartum depression; HPA axis; Stress; Allopregnanolone
• ISSN: 0091-3022; 1095-6808
• DOI: 10.1016/j.yfrne.2018.12.001

•The pathological mechanisms implicated in postpartum depression are diverse, but exert influence over one another.•Stress and adverse life events are prevalent risk factors for postpartum depression.•There is a bidirectional influence between stress and epigenetics implicated in postpartum depression.•Epigenetic and neuroendocrine changes associated with postpartum depression influence neuroinflammation.•Biochemical changes are linked to circuit-level changes which may contribute to postpartum depression. This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.