(PSYCHIATRIC TIMES) - The transition to parenthood is filled to the brim with behavioral extremes. Parents who are otherwise emotionally stable are in one moment thrilled and happier than they have ever been and confused and fearful the next. Afriend of mine once theorized that these reactions occur because "parenting is an amateur sport" played by persons who are highly motivated to do the right thing but who often have no idea what that right thing is.
For some couples, the transition to parenthood is not filled with this rich mixture of great perplexity and great joy. For them, parenthood is mostly filled with sadness and even despair. Postpartum depression was originally coined to describe this experience in the mother, although it is becoming clear that fathers can experience very similar emotions too.
Is there a molecular basis for postpartum depression—at least for the type that mothers experience? Recent findings, which I describe here, may answer this question. First, we will focus on several background behavioral and molecular issues and then move on to some interesting data about births in genetically manipulated laboratory animals. Feel free to skip to the “Data” section if postpartum depression rates and g-aminobutyric acid (GABA) receptor biology are working parts of your vocabulary.
As you know, the probability of experiencing major depression is twice as high in women as it is in men, and pregnancy does not buffer against this risk. Postpartum depression afflicts about 20% of mothers. Higher rates are seen in adolescent mothers than in older mothers.
Mental health professionals who are considering treatment for a depressed pregnant patient must make choices that can be particularly troublesome. Many clinicians are concerned about the potentially damaging effects of antidepressant medications on the developing fetus. Should a woman be treated during pregnancy? As I have discussed in this space before, serotonin plays a dramatic role in gestational brain development, especially in the thalamus. Concerns about serotonin’s effects on brain development actually held up the FDA’s approval of fluoxetine.
This risk is also observable after parturition. If depression remains untreated, the risk of drug and alcohol abuse and suicide and infanticide greatly increases. Yet, psychotropic drugs may expose a breast-fed baby to these medications. Are there risks associated with this exposure? The possibility of adverse consequences is not zero, although there is a critical need for further research in this area. As if pregnancy were not complicated enough, balancing the risk of potential behavioral consequences of depression with the pharmacological risk of treatment is quite challenging indeed.
There is increasing evidence that men can also experience depression after the birth of their child. The rates can be astonishingly high—about 1 in 4 fathers are affected in some studies; this rate climbs to 1 in 2 if his spouse is also depressed. The effect can be recursive. Loss of emotional support from the female because of depression may cause or exacerbate depression in the male, which in turn may retrigger depressive behaviors in the female.
Depression is a big deal for some families in the transition to parenthood; it is thus gratifying to report some very promising findings regarding its molecular underpinnings. We need only one more piece of background information, which involves a very particular animal model of depression, to understand it fully.
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