According to the Centers for Disease Control and Prevention (CDC), one in 10 women in the United States experiences PPD, which causes feelings of hopelessness, worthlessness, exhaustion, sadness, and more. It is one of many perinatal mood and anxiety disorders (PMADs) that affect one in five people during pregnancy and postpartum.
What Causes Postpartum Depression?
Postpartum depression is caused by biological, psychological, and social factors. “There are biological risks that a test like the one used in the study might be able to pick up,” explains Eynav Accortt, PhD, a clinical psychologist, assistant professor of obstetrics and gynecology, and director of the Reproductive Psychology Program at Cedars-Sinai. “There’s also the personal history of depression or anxiety. There are psychological factors, like chronic stress, trauma, or unresolved grief. Then we have social risk factors, which could include racism or lack of support. And neurotransmitters are involved, which is why [antidepressants] help some people,” Dr. Accortt adds.
How Do Biological Factors Affect Postpartum Depression?
Senior study author Sarven Sabunciyan, PhD, and his team discovered that, compared with healthy people, those with PPD had lower levels of extracellular mRNAs. Those mRNAs are needed to complete a process called autophagy. Essentially, autophagy is the process in which cells clear out old parts that are aging and not working well anymore. When cells can’t clean house, they don’t function properly. Problems with autophagy have also been associated with conditions like Alzheimer’s and Parkinson’s disease. Dr. Sabunciyan explained that the current thinking is that PPD and other mood disorders are sometimes caused by imbalanced neurotransmitters—things like dopamine and serotonin—in the brain. However, this study suggests while abnormal neurotransmitter levels might be related to PPD, they might not be the root cause. “The idea has been that neurotransmitter activity, like serotonin activity, is messed up, and it probably is, but the underlying cause of this is potentially because cells are not able to clear out components that are aging,” says Dr. Sabunciyan, a neuroscientist at the Johns Hopkins Children’s Center and assistant professor in the Stanley Division of the department of pediatrics at the Johns Hopkins University School of Medicine. “There are a number of papers showing that serotonin reuptake inhibitors (SSRIs) increase autophagy in the brain in animal models. This is how a lot of antidepressants are actually working: by increasing autophagy,” Dr. Sabunciyan adds. He says his findings could open the door to new treatments for PPD. Historically, medications for PPD have targeted neurotransmitters. But using treatments that boost autophagy could be more effective. He said clinical trials for such medications are underway to test their effectiveness in treating Alzheimer’s.
Will There Be a Test to Detect Postpartum Depression?
More research is needed before a blood test predicting PPD is available. The authors say this study was limited by a small number of participants and a lack of racial diversity. The analysis used on the blood samples is also expensive, requiring special equipment. “We are very optimistic we’re going to be able to come up with a test,” says Dr. Sabunciyan. “We’re going to rerun these tests in a bigger, more diverse population and figure out a handful of genes these patients with PPD have in common and test for those. That would take the cost from thousands of dollars per blood sample to about $10 per test.”
What Is The Benefit to Identifying Postpartum Depression Early?
Nearly 50% of people experiencing a perinatal mood disorder are never identified, Dr. Accortt says. Adding a blood test like this would be another tool for helping new parents. “Perhaps we could prevent them from developing severe depression or anxiety, and minimize the effect it has on the entire family. This disorder affects the newborn, older children, and the partner,” Dr. Accortt continues. “We have every single pregnant person in this country take the gestational diabetes test. PMADs are more common than gestational diabetes, and the long-reaching effects are biopsychosocial in nature.” Expecting parents who are at risk for developing PPD could then make lifestyle changes to protect their mental health, Dr. Accortt explains. That includes making more time for sleep, nutrition, and relaxation each day. They could also locate mental health professionals in advance should they need them after birth. “Once there’s full-blown depression or anxiety interfering with your functioning, you do need professional help,” she said. “That can look like group therapy with a maternal mental health provider, individual therapy, and reproductive psychiatry.” If you are pregnant or postpartum and feel anxious, depressed, or mentally unwell, call the Postpartum Support International HelpLine at 1-800-944-4773 or text “Help” to the same number. Talk to your loved ones about how you’re feeling, and don’t hesitate to seek professional care from experts who can help you feel well again.
