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Postpartum depression: psychoneuroimmunological underpinnings and treatment

Authors Anderson G, Maes M

Received 12 December 2012

Accepted for publication 3 January 2013

Published 21 February 2013 Volume 2013:9 Pages 277—287


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

George Anderson,1 Michael Maes2

1CRC Clincial Research Centre/Communications, Glasgow, Scotland; 2Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand

Abstract: Postpartum depression (PPD) is common, occurring in 10%–15% of women. Due to concerns about teratogenicity of medications in the suckling infant, the treatment of PPD has often been restricted to psychotherapy. We review here the biological underpinnings to PPD, suggesting a powerful role for the tryptophan catabolites, indoleamine 2,3-dixoygenase, serotonin, and autoimmunity in mediating the consequences of immuno-inflammation and oxidative and nitrosative stress. It is suggested that the increased inflammatory potential, the decreases in endogenous anti-inflammatory compounds together with decreased omega-3 poly-unsaturated fatty acids, in the postnatal period cause an inflammatory environment. The latter may result in the utilization of peripheral inflammatory products, especially kynurenine, in driving the central processes producing postnatal depression. The pharmacological treatment of PPD is placed in this context, and recommendations for more refined and safer treatments are made, including the better utilization of the antidepressant, and the anti-inflammatory and antioxidant effects of melatonin.

Keywords: SSRI, kynurenine, IDO, TDO, melatonin

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