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Add to Risk Factors:

Chronic illnesses caused by neuroendocrine irregularities including irritable bowl syndrome and fibromyalgia typically put individuals at risk for further health complications. However, it has been found that these diseases do not increase risk for postpartum depression.

Neurobiology:

A review of various fMRI studies show significant differences in brain activity between mothers with postpartum depression and those without. When at rest, that is not cued by anything in the environment, mothers with PPD have less activity in the left frontal lobe and increased activity in the right frontal lobe when compared with healthy controls. They also have decreased connectivity between vital brain structures including the anterior cingulate cortex, dorsal lateral prefrontal cortex, amygdala, and hippocampus. These areas are important for empathy, memory, and emotion regulation and may explain depressive symptoms as well as decreased motivation toward caregiving. Brain activation differences between depressed and nondepressed mothers is even more pronounced when stimulated by infant and non-infant emotional cues. Depressed mothers show greater neural activity in the right amygdala toward non-infant emotional cues as well as reduced connectivity between the amygdala and right insular cortex - a pattern consistently found in those with depression and anxiety. Recent findings have also identified blunted activity in anterior cingulate cortex, striatum, orbitofrontal cortex, and insula in mothers with PPD when viewing images of their own infants.

More robust studies on neural activation regarding PPD have been conducted with rodents than humans and has allowed for greater isolation of specific brain regions, neurotransmitters, hormones, and steroids.

Causes:

Understanding the neuroendocrinology characteristic of PPD has proven to be particularly challenging given the erratic changes to the brain and biological systems during pregnancy and postpartum. A review of exploratory studies in PPD have observed that women with PPD, have more dramatic changes in HPA axis activity, however directionality of specific hormone increases or decreases remain mixed.

Treatment:

Oxytocin has been shown to be an effective anxiolytic and in some cases antidepressant treatment in men and women. Exogenous oxytocin has only been explored as a PPD treatment with rodents, but results are encouraging for potential application in humans.