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The Ties That Bind: Maternal-Infant Interactions and the Neural Circuitry of Postpartum Depression

Year: 2010

Type: article

Abstract: Little is known about the pathophysiology of postpartum depression.While the same can be said for many (if not most) psychiatric illnesses, in the case of postpartum depression the need for pathophysiological studies to guide the development of novel treatments is particularly pressing because the illness affects not only the woman who experiences it, but also her newborn and other members of her family (1).But while pathophysiological studies of postpartum depression are particularly important, they are also very difficult to conduct, given the biological and logistical complexities that characterize the postpartum period.Therefore, the study by in this issue of the Journal is a welcome addition to the literature.The authors used functional magnetic resonance imaging (fMRI) to study 16 healthy women and 14 unmedicated unipolar depressed women within 12 weeks of giving birth.While being scanned, subjects completed a task that included shape and face matching blocks, with the latter including angry and sad faces.This task is designed to probe between-group differences in amygdala activity.Previous fMRI studies using similar tasks in patients with depression demonstrate abnormalities in amygdala activity and amygdala-medial prefrontal cortex connectivity in response to negatively valenced emotional faces (3).However, the precise nature of those abnormalities, and the extent to which they differ in unipolar versus bipolar depression, remains unclear.Given the previous literature, Moses-Kolko et al. focused their analysis on activity in the amygdala and the medial prefrontal cortex.Their major finding was a group-by-condition interaction in the dorsomedial prefrontal cortex (the finding was specifically in Brodmann's area 32).While both depressed and comparison mothers activated this region more in response to faces than to shapes, depressed mothers activated more in response to shapes than comparison mothers, and comparison mothers activated more in response to faces than depressed mothers.As discussed below, the dorsomedial prefrontal cortex is known to mediate important aspects of social cognition.Therefore, it is notable that depressed mothers, relative to comparison mothers, show decreased activation in this region in response to the social stimulus of a face.Moses-Kolko et al.'s finding indicates that it is important to focus research and treatment strategies not only on a mother's depression, but also on her ability to engage affectively with her infant.A hallmark of depression is increased self-focus, particularly in the form of self-referential negative thoughts; research suggests that this symptom may be mediated by the dorsomedial prefrontal cortex.For example, Johnson et al. (4) found associations between activity in the

Source: American Journal of Psychiatry

DOI: 10.1176/appi.ajp.2010.10081159

Authors: Ellen Leibenluft, Kimberly A. Yonkers

Institutions: National Institutes of Health, National Institute of Mental Health

Language: English

Topic: Maternal Mental Health During Pregnancy and Postpartum

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: Pfizer, National Institutes of Health, National Institute of Mental Health