DR. DY PATIL BIOTECHNOLOGY & BIOINFORMATICS INSTITUTE
The day a woman becomes a mother is considered the happiest day in her life. She is expected to be overjoyed and perfectly capable of raising the newborn baby. However, at least 10-20% of the new moms suffer from something called postpartum depression which if left unrecognized or untreated in more severe cases can turn out to be life-threatening for the mother, the child, and her entire family.
What is Postpartum Depression?
Clinicians from the time of Hippocrates have associated the postpartum period with mood disturbances. The rapid hormonal changes, that is, the rapid decrease in the reproductive hormones, that happen during the postpartum period can lead to vulnerability and depression in susceptible women. Postpartum Depression (PPD) doesn’t always last for only the postpartum period but can continue over six months after delivery.
During pregnancy, female hormones like estrogen and progesterone are at the highest level ever. When their levels start dropping to the normal, pre-pregnancy level, it may lead to depression. This can be compared to the hormone changes that happen before menstruation, but the postpartum hormone swings are a bit extreme. The exact mechanism by which progesterone affects mood is unknown, although there is a growing body of evidence based on blood tests and brain scans. One finding of this study is that progesterone can activate the amygdala, a tiny almond-shaped region of the brain. The brain’s primary alarm system is the amygdala. It reacts to environmental stimuli by quickly determining whether they are threats and, if so, producing fear and anxiety—an early evolutionary defense mechanism. It also appears to increase amygdala activation. Another hormone that drops after childbirth is the thyroid which regulates how the body uses and stores the energy acquired from food. A low level of thyroid also contributes to depression-like symptoms.
GABA, the feel-good/stay-relaxed neurotransmitter that is similarly influenced by the thyroid, is stimulated by progesterone. When progesterone levels fall, GABA levels fall as well, resulting in anxiety and depression.
A steep decrease in the allopregnanolone levels and failure of the gamma-aminobutyric acid (GABA) receptors to adapt to this decrease may add to the possibility of PPD. Allopregnanlone is a neurosteroid that is produced naturally in the body from the hormone progesterone. Allopregnanolone and pregnanolone are used to sedate and anaesthetize the foetus during pregnancy. Depressed mothers can affect their child’s health. There are higher chances of the child being underweight and stunted in the first year of life. Maternal depression can be associated with the impairment in the child’s linear growth after the first year PPD can also be seen in healthy women without a history of depression.
As it is seen in many new mothers, there is a range of symptoms for PPD. It can start with feeling restless, not getting sleep even when the baby is asleep, not feeling hungry, feeling paranoid about something happening to the baby, and may lead up to having extremely dangerous thoughts of harming herself or the baby or suicidal thoughts. The most important step towards being a healthy mother with a healthy mind after starting to feel these symptoms is to accept them. Sometimes due to the extreme societal pressure of being happy about being a mother and taking care of the child can lead to neglecting these symptoms which can make them fester into something ugly. Having postpartum blues or PPD does not mean that a woman is weak or incapable of being a good mother. It is just her body’s reaction to the hormone drop and the severe fatigue and pain she has undergone during the entire process of childbirth.
A potential cure
As per the research done by Sage Therapeutics, Massachusetts, a drug called brexanolone (Zulresso; Sage Therapeutics) was suggested as a potential cure for PPD in adults and has been approved by the FDA on March 19, 2019. Brexanolone is a new antidepressant with a novel mechanism of action. It is an intravenous formulation of the endogenous neurosteroid allopregnanolone which is a major metabolite of progesterone. GABA activity at synaptic and extrasynaptic GABAA receptors is potently modulated by allopregnanolone, a potent positive allosteric modulator. It restores the third-trimester hormone levels and hence allows the receptors to adapt and improve the symptoms.
As per the phase-3 clinical trials conducted by Sage Therapeutics, the drug when administered as an intravenous infusion over 60 hours was able to produce a significant reduction in the Hamilton Depression Rating Scale (HAM-D) scores in patients with moderate to severe PPD or PPD. Some common adverse effects of this drug are drowsiness, dizziness, and headaches but prolonged infusions pose a threat of oversedation and loss of consciousness. Due to this a Risks Evaluation and Mitigation Strategies (REMS) program have been put in place and the drug administration only takes place through a national registry and in a supervised medical facility.
PPD in men
PPD, which affects about 8% to 10% of fathers, is most common between the first three to six months after a baby is born, but it might develop over a year rather than developing in the first four weeks. In addition, guys may be more prone to impatience, indecisiveness, and a limited range of emotions. History of depression, marital problems, poverty, and unexpected pregnancy are all potential risk factors that can lead to the development of PPD in men. Sleep deprivation and a disrupted circadian rhythm, both of which have been linked to depressive symptoms in women, could raise a man’s risk of having PPD.
A father experiences hormonal changes during and several months after pregnancy which assists in the father-child relationship. A decrease in testosterone levels and an increase in estrogen, vasopressin, cortisol, and prolactin levels are said to be associated with a stronger parent-infant attachment. However, these changes in the hormone levels can lead to PPD or aggravate the already present symptoms in men.
The stigma around PPD and general mental health in India
In some parts of India, PPD is still regarded as something that only happens to weak women who are incapable of taking care of their babies or are looking for reasons to get rid of the responsibility. It is still believed that practical, focused, and strong-minded women do not undergo such things. This just proves how poor mental health is treated in this country. Depression, anxiety, panic are straight up disregarded or discussed behind closed doors in hushed voices because it is considered as a sign of weakness. Even now, in 2021, most of the Indian families will ignore the term depression and dismiss it as something made up.
Students, young adults, and the elderly likewise have no safe space to go-to when it comes to discussing matters of the mind. It is a sad statement to read that for every 100,000 citizens, there are only 0.75% psychiatrists in India.
This begs for a time and place where mental health can be discussed as openly as a person can discuss a broken bone, where it is not considered craziness or an act put up as a way of seeking attention, and lastly where it is normalized to have bad days where the mind won’t cooperate with the body.