The functioning of the hypothalamic-pituitary-adrenal (HPA) axis in postpartum depressive states: a systematic review

Author(s)

Garcia-Leal, Cybele ^[1] ; De Rezende, Marcos Goncalves ^[1] ; das Gracas Corsi-Zuelli, Fabiana Maria ^[1] ; De Castro, Margaret ^[2] ; Del-Ben, Cristina Marta ^[1]

Affiliation

^[1] Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Neurosci & Behav, Div Psychiat, Ave Bandeirantes 3900, BR-14049900 Ribeirao Preto - Brazil

^[2] Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Internal Med, Div Endocrinol, Ribeirao Preto - Brazil

• Document type: Review article
• Source: EXPERT REVIEW OF ENDOCRINOLOGY & METABOLISM; v. 12, n. 5, p. 341-353, 2017.
• Web of Science Citations: 2

Abstract

Introduction: A large body of literature suggests the role of the hypothalamic-pituitary-adrenal (HPA) axis in postpartum depression (PPD). Nonetheless, these studies present discrepant methodology and results; thus, this hypothesis deserves further exploration. Areas covered: This review included studies investigating the HPA axis in PPD or postpartum blues published until November 2016. In total, 48 studies met the inclusion criteria. The HPA axis was mostly investigated in the immediate postpartum period (62.5%), and the majority of studies collected samples in the morning (43.8%), with one measure in a single day (43.8%), and blood was the fluid more often collected (58.4%). Seven out of 21 studies evaluating postpartum blues, and 15 out of 28 studies evaluating PPD detected abnormalities in the HPA axis functioning. Expert commentary: We found a significant heterogeneity in the methodology adopted by studies and consequently, in the results. Despite that, the majority of studies reported HPA changes in women with PPD during the remote period. Notably, reactivity tests pointed to attenuated HPA axis response. Ideally, future investigations should use validated reactivity tests, include larger sample sizes, consider many measures of cortisol throughout the day, and more than one day of collection. We also recommend that studies continue to use validated scales for mood assessment. (AU)

• FAPESP's process: 10/09066-6 - Genetic-environmental interaction in the postpartum depression
• Grantee: Cristina Marta Del-Ben
• Support Opportunities: Regular Research Grants
• FAPESP's process: 16/12195-9 - Impact of early life stress in the inflammatory profile of first episode of psychosis (FEP) patients and in the animal model of post-weaning social isolation
• Grantee: Fabiana Maria das Graças Corsi Zuelli
• Support Opportunities: Scholarships in Brazil - Master