The pathophysiology of estrogen in perinatal depression: conceptual update

Authors

Anne M. Nielsen, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois, USA. anne.nielsen@northwestern.edu.
Catherine S. Stika, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Katherine L. Wisner, Children's National Hospital, Developing Brain Institute and George Washington University School of Medicine, Washington, DC, USA.

Document Type

Journal Article

Publication Date

8-3-2024

Journal

Archives of women's mental health

DOI

10.1007/s00737-024-01494-6

Keywords

Estrogen; Postpartum depression

Abstract

PURPOSE: Estrogen levels fall sharply after parturition and have long been considered an etiologic contributor to postpartum depression (PPD); however, no differences have been reported in plasma hormone concentrations in people who develop PPD. We examine the question: What is the current view of estrogen and the neurophysiologic processes it impacts in the development and treatment of PPD? METHODS: A literature review of the role of estrogen on candidate hormonal and epigenetic systems in the peripartum period was performed, including landmark historical studies and recent publications on estrogen-related research. The authors reviewed these papers and participated in reaching consensus on a conceptual framework of estrogen activity within the complexity of pregnancy physiology to examine its potential role for driving novel interventions. RESULTS: Estrogen fluctuations must be conceptualized in the context of multiple dramatic and interacting changes inherent in pregnancy and after birth, including progesterone, corticosteroids, inflammation, circadian biology and psychosocial challenges. Individuals who develop PPD have increased sensitivity to epigenetic alteration at estrogen-responsive genes, and these changes are highly predictive of PPD. An effective estrogen-based treatment for PPD has yet to be found, but interventions focused on associated inflammation and circadian rhythms are promising. CONCLUSIONS: Our understanding of the biological basis of PPD, one of the most common morbidities of the perinatal period, is expanding beyond changes in gynecologic hormone concentrations to include their impact on other systems. This growing understanding of the many processes influencing PPD will allow for the development of novel prevention and treatment strategies.

APA Citation

Nielsen, Anne M.; Stika, Catherine S.; and Wisner, Katherine L., "The pathophysiology of estrogen in perinatal depression: conceptual update" (2024). GW Authored Works. Paper 5523.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5523

Department

Obstetrics and Gynecology