Israeli researchers find breakthrough in postpartum depression diagnosis, treatment

Postpartum depression (PPD) – a form of serious emotional melancholy that occurs in an average of 15% of woman after having a baby, causes frequent crying, guilt, anxiety, emotional highs and lows, frequent crying, fatigue, guilt, anxiety and difficulty caring for the baby. It can even happen to the fathers, but much more rarely.

Giving birth, especially for the first time, is exciting but can also be tiring and overwhelming, and it’s normal to have feelings of worry or doubt, However, if your feelings include extreme symptoms, you may have PPD. It can be treated with psychological counseling and medications, but these are not always effective in eliminating the gloom.

In a new study published in the journal Translational Psychiatry under the title “A unified model of the biology of peripartum depression,” Prof. Tsachi Ein-Dor of the Ivcher School of Psychology at Reichman University in Herzliya, with doctoral student Gal Levin, developed a theory that for the first time unifies all the processes impacting the likelihood of developing PPD and the severity of its symptoms. In the study, the researchers also showed that new pharmacological and psychotherapeutic strategies may help in dealing with PPD. 

They developed a comprehensive biological model which explains the different ways in which depression develops around and after birth. According to this, there are four main factors that may lead to the appearance of the symptoms we know as PPD – immune system activity, continuous stress, hormonal imbalance and a reduction in activities that involve closeness such as breastfeeding and skin-to-skin contact.

Diagnosing PPD

Today, any two women experiencing different symptoms out of the nine included in the definition of PPD receive the same diagnosis. The new model allows not only for a more efficient diagnosis but also for the adaptation of unique treatment for each patient, according to her specific symptoms of depression.

In addition, through a preliminary test taken at the beginning of pregnancy, the model is also able to predict the onset of the disorder even before the first symptom appears and outlines new goals for highly targeted drugs that can improve patient's quality of life with significantly reduced side effects.

Ein-Dor noted that every year, an estimated 174 million women around the world suffer from PPD. Although the discourse on the treatment of the disorder began in ancient Babylon, to this day there is no effective psychological or medicinal treatment that works for sufferers.

The main obstacle to finding such a treatment lies in the multitude of reasons for the development of depression, which are seemingly unrelated to one another. Women are twice as likely than men to be affected by the disorder due to the activity of the female sex hormone estrogen. Mothers’ breastfeeding, rooming-in and parents’ skin-to-skin contact and social support are very important, as they may lead to a reduction in depressive symptoms, he said.

The four factors lead to increased production of toxic substances and a reduction in the production of substances necessary for normal mood and activity. Each factor alone can promote the onset of depression, but the mutual interaction smong them makes them more powerful and is what makes depression so common. Specifically, these factors affect how the body and brain use the amino acid tryptophan. 

This amino acid, Ein-Dor continued, undergoes different metabolic processes in two main paths – one enables the production of serotonin and melatonin, and the other results in the production of various substances used, among other things, to increase brain activity and produce energy (NAD+ and quinolinic acid). When the system is in balance, there is enough serotonin and melatonin that are necessary for normal cognitive activity and for regulating sleep and appetite, and the amount of energy-producing substances is balanced.

According to the model, extreme changes in the four factors can disrupt the balance and bring about a change in the equilibrium between the two paths. As a result, the amount of the neurotransmitter serotonin and its precursor melatonin becomes insufficient, and the proportion of energy-producing substances becomes high to the point of toxicity that leads to the death of cells and other destructive processes in the brain.

Their model explains that ongoing stress will tilt the scales towards the energy-producing substances at the expense of production of serotonin and melatonin. It can also lead to chronic illness that may bring about long-term inflammation, a lack of social support and closeness, or an imbalance in estrogen and progesterone. A decrease in melatonin leads to sleep problems, lack of serotonin leads to cognitive difficulties, and the toxicity resulting from the excess of energy-producing substances leads to the death of cells and the loss of pleasure from activities that were enjoyable in the past.