Innovative postpartum depression study offers new hope for mood disorders patients

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Regional Mental Health Care London (RMHC) psychiatrist Dr. Verinder Sharma of the Mood Disorders Program is conducting a study of pregnant women with a diagnosis of depression or bipolar disorder in order to better understand predictors of postpartum depression (PPD). The study will include 200 women who will be followed from the third trimester of their pregnancy through to one year after giving birth.

Verinder, also a professor of psychiatry and obstetrics and gynecology, University of Western Ontario, explains why this study is so necessary: “The literature on postpartum disorders has largely focused on the “baby blues” or PPD. Most research studies have used major or minor depression as standards for identifying women with postpartum depression. However, women in the postpartum period also have a higher risk for the onset and exacerbation of bipolar disorder. In fact, women with bipolar disorder may be more likely to experience postpartum relapses than women with depressive disorder.”

Original approach to testing

In addition to standard research study methods, Dr. Sharma’s study will include two tests not typically used: estrogen saliva testing and magnetic resonance imaging (MRI):

The rapid decline in estrogen levels after delivery is believed to contribute to the development of PPD in susceptible women. Consistent differences in hormonal levels have not so far been found between women who develop PPD and those who do not, but existing studies have assessed only serum estrogen (i.e. levels in the blood). An advantage of saliva testing is that it provides an estimate of the level of estrogen available to tissue for physiological purposes. This might differ between women who do and do not experience PPD.

Biochemical and structural changes in the brain have been implicated in many neurological conditions; however, neuroimaging studies in PPD are virtually nonexistent. Such studies are critical to establish the metabolic abnormalities characteristic of the disease and to determine whether such abnormalities represent disease “biomarkers”. Once established, these biomarkers could be used to gauge disease severity, monitor progression and evaluate the effects of behavioural or drug therapy.

The outcomes

Early detection of PPD is critical to provide the most effective treatment. “There is evidence that the clinical picture of bipolar PPD may be different from that of non-bipolar PPD,” says Verinder. “The failure to recognize the differences in the past has resulted in over-diagnosis of depressive disorder at the expense of bipolar disorder and, consequently, a misuse of antidepressants. This is serious because antidepressants have not been proven to prevent depression in bipolar disorder, and may actually worsen the course of illness. It is imperative that we better understand these differences to provide the best possible care for all our patients.”

For more information about this study, please contact: Cynthia Corpse, research coordinator, ext. 47600, or email: cynthia.corpse@sjhc.london.on.ca.