Pathophysiology of postpartum affective disorders: classification, current concepts
REVIEWS
Abstract
This literature review is devoted to the issue of studying the pathophysiological mechanisms of postpartum affective disorders, one of which is postpartum depression. The difficulties of classifying mental disorders of pregnancy and after childbirth are considered, in particular, the presence of postpartum obsessive-compulsive disorder, postpartum panic disorder, posttraumatic stress disorder associated with pregnancy and childbirth is reported, the term “perinatal grief”, “posttraumatic growth”, “posttraumatic potential of reproductive losses” and various other terms and concepts are considered, which indicates the complexity and ambiguity of classifying mental disorders of pregnancy and after childbirth. Data from various studies on changes in hormone levels as one of the leading mechanisms for the development of mental disorders in the postpartum period are presented. The influence of oxytocin and its anxiolytic effect, as well as the effect of the oxytocin receptor on the development of postpartum affective disorders are considered. Information is provided on the influence of reproductive hormones on the development of postpartum depression, the role of the brain-derived neurotrophic factor BDNF is studied. The influence of proinflammatory and anti-inflammatory cytokines is considered, for example, it is shown that the levels of IL-1β, IL-6, TNFα are increased in patients suffering from depression, the role of neuroactive steroids is discussed. Studies on the genetic aspect of postpartum affective disorders, the relationship between the serotonin transporter gene and the development of postpartum depression are discussed, the role of the estrogen receptor in the development of postpartum affective disorders is considered. Data are provided on changes in the central nervous system during pregnancy and after childbirth, in particular, changes in brain structures that affect maternal behavior towards offspring, the medial preoptic area (mPOA), which controls care and care for offspring, transformations in synapses are considered, and data on changes in the volume of gray matter of the brain during pregnancy and after childbirth are provided. Considerable attention is paid to the relationship between sleep disorders and circadian rhythms as a provoking factor in the occurrence of mental disorders during pregnancy and after childbirth.
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